What is a Scalp Reduction?

A scalp reduction, also known as an alopecia reduction (AR), is a surgical procedure that creates a high-density appearance by removing the areas of the scalp that are experiencing hair loss. It was first coined by Dr. Sparkuhl in 1978, and he called it a “surgical excision of redundant tissue from one or more areas of scalp alopecia”. Although it can achieve results that are hard to replicate with traditional grafting procedures, it can come at a significant cost.

How does a Scalp Reduction Procedure Work?

An AR procedure follows these steps:

  • Under localized anesthesia, the surgeon cuts away the balding area of the scalp. Usually a portion somewhere between the crown and the vertex transitional point is removed.
  • The remaining skin (which is able to grow hair) is sewn back together.

Sometimes, the scalp is vigorously massaged for weeks before the surgery begins. This is to increase the scalp’s laxity. A scalp with a high level of laxity means that more of the scalp can be removed with less of a chance for complications.

Scalp Reduction and Hair Transplants

It is not uncommon for a surgeon to use a scalp reduction in combination with a traditional hair transplant for maximum density but there is a danger of combining both procedures during the same operation. If there is too much trauma to the overall scalp then the interruption of blood flow can increase the chances of scalp shock loss as well as necrosis.

Scalp Reduction Candidates

An ideal candidate for an AR procedure displays the following characteristics:

  • Male
  • Middle-aged or older.
  • A Norwood-Hamilton male pattern hair loss (MPH) classification of 4, 5, or 6, according to the chart.
  • Dense hair on the back of the head and on the sides (for a uniform appearance after surgery).

An AR procedure can be unsuccessful due to:

  • A tight scalp.
  • Hair loss on the sides of the head and the back of the scalp.
  • A Grade 7 Norwood-Hamilton MPH.
  • An abundance of preexisting hair (in which case medical therapy is preferable).

Potential Complications

The chance of complication increases with the size and scope of the operation. A major scalp reduction may also be called a “scalp lifting”. This invasive procedure almost always involves severing blood vessels and nerves so that more of the scalp may be moved in a single sitting. While this does cut down on the number of procedures required, and may allow a surgeon to remove a larger portion area of scalp at once, this method always increases the likelihood of complications, and can even leave the scalp feeling completely numb forever. Nonetheless, an AR of any size always poses the risk of:

  • Bleeding
  • Infection
  • Ischemic complications – a lack of blood flow and oxygen to the tissue that can cause necrosis.
  • Scalp thinning – if the scalp has been greatly stretched, it can become thinner as a result.
  • A disrupted hair geometry – the hair’s directional pattern of growth is severely altered. The lack of a hair whorl, which controls the circular outward growth at the crown, can cause an unnatural appearance and additional difficulties when styling the new hair.
  • “Stretch back” – the areas of the scalp that have been stitched back together begin to lose their elasticity, either partially or completely. This can cause a bald area of flappy scar tissue to form called a “dog ear scar”.

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