Scalp reduction surgery, also known as alopecia reduction, is a procedure designed to treat hair loss, particularly male or female pattern baldness. The operation decreases the area of non-hair-bearing scalp by physically removing it. The surgeon then stretches the surrounding skin, which contains active, hair-producing follicles, to cover the void. This method reduces the size of the bald region, creating the appearance of fuller hair.
The Surgical Process
The scalp reduction procedure is typically performed on an outpatient basis, utilizing local anesthesia combined with intravenous sedation. The surgeon begins by marking the area of bald skin to be removed, usually in an elliptical, Y, or T-shaped pattern. The bald section of the scalp is then cut away down to the subgaleal plane, while preserving underlying nerves and blood vessels.
Once the hairless skin is removed, the surgeon performs “undermining” of the surrounding hair-bearing scalp tissue. This technique separates the skin layer from deeper tissues to increase mobility and elasticity, allowing the skin to be stretched. To further enhance movement and reduce tension, a procedure called galeotomy—making small incisions in the galea, a dense fibrous layer beneath the scalp—may be performed.
The mobilized edges of the hair-bearing scalp are then pulled together and sutured to close the wound. The goal is to bring hair-producing skin from the sides and back of the head over the previously bald area. This closure, performed with sutures or surgical staples, immediately reduces the visible expanse of baldness.
Determining Patient Suitability
A candidate for scalp reduction surgery must meet specific physical criteria, as the procedure relies heavily on the mechanical properties of the scalp. A primary requirement is sufficient elasticity and laxity of the remaining scalp skin. The skin must be loose enough to stretch and cover the excised area without excessive tension, otherwise the wound cannot be closed safely.
The degree and pattern of baldness are important considerations, as the surgery is most effective for extensive hair loss, often in the crown or vertex area. The patient must have dense, healthy hair in the surrounding areas, particularly the sides and back of the head, since this tissue will be stretched into the new location. Scalp reduction is not recommended for individuals with multiple small bald patches or rapidly progressing hair loss.
Overall health status is evaluated, and patients with conditions that impair wound healing, such as uncontrolled diabetes or certain clotting disorders, may be advised against the procedure. The best candidates have stable, established pattern baldness and reasonable expectations about the degree of coverage and the potential for scarring.
Post-Operative Care and Recovery
Following the procedure, the scalp will experience tightness, swelling, and mild to moderate discomfort, managed with prescribed pain medication. For the first 24 to 48 hours, a pressure dressing is often applied, and patients must keep their head elevated, even while sleeping, to minimize swelling. The feeling of tightness usually persists for several weeks but gradually improves as the scalp adjusts to its new position.
Wound care involves keeping the surgical site clean and dry for the initial few days. Gentle hair washing can usually be resumed around day three, but patients must avoid scrubbing the incision line or applying high water pressure. Strenuous activities, heavy lifting, or any activity that increases blood pressure or tension on the scalp must be avoided for approximately three weeks to prevent disruption of wound healing.
Sutures or staples are generally removed by the surgeon between one and two weeks after the operation. Patients may notice that some hair around the incision temporarily thins or falls out, known as telogen effluvium, which is a normal response to surgical trauma. Most people can return to work and light activities within a few days to two weeks, depending on the extent of the surgery and their healing progress.
Expected Results and Potential Complications
The primary, immediate result of scalp reduction is a measurable decrease in the size of the bald area, often achieving a 30 to 50 percent reduction in the crown region. However, a linear scar along the incision line is an unavoidable consequence of this surgery.
Surgeons may employ techniques like a trichophytic closure, where the incision is angled to allow hair to grow through the scar, helping to camouflage its appearance. Over time, the results can be affected by “stretch-back,” where the stretched skin gradually relaxes, causing the scar to widen and the bald spot to reappear. This may necessitate a subsequent touch-up procedure.
Potential complications include common surgical risks such as infection, bleeding, and the formation of a hematoma (a collection of blood under the skin). Due to the manipulation of scalp tissue, temporary or permanent numbness and tingling sensations are possible from nerve involvement. In rare cases, poor blood flow due to high tension can lead to skin necrosis, or tissue death.