Scalp Reduction Surgery

Androgen alopecia, so-called male baldness, is one of the most common forms of hair loss and, despite the name, affects both men and women.

Around one in three men has some form of hair loss, and it also affects a growing number of women. It can start at different ages and progress to varying degrees.

Scalp Reduction
Before After Photos

If you are struggling with hair loss, surgical hair replacement options may work for you. Scalp expansion, flap transposition, and scalp reduction surgery can reverse the results of hair loss by restoring hair-bearing scalp to make a fuller head of hair.

Depending on the nature and amount of hair loss you are experiencing, follicular unit hair grafting may be utilised in conjunction with these methods to improve the appearance of the hairline and overall hair growth pattern. When performed by an experienced surgeon, surgical hair restoration delivers a proven hair loss remedy that can bring back your hair with remarkably natural results.

Planning Your Surgery

The Consultation

During the consultation, Dr. Barnouti will discuss your desired changes in appearance and explain the different options available to you, the procedure itself, and its risks and limitations.

Dr Barnouti may also take “before” photos, and give you detailed 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 surgeon if you have had previous hair restoration surgery if you smoke, or if you take any drugs or medications (including aspirin). Also, inform 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 to see photos of recent patients before and after surgery.

Scalp reduction surgery involves the surgical removal of parts of the already bald scalp, followed by the stretching of the parts of the scalp, which still has new hair growing on it. Following stretching, the scalp is then moved to a higher position on the head. This procedure may be recommended at the same time as hair grafting to leave a smaller bald area, which then needs fewer hair grafts afterwards to cover it. Suitable candidates for this procedure are patients with excellent hair on the sides and back of the scalp that can be stretched upward to cover the bald scalp to be cut.

The surgery

Scalp reduction (permanent solution)

Scalp reduction is usually performed using a local anaesthetic and a sedative to assist in relaxing and reducing anxiety. Usually, a portion of the scalp, two to five centimetres wide, can be removed in one session, and the remaining skin is then stitched back together. Newer techniques of scalp reduction may also be used: these include scalp expansion and scalp extension, which are explained below.

Scalp expansion (permanent solution)

With a scalp expansion, balloon-like devices called tissue expanders are implanted under the sides and back of the scalp where the hair is still growing. These are gradually inflated over a four—to twelve-week period, resulting in an increase in the amount of loose hair-bearing tissue as the skin stretches. The following scalp reduction surgery produces more loose bald skin than would be possible if it had not been stretched before surgery.

Scalp extension (also known as Frechet Extender).

Scalp extension involves using a surgical device made of two rows of hooks linked by elastic bands. This device is placed on the scalp’s surface during the first scalp reduction procedure. Over a one-month period, the tension in the bands gets tighter, constantly and gently pulling upwards on the hair-bearing tissues. This loosens and stretches the scalp, allowing for another, and normally greater, scalp reduction to be done.
With scalp extension, a faster series of scalp reductions can be completed 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 a year or longer for the procedures to be accomplished. The treatment is much quicker now!
Scalp extension has some of the benefits of scalp expansion; however, it causes less discomfort and deformity. However, the amount of tissue stretch is generally less than can be achieved with scalp expansion devices.

What are the risks associated with this procedure?

Plastic surgery, like any surgical procedure, carries inherent risks and potential complications.

Please read our Risks and Complications of Plastic Surgery page.

After Surgery

Patients usually experience swelling and 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. You will be going home on the same day, and the wound on the scalp does not require dressing after the procedure.

The scalp will remain numb for 12-24 hours, following that you will need simple analgesia.

A follow up appointment will be arranged in 7-10 days after surgery.

You will need to avoid sun exposure for a week and any strenuous work that may increase your blood pressure.

Getting you back to work and normal activities

You should be able to resume normal daily activities over the next several days slowly.

Shampooing and gentle combing can be started next day.

Most patients can return to work within 3-5 days following the procedure.

Strenuous activity must be kept to a minimum for 10 days.

Most patients who decide to undergo scalp reduction are satisfied with the results.

While there may be particular scarring around the incision, it is usually covered by hair. A hair transplant procedure can better cover the scars.