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Surgical baldness treatments: scalp reduction and scalp extension

Scalp reduction surgery is exactly what the name suggests; surgery to reduce the size of the area of the scalp that has suffered significant hair loss in a man developing male pattern baldness. Scalp reduction surgery usually focuses on reducing the appearance of hair loss at the crown. Bald areas of scalp at the top of the head are removed, and the remaining areas at the side of the scalp, which are richest in hair follicles, are pulled up and stitched together. Modified techniques involve prior scalp extension surgery.

Scalp reduction surgery was a highly popular solution to male pattern baldness in the 1970s and 80s, but it has declined in popularity in recent years due to advances in hair transplant technology.


How is scalp reduction surgery performed?

Scalp reduction surgery is usually performed under local anaesthetic, although you may also be given a sedative to help you relax. A strip of scalp is then cut from the bald area at the top of your head and removed. This strip can be between two and five centimetres wide and will be shaped to suit your individual requirements. The most common form of scalp reduction surgery removes a Y shape flap.

The scalp either side of the incision is then stretched and stitched together, bringing the areas of hair growth up on to the top of the head. This will feel tight shortly after your scalp reduction operation but this feeling will fade as the skin stretches and new skin cells grow.

Scalp reduction surgery may need to be repeated several times to achieve the desired result as the scalp can only be reduced by a few centimetres at a time. Furthermore, as the new tighter scalp relaxes and stretches out, you may find that your bald patch returns and further surgery is required.


Are you a good candidate for scalp reduction surgery?

Scalp reduction surgery only works for balding at the crown, and is not suitable for frontal or temporal hair loss. It is also only suitable if you have healthy hair growth at the sides and back of your head that can be pulled into position to replace the removed bald areas. The thicker your natural hair the better, as this allows for additional scalp reduction grafts to be taken to disguise any scarring or stretch marks.

Enhancing scalp reduction surgery

Scalp extension and scalp expansion are two techniques that can enhance the effectiveness of scalp reduction. Both stretch the scalp in advance of the surgery, providing greater flexibility and a larger area of healthy hair growth to pull up to the top of the head.


What is scalp extension?

Scalp extension stretches the scalp using a device called a Frechet extender. This is a stretchy membrane with hooks at the edges, which is placed below the scalp during an initial operation that is done prior to scalp reduction surgery. The membrane is stretched and anchored by a series of small hooks placed at the edge of the area of healthy hair growth.

The scalp extension membrane is left in place for around four weeks, during which time it gradually returns to its unstretched form, slowly pulling the scalp in the process, encouraging new cell growth by stretching the skin.

At the end of the process, the scalp extension expander is removed and scalp reduction surgery is performed. This surgery will be much more effective than a stand-alone scalp reduction, as scalp extension provides much more scalp skin to work with. If necessary, the expander can be re-sited during the scalp reduction, allowing for further surgery a few weeks later.

Scalp reduction surgery with scalp extension usually takes no more than three months in total, compared to an average of 18 months for unaided scalp reduction.


What is scalp expansion?

Scalp expansion works on a similar premise to scalp extension, but achieves the stretching through a different and more effective technique.

When you have scalp expansion, a small balloon is inserted on either side of the skull, beneath the areas of healthy hair growth. Over a period of one to three months, these balloons are slowly inflated by injecting a sterile saline solution. As they increase in size, they stretch the scalp, encouraging new cell growth in the areas of healthy hair. This happens in much the same way that the skin of the abdomen grows to accommodate a pregnancy.

After the scalp has stretched sufficiently for the required scalp reduction to take place, the balloons are deflated and removed and the scalp reduction operation proceeds as above.

Scalp expansion has the advantage that a great deal can be achieved with just two surgeries – to insert and remove the balloons – compared with the multiple surgeries often required for extension or unaided scalp reduction. As much as 50% more scalp can be removed following scalp expansion, making the whole process of hair restoration faster and more effective. However, the major disadvantage is the deformation of the shape of the head while the balloons are inflated, which can be difficult to disguise.


Alternatives to scalp reduction surgery

Scalp reduction surgery is rarely undertaken these days, as hair transplant techniqueshave advanced. However, in certain cases, scalp reduction can still provide the best solution for male pattern baldness. Your specialist will advise you of the right hair restoration remedy for your personal circumstances.


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