Scalp reduction procedures reduce the balding areas by removing segments of the bald scalp and stretching the hair-bearing scalp to a higher position. Scalp reductions do not, by themselves, produce the cosmetic result of grafts or flaps, but aid in coverage and styling situations. Scalp reductions for the routine treatment of male pattern baldness have fallen out of favor in recent years.
When used with hair grafts, scalp reductions decrease the area for hair grafting. This stretching of the scalp can be repeated as soon as the scalp loosens up enough to allow such reduction, usually after three months. A process called scalp extension can accelerate the reduction.
A significant reduction can be performed if the scalp is loose enough. Usually, a portion of the scalp two to five centimeters (3/4″ to 2″) wide can be removed in one session. Because the scalp is being stretched, this procedure diffusely separates the hair in fringe areas, creating a good cosmetic effect.
Scalp reductions leave scars within the bald areas of the scalp, which are camouflaged by hair styling or by hair grafts. Scalp reductions can be done before hair grafting is started. Alternatively, scalp reductions can be done after the hair grafting is completed. In this latter situation, the grafts are inserted in such a pattern that leaves an area of bald scalp to be removed at a later date. In some cases, a limited number of hair grafts can be done simultaneously with scalp reductions.
Also, scalp reduction can be done after Juri flaps are performed and healed in place.
The most frequent use of scalp reduction principles over the past 10 tears has been for scar revision or lesion removal of the scalp.
Skin is removed from within the dotted lines and the scalp edges are pulled upward and stitched in place.
Potential results after one or two scalp reductions. Further reduction procedures may be done.
The bald area has been reduced by scalp reductions. Hair grafts are shown filling in the remaining bald areas.
An example of styling, with the completed result after multiple scalp reductions and hair grafts.
This procedure is now rarely if ever indicated for male pattern baldness in our practice. It is included here for historical or reconstructive reference.
A procedure designed by Dr. Patrick Frechet of Paris, France, has become known as “scalp extension”. Scalp extension allows scalp reduction to be performed with much greater effect and allows previously determined non-candidates to have successful scalp reductions. Basically, it involves the use of a surgical device, made of two rows of hooks connected by broad-based elastic bands, that is placed on the undersurface of the scalp during the first scalp reduction. Over a one-month period, elastic recoil causes a constant, gentle upward pull of the hair-bearing tissues, thereby loosening and stretching the scalp. This allows for another, and usually greater, scalp reduction to be done. The scalp extension process can be repeated. With scalp extension, the complete series of scalp reductions can be done within a 30- to 90-day period. In the past, some scalps could not be reduced at all and those that could be reduced often took as long as 1 1/2 years for the procedures to be completed. Scalp extension has some of the benefits of scalp expansion, although the amount of tissue stretch is less. Its great advantages are that it causes little or no discomfort and deformity. It is a relatively simple procedure, thereby adding little time and difficulty to the scalp reduction operation.
Scalp reduction- extender is to be inserted
Scalp reduction completed- extender in place.
After four weeks- sides of scalp stretched.
Extender removed. Results after second reduction.
Balloon-like devices (tissue expanders) are implanted under the hair-bearing sides and back of the scalp. These are gradually inflated over a four to twelve week period. This results in a great amount of loose hair-bearing tissue, allowing for massive scalp reductions or flap procedures. This technique works wonders in reconstructive scallp situations where there are large areas of hair loss from injury, tumors and burns.
Expanders fully inflated before removal and
definitive surgical procedure.
Incisions are made, the expanders are removed,
the bald scalp is cut out.
Baldness reduced after scalp expansion.
Scalp Laxity Examples
Before: Skin Pinch Test
After: 1 day
Scalp Laxity video examples
View the video examples that we encourage those considering hairline lowering to could make and e-mail that could help us determine whether one is a good candidate for a one stage hairline lowering/forehead reduction.
The movie shows what I think is good scalp flexibility on myself and my assistant surgeon. This would allow us to lower a hairline (if one has one) at least 2 and probably 2.5 cm.
Pinch Test – Type 1
Excellent – Scalp / forehead inch test which should allow about 3 cm of shortening of the forehead (lowering of the hairline)
Pinch Test – Type 2
Good – Scalp / forehead pinch test for forehead / scalp flexibility. This amount should allow for 2-2.5 cm of shortening of the forehead (lowering of the hairline).
Ruler Measurement Test
While pressing down firmly, pull up on a point below hairline as high as possible and set that point of the fingertip at zero
Push fingertip as far downward as possible and take measurement of the movement. We like to see 2 cm or more of excursion