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Scalp Reduction
 

For the majority of men, balding is an unfortunate yet inevitable reality. Hair loss can begin as early as the teens, leading a lack of self-confidence. Most often, such hair loss is not caused by an illness but is simply a genetic trait.

New surgical techniques make it possible to re-create a thick, full head of hair by moving areas of existing hair to the bald areas. For patients looking for alternatives to hair transplants, many doctors now offer scalp flaps and scalp reductions to produce a new, natural-looking head of hair. Scalp reductions take advantage of the elastic properties of skin. In this procedure, the doctor removes a bald section of scalp, and stretches the remaining skin up and over the removed area. The procedure moves the hair on the sides of the head up to the previously bald area.

Scalp reduction and scalp flaps surgeries can be used in combination, and hair transplants (grafts) are often utilized to fill in the small bald patches that remain after these more aggressive procedures.

Scalp Reduction Photo Gallery
Scalp Reduction Video Gallery
 
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What are some of the most common benefits of this surgery?
Like all hair restoration procedures, scalp reductions are designed to produce a more healthy, youthful. Scalp reductions have a significant advantage over hair transplants in that they produce immediate results.

Scalp reductions are normally performed on men with balding on the crown of the head. Lifting the existing hair from around the sides of the scalp brings healthy hair follicles to the top of the scalp by simply raising them several inches. The hair then continues to grow at the same rate. It will not thin or die unless hair on the sides of the head also thins and dies.

If you're considering a scalp reduction, the following information will provide you with a good introduction to the procedure. For more detailed information about how this procedure may help you, we recommend that you consult a board-certified plastic surgeon with experience in hair replacement procedures.
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What will happen at the initial consultation?
During the consultation, your surgeon will talk to you about the changes you would like to make in your appearance. He/she will explain the different options available to you, the procedure itself, and its risks and limitations. He/she will also explain the kind of anesthesia required, surgical facility, and costs.

He/she may also take “before” photos, and give you specific instructions to prepare for surgery, including guidelines for eating and drinking, smoking and taking or avoiding vitamins, supplements and medications.

Be sure to tell your doctor if you have had previous hair restoration surgery, if you smoke, or if you take any drugs or medications (including aspirin). Also tell your doctor if you have a tendency to form large scars or keloids.

Take this opportunity to ask all the questions you have about the surgery, and ask to see photos of the doctor’s recent patients, before and after surgery. Also ask for, and follow up on, patient references. Learning everything you can about your options, risks and benefits is the key to making an informed decision. See Questions to ask your doctor below.
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How are scalp reductions performed?
In scalp reductions, doctors remove small areas of the scalp and rely on the elastic property of the skin to cover those areas of baldness. This procedure decreases an entire area of baldness, and may be used in combination with transplants to produce an even fuller head of hair. Scalp reductions are generally performed on people with balding on the top of the head.

Most scalp reductions are performed under general anesthesia. Sometimes doctors will opt for a local anesthesia instead (like that used by dentists) combined with a sedative to make you drowsy. You'll be awake but relaxed, and although you may feel some tugging and mild discomfort, you won’t feel any pain.

In many cases, the procedure will be done in two steps. First, about 4-6 weeks prior to the actual procedure, doctors will reroute some of the arteries in the patient’s head. This operation ensures proper blood flow after the scalp reduction is done.

In the second step, the surgeon creates a thick Y-shaped incision at the top-back portion of the patient’s head. Skin in this area is removed, and the back and sides of the scalp are lifted upward and inward to cover and close the area. The incision is closed and sutured. Any scarring is usually covered by hair styling.
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How long does the surgery take?
Scalp reductions require about 3-4 hours for each step of the operation.
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Where will the procedure be performed?
A scalp reduction can be done in the hospital or in an office surgical suite, depending on your preferences as well as your surgeon’s. The longer the procedure is expected to take, the more likely that general anesthesia will be recommended. You may be allowed to return home within a few hours of the surgery, and spend the night in the comfort of your own home, or it may be necessary to spend the night in the hospital so your recovery process can be monitored by medical staff.
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How much pain is there?
The amount of pain experienced varies from person to person and depends on the extent of the procedure. There may be some discomfort following the procedure that can be alleviated with oral medication. You should discuss your goals, budget, and pain tolerance with your surgeon in order to help him/her determine the procedure, or combination of procedures, that will produce the best results for you.
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What can I expect after the procedure?
Patients normally experience swelling and some numbness for the first few days following the procedure. Because the skin needs time to soften, tightness in the scalp is also common for several months after the operation. Scabbing is also common. Most patients will be able to return to work within 3-5 days following the procedure.
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What is the recovery period like?
You should be able to slowly resume normal daily activities over the next several days. Shampooing and combing should be avoided for at least 5-7 days. Strenuous activity should be kept to a minimum for about 2 weeks.
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What is the long-term outcome like for most people?
Most patients who decide to undergo scalp reduction are pleased with the results.

While there may be some scarring around the incision, it is normally covered by hair. A hair transplant procedure can be used to better cover the scars. Occasionally, the skin loosens again after a scalp reduction, and the bald area begins to enlarge, moving the hairline back to its original position.
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Other information (alternatives, common combinations, procedure-specific info):
Other hair replacement treatments include hair transplants, wigs and drugs therapy. Both scalp flaps and reductions are normally done in combination with hair grafts in order to fill in the remaining thinning or balding areas. And sometimes reductions and flaps will be done together. Depending on the individual, these combinations often give patients the most natural looking results.
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Risks and limitations:
Scalp reduction is usually performed on patients with balding on the crown of the head. Men whose hair is just beginning to thin, or whose hair patterns are still changing, may want to choose a different type of treatment.

Scalp reduction will produce scars where the incisions were made. The scars are usually faint and concealed by hair. You can reduce your risk of any complications by closely following your surgeon's instructions both before and after surgery.
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Ideal Candidate:
In general, the best candidates for scalp reduction are:

  • Physically healthy
  • Psychologically stable
  • With nearly complete balding around the top portion of the scalp
  • Informed about the procedure
  • Informed about the balding process
  • Possessing healthy hair growth on the sides and back of the head
  • Realistic about the outcome
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Questions to ask your doctor:
  1. Are the desired results I described realistic?
  2. Where is the surgery performed? How long will the procedure take?
  3. Would a hair transplant or drugs (such as Propecia) work better for me?
  4. Are there other procedures that I should consider to enhance the effects of this procedure?
  5. What kind of anesthesia is used?
  6. What is the recovery period like? How soon can I return to work following the procedure?
  7. Are there certain types of shampoo that I should use or avoid using following my hair replacement surgery?
  8. How much does it cost?
  9. What is your experience in performing this procedure? (How long has he/she performed this procedure, and how many he/she has performed in the past year?)
  10. What percentage of patients have had significant complications? (The physician should disclose this information to you.)
  11. Will you repeat or correct procedures if it does not meet agreed upon goals? And if the procedure must be repeated / corrected, will I be charged again? (The physician should provide you with his/her policy on this issue.)
  12. May I see "before and after" photos of recent patients? The physician should provide many photos of recent patients.
  13. May I have the names and contact information for several recent scalp flap/reduction patients? (Follow up to get first-hand information on the procedure and the surgeon.)
  14. Could I observe the exact procedure I am considering before I decide to have the surgery? (Either on videotape or ask to view one in real life.)
  15. What should I expect post-operatively, in terms of soreness, what to watch for, medication, bathing, and level of activity?
  16. Who will be assisting during the surgery? What are their qualifications? (Does the plastic surgeon perform the entire surgery?)
  17. Have you ever had your malpractice insurance coverage denied, revoked, suspended?
  18. Do you offer patient financing?
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Be sure to:
  • Tell your doctor about any allergies you have (to foods, drugs, environmental elements)
  • Tell your doctor if you have any serious medical condition(s).
  • Tell your doctor about all medications you are taking (both prescription and non-prescription)
  • Carefully follow any instructions your surgeon gives you regarding eating and drinking, smoking, and vitamins.
  • Avoid aspirin and aspirin-containing medicines for two weeks prior to surgery.
  • Arrange for someone to drive you home after surgery.

The information on this web site is only intended as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. The best method of determining your options is to consult qualified surgeons who are able to answer specific questions related to your situation.

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How do I finance this procedure?
Did you know that 29% of all Americans have considered having an elective procedure? Of those, 60% would schedule a procedure immediately if financing was available. With iEnchance's patient financing options, money no longer has to be the barrier between you and your new image. By filling out our on-line application you can qualify for a loan in as little as 30 seconds.
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Related Articles
Please review the following articles for more information on this procedure.
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Facts:

*Top 5 Surgical Cosmetic Procedures in 2008:

1. Breast Augmentation: 356,000
2. Liposuction: 341,000
3. Blepharoplasty: 195,000
4. Rhinoplasty: 152,000
5. Abdominoplasty: 147,000

*Top 5 Non-Surgical Cosmetic Procedures in 2008:

1. Botox: 2,464,000
2. Laser Hair Removal: 1,281,000
3. Juvederm/Restylane: 1,263,000
4. Chemical Peel: 592,000
5. Laser Skin Resurfacing: 571,000

* Data collected from the American Society of Plastic Surgeons (ASPS)
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