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Hair: Scalp reduction
A scalp reduction is a surgical procedure designed to reduce the amount of bald skin on the head. The procedure involves removing part of bald scalp, then pulling together the adjacent hairy scalp, thereby reducing the overall balding area. The effect is an immediate reduction of baldness, and an increase in the hairy area.
The main benefit of simple scalp reductions is that it rapidly reduces and, after several procedures, substantially eliminates baldness. But in general, men opt for scalp reduction so that they may become better transplantation candidates - reductions can allow those with substantial hair loss who had not previously been considered good candidates for hair transplantation procedures to become better candidates. The reductions leave less bald area to cover with transplants.
A series of reductions are almost always concluded with hair transplant procedures, which can achieve greater hair density after the bald area has been substantially reduced. The fine scar remaining from the last reduction procedure is covered by the mini and micro graft transplants.
Sometimes, the skin of the scalp may be too tight for a scalp reduction procedure. In that case, Tissue Expansion is necessary, which involves placing a silicone balloon under the scalp and then inflating the balloon gradually to expand the scalp. After the scalp has stretched, there is enough skin to work with for the scalp reduction technique.
What does it cost?
A scalp reduction can cost anywhere from $1,500 - $3,500 but this varies from surgeon to surgeon and according to where they practice. There may be additional costs such as anesthesia, operating room facility, prescription medicines, etc.
What happens during the procedure?
The procedure is usually performed in an outpatient surgical center, either operated by your surgeon or a hospital facility and takes about 1-2 hours. The scalp is numbed with local anesthetic and you may be given a sedative but you are awake during the entire procedure. An incision is made, usually on the top center of the head, from the front to the back. Skin is loosened from the underlying tissue and excess skin is removed. The remaining skin on both sides is stretched gently over the midline area and the edges are sutured together. These sutures are removed in seven to ten days
In Tissue Expansion, expanders are inserted during an initial surgical session and then gradually filled with a saline solution over a period of several weeks. As the expanders are they stretch the skin covering them. During a second surgical session, the expanders are removed and the scalp reduction surgery is performed.
To achieve adequate results, several simple reduction procedures are usually performed over 3-4 month intervals. The number of procedures performed and the amount of scalp to be removed during each procedure depends upon the size of the bald area and the looseness of the scalp. With each successive procedure, the fine scar remaining from the previous procedure is removed along with more bald scalp so that at the end there is only a single scar.
Are there risks or potential side effects?
As with all surgeries, there is always a possibility of complications following scalp surgery including infection, bleeding, a reaction to the anesthesia, hematoma, seroma, nerve damage and the occurrence of asymmetries or irregularities. Scalp reduction patients may develop slot deformity, an unnatural appearing dent in the scalp.
Simple reduction procedures typically result in an unnatural appearance immediately following surgery, although sometimes the change can be almost unnoticeable. Since no new hair is added, the results may also be limited. The goal of a simple reduction procedure, like all surgical treatments for hair loss, is only to create the illusion of having more hair, in this case by reducing the bald spot.
Be sure to ask your surgeon about all of the risks associated with the procedure you are considering before you make any decision.
What to expect post-procedure?
A light head dressing is usually worn for 24-48 hours, after which regular hair washing can be resumed. Stitches are usually removed in one week. The healing incisions and sutures can affect appearance for a few days to two weeks after the procedure. To reduce the unnatural look immediately after surgery, existing hair can be combed to camouflage the surgery, or a hat, cap, or hairpiece can be worn temporarily. Some men simply choose to take a few days off work, until the incision is less noticeable.
Another common problem following scalp surgery is bleeding. Some bleeding is expected because the scalp contains many blood vessels. Bruising of the skin around your eyes frequently occurs, but it usually goes away within two weeks. Swelling is normal and may occur three to four days after surgery. Infection is not a common complication, however, antibiotics, and occasionally, medication can be prescribed to alleviate discomfort after the procedure. Your surgeon will give you instructions for post-operative care and may prescribe a topical antibiotic to keep your scalp moist and clean, encourage healing, and discourage infections. You can generally resume shampooing within a day or two.
How soon does normal life resume?
Mild tightness of the scalp may be felt for one or two weeks following surgery. The swelling subsides within 10 days. The procedure can be repeated up to several times at three to four month intervals if further reduction in the bald area is necessary.
Who performs it?
A plastic or dermatologic surgeon or an otolaryngologist (ENT) normally performs scalp reduction surgery.
Are you a good candidate?
The best candidates for scalp reductions are men with a clear bald spot, who also have ample hair along the sides and back of their heads for later transplants. Those with a clear bald spot and dense hair along the sides and back will achieve greater visual impact than those with less dense hair. Curly hair will generally appear denser than straight hair.
As with all elective surgery, good health and realistic expectations are prerequisites, but if you want to have fuller looking hair, then scalp reduction surgery may be appropriate, especially if:- Your surgeon is aware of any and all medical conditions and any allergies you may have and whether you are a smoker. Also, tell your surgeon about any medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription).
- You do not suffer from severe cardiovascular problems
- You are not prone to scarring problems such as keloids
- You have a good understanding of the healing process and the limitations of the procedure.
Scalp reduction procedures may also be used to repair the appearance of a person who has suffered a traumatic injury to part of the scalp, for example from an automobile accident or fire. Sometimes scalp reductions are performed on those who suffer chronically inflamed scalps as a result of artificial hair implants. In these cases, the severely damaged portion of scalp is removed, and the adjacent scalp is pulled together and sutured to close the opening.
How to prepare for surgery?
Your doctor will give you specific instructions to prepare for surgery but here are some general guidelines:- Massaging your own scalp gently a couple of times each day for several weeks before surgery will allow for greater bald scalp to be removed during a simple reduction procedure. The general pattern of the massage is to knead the scalp up.
- Avoid aspirin, any aspirin containing medication or any other non-steroidal anti-inflammatories (NSAID), such as MotrinŽ or AdvilŽ, for two weeks prior to treatment. Because aspirin thins the blood, it can interfere with normal blood clotting and increase the risk of bleeding and bruising.
- Smoking inhibits the healing process, so stop smoking before your procedure and if you start again, make sure it is after you are completely healed.
- Avoid drinking alcohol a few days before your surgery.
- Make sure to follow any fasting instructions the night before and morning of your surgery. Your doctor may insist on an empty stomach depending on the type of anesthesia.
- Make sure that you arrange for someone to bring you home and to help you out for 24 hours after surgery.
Are there alternatives to this surgery?
Other methods of hair restoration include scalp reduction and scalp flap procedures, but they do not have the same restorative effect, especially in terms of filling in the hairline. Alternatives to surgery are oral medications such as Finasteride (Systemic), sold under the brand name Propecia or topical solutions such as Minoxidil, sold under the brand name Rogaine. Minoxidil stimulates new hair growth, while finasteride slows the rate of hair loss.
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To view Personal Stories about this procedure contributed by our members, Click Here.
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