Scalp Reduction Surgery

Contents

In this article we will look at:

• Overview
• Am I eligible for scalp reduction surgery?
• How is the scalp reduction procedure performed?
• Are there any risks/side effects of scalp reduction surgery for hair?
• Are there any post-treatment guidelines for scalp reduction surgery?
• What are the advantages of scalp reduction surgery for hair?
• How many sessions of scalp reduction surgery for hair are required to produce desired results?
• How long will it take to recover from scalp reduction surgery for hair?
• Am I an ideal candidate for scalp reduction surgery?
• What is the cost of scalp reduction surgery in India?
• Are the results of scalp reduction surgery permanent?
• More Hair Treatment-Related Topics
• References

You can click on any of the links above to navigate to the section of your interest.

Overview

Scalp reduction surgery also known as scalp lifting, as the name itself suggests, is a surgery which removes parts of the scalp affected by alopecia. Scalp is the part of the skin that covers the topmost part of your head. The purpose of this surgery is to remove the bald areas from the scalp.   

The healthy parts of the scalp are then stretched and repositioned so that the bald areas are considerably diminished. 

This surgery is not for people suffering from male pattern baldness, but is recommended for people who have patches of bald areas on the scalp. Scalp reduction is also not suitable for covering areas of hair loss in front of the scalp, as it can cause scarring.  

This surgery is performed only when there is not enough donor hair available for performing an FUT or FUE procedure. 

Am I eligible for scalp reduction surgery?

You are eligible for scalp reduction surgery, if:  

• you have lost too much hair and do not have enough donor hairs for an FUT or FUE hair transplant procedure.
  
  
• you have good hair growth on the sides and back of your scalp, so that the skin can be stretched upwards to cover the bald areas of your scalp.
  
  
• you do not suffer from disorders such as uncontrolled diabetes, chronic skin or liver disease, cancer, metabolic disorders, autoimmune diseases, and certain blood disorders such as platelet dysfunction syndromes, thrombocytopenia, hypofibrinogenemia, and hemodynamic instability,  

How is the scalp reduction procedure performed?

Pre-Surgery Preparation

Before the actual scalp reduction surgery, depending on the patient’s health and surgical requirements, the doctor may advise him/her to undergo some preparatory procedures. These procedures are performed to prepare the scalp for scalp reduction surgery.  

The preparatory procedures include: 

• Scalp Massage
• Re-Routing of Blood Vessels
• Scalp Expansion
• Scalp Extension

Scalp Massage

In some clinics, scalp massage is done regularly for a couple of weeks prior to the surgery. This is done to increase the laxity of the scalp or to make it flexible and loose.

Loose and flexible scalp skin allows the doctor to remove more bald areas of the scalp with less probability of complications occurring. 

Re-Routing  of Blood Vessels

Depending on your health condition, surgical requirements, and the location where the scalp area needs to be reduced, the surgeon may have to perform a minor operation, at least 4 to 6 weeks before the scalp reduction surgery.
It involves the following steps: 

1. At the outset, anesthesia is administered, as required.
   
   
2. The surgeon hen creates an incision to reroute the blood vessels in the scalp. This ensures proper blood flow to the rest of the scalp after the surgical scalp reduction.
   
   
3. After rerouting the arteries, the surgeon closes the incision and dresses the wound.

Post the procedure, the doctor will ask you to visit the clinic for regular follow-ups, in the intervening 4 to 6 weeks, to ensure that the blood flow through rerouted blood vessels is normal.  Scalp Expansion  

Scalp expansion is a tissue expansion procedure, which may take upto 12 weeks. It helps to increase or expand the amount of hair bearing tissue, as the skin gradually begins to stretch. The stretching of the skin creates a greater amount of loose bald skin, which the doctor can easily remove during the scalp reduction surgery, with minimal risks of complications occurring.

The following steps are involved in the scalp expansion procedure:

1. At the outset, anesthesia is administered to you as per your requirement.
   
   
2. The surgeon then makes incisions on the back and sides of the scalp where the hair is still growing.
   
   
3. Through the incisions, tissue expanders, which are balloon-like devices are implanted.  
   
   
4. The surgeon then sutures and dresses the incision wounds.
   
   
5. Depending upon your requirement, the surgeon then, over a period of 4-12 weeks injects saline into the tissue expander device which gradually inflates. As the expanders inflate, the tissue/skin around them begins to grow and expand.
   
   
6. After the desired skin expansion is achieved, the surgeon again creates incisions on your scalp and removes the tissue expanders.
   
   
7. The incisions are then sutured and dressed.
   
   
8. You are then given an appointment for the scalp reduction surgery.

Scalp Extension

In the scalp extension procedure, a surgical device consisting of two rows of hooks connected by elastic bands is used. 

The procedure involves the following steps: 

1. At the outset anesthesia is administered to you as per your requirement.
   
   
2. The surgeon creates incisions through which the entire device is inserted under the surface of the scalp, with the two rows of hooks lined on either of the hair-bearing sides of the scalp.  
   
   
3. He then sutures and dresses the incision wounds.

The elastic bands create a pull and tension which brings together the hair bearing tissue from both sides of the scalp.

After a desired extension of the skin is achieved, the excess bald skin is easily removed by the surgeon, during the scalp reduction surgery.  The hair bearing tissue is now brought closer and sutured so that the bald patch completely disappears. 

Scalp Reduction Procedure

The scalp reduction procedure involves the following steps:

1. At the outset anesthesia is administered to you as per your requirement. Most of the time, scalp reduction surgery is performed under general anesthesia, though on certain occasions doctors may use local anesthesia, coupled with a sedative to make you drowsy, whilst he operates.
   
   
2. The surgeon then creates a Y-shaped incision at the top-back portion of the your head.
   
   
3. The skin in this area is removed as required.
    
4. The surgeon then lifts the back and sides of the scalp upward and inward to cover and close the area.
   
   
5. He then sutures the incision wound and dresses it.

There may be scarring after the procedure, which is usually covered by hair styling.

Are there any risks/side effects of scalp reduction surgery for hair? 

  Patients normally experience swelling, accompanied by numbness, for the first few days following the procedure. Tightness in the scalp along with scabbing is also very common for a few months after the operation. The skin takes time to soften. 

This procedure involves severing blood vessels and nerves to remove as much of the bald area as possible, hence the possibility of complications increases with the size and scope of the surgery. Some of the risks involved are:  

• bleeding
• infection
• allergic reaction
• improper healing
• the death of skin tissue leading to the death of hair follicles
• scalp thinning
• scar tissue formation
• possibility of the scalp area becoming numb permanently
• disrupted hair growth pattern which can be difficult to style
• noticeable scar on the head

Are there any post-treatment guidelines for scalp reduction surgery? 

You should avoid shampooing and combing your hair for at least five to seven days. Avoid any form of strenuous activities, including exercising, for a period of two weeks after the surgery.   Even after that make sure you do not perform strenuous exercises for at least three more weeks.   

You need to take the medicines prescribed by the doctor regularly on time.

What are the advantages of scalp reduction surgery for hair? 

Scalp reduction treatments deliver immediate, yet excellent results compared to hair transplants.

Post the scalp reduction surgery, the hair still continues to grow at the same rate. The hair neither thins nor dies, unless the hair on the sides also thins or dies.

How many sessions of scalp reduction surgery for hair are required to produce desired results?

Usually, one portion of the scalp (two to five centimeters wide) can be removed in one session which can be between 2 to 4 hours.  The remaining skin is then stitched back together.

Procedures such as scalp expansion and scalp extension may reduce the number of scalp reduction surgery sessions to one. 

How long will it take to recover from scalp reduction surgery for hair? 

Your recovery period would be largely dependent on your overall health condition. 

Most patients will be able to return to work (as long as the work does not involve physical exertion) within three to five days following the procedure. Though, it would be wise to avoid any form of strenuous activity till at least after two weeks of the surgery. You will be able to resume your normal routine gradually after the two-week period. 

Am I an ideal candidate for scalp reduction surgery? 

You are an ideal candidate for scalp reduction surgery, if you: 

• are physically healthy
• are psychologically stable
• have complete balding around the top portion of the scalp
• possess healthy hair growth on the sides and back of the head
• realistic about the outcome
• do not suffer from uncontrolled diabetes
• do not suffer from chronic skin
• do not suffer from liver disease
• do not suffer from cancer
• do not suffer from metabolic disorders
• do not suffer from autoimmune diseases
• certain blood disorders such as platelet dysfunction syndromes, thrombocytopenia, hypofibrinogenemia, hemodynamic instability

  Make sure the doctor explains the procedure in detail and you are aware of the side effects if any.

What is the cost of scalp reduction surgery in India? 

Cost of intense pulsed light treatment can vary depending upon the city/locality,  clinic/hospital type & amenities, experience of the provider, the technology & material used, the extent of scalp reduction etc.

Please consult your doctor to get the exact treatment plan and price quote suiting your unique needs.

Are the results of scalp reduction surgery permanent? 

Most of the patients who undergo scalp reduction are pleased with the results.

Occasionally though, the skin loosens again after a scalp reduction, and the bald area begins to enlarge, moving the hairline back to its original position.

More Hair Treatment-Related Topics

People interested in this topic also read:

• Hair Fall Treatment Procedures
• Hair Transplantation Procedures Overview
• Follicular Unit Transplantation (FUT)
• Follicular Unit Extraction (FUE)
• Scalp Reduction Surgery
• Artificial/Synthetic Hair Implant
• Platelet-Rich Plasma (PRP) Therapy for Hair Growth

References

1. Craig S. Schauder, M.D., D. Bluford Stough, III, M.D., David M. Spencer, M.D. Achieving the Optimal Result with the Modified-S Pattern for Scalp Reduction. 2018. Available at: http://journals.sagepub.com/doi/abs/10.1177/074880689401100204?journalCode=acs. Accessed February 27, 2018. 

2. ALT T. Aids to Scalp Reduction Surgery. 2018. Available at: http://onlinelibrary.wiley.com/doi/10.1111/j.1524-4725.1988.tb03505.x/full. Accessed February 27, 2018.