Scalp reductions always bad?

[TC17]

What's the deal with scalp reductions? I've seen that many of the recommended physicians no longer perform them, and I've seen elsewhere that they are frowned upon, but why? It makes sense that if you can reduce the bald area that needs to be covered, you can have a better overall result when you/if you decide to have a transplant.

 

Conclusory statements are of no help to me, so if anyone responds, please explain why they're such a bad idea.

 

*also, on a related note about things that are frowned upon, a kid I go to school with has been using a laser comb for the past 6 months and has seen results. no meds, no HT, just the comb. maybe it's coincidental, but he's happy and the difference is noticeable.

[the B spot]

Not a fan. If your balding enough to require a scalp reduction/flap your likely going to bald where the scar is supposedly hidden.

 

Additionally, scalp reductions reduce overall scalp laxity and produce some very odd hair angles. The risk of stretching is high as well, even more so than a standard strip session.

 

With current closure technology and FUE there is no reason scalp reductions or flaps need to be used whatsoever.

 

Hair systems have improved to the point that those candidates have yet another choice, with 0% harm, of a crown piece in addition to covering the front of the scalp with HT's if they desire.

 

For certain patients a brow lift may be appropriate-- in some patients who have had a poor HT with a hairline too low, it is possible to remove a small strip, pull the forehead tissue "up", then transplant a natural, age appropriate hairline. This is used when too many bulky mini-grafts/plugs were used directly into the hairline and cannot be disguised or are too numerous to punch out and recycle. I believe this procedure has a great deal of success in skilled hands.

 

Those with aggressive balding are likely just not candidates, and at best may be candidates for FUE on a small scale to provide a limited or acceptable cosmetic improvement.

 

It "sounds" like a good idea, but there is no need for these measures, with the exception of an extreme case described above. Again, for those needing some form of repair work, it may be an option, but never a virgin scalp as an option.

 

My personal opinion, of course.

[Al - Moderator]

A scalp reduction looks great right after it's done. You can easily see that there's less bald area in the after photos. However the skin stretches back over time and within 3 to 4 months you will look like you never had one done. I had 5 scalp reductions over a 5 year period long ago. Same stretch back happened all 5 times. Complete waste of time and money.

 

 

As far as laser combs go, it worked on me too, but for some reason this forum is overwhelmingly against them, so I haven't posted about it in over a year. I found it works best for me in (what used to be) "permanent" shock loss areas around old HT donor scars.

[Severn]

I had 3 back in '96. I think they could be a valuable procedure if you have a very small area to cut out. But here are my pics showing results after 13 years. It's left a very odd balding shape along with a stretched scar. Now I am forced to address this area in a HT instead of working from the hairline back. Lucklily though, my hairline and forelock area is passable.

 

scar highlighted

[..]

When u get these scalp reductions. do they put inflator bags in under the scalp for a month so to stretch the skin that will then be cut away , or is that only in certain cases ?. The pic above doesnt seem that bad, im not sure what level of hair loss was like before the scalp reductions (nw5?) but with a few thousand grafts in that triangle bald area could turn out pretty good doc/donor/elasticity dependant

[Severn]

Originally posted by ..:

When u get these scalp reductions. do they put inflator bags in under the scalp for a month so to stretch the skin that will then be cut away , or is that only in certain cases ?. The pic above doesnt seem that bad, im not sure what level of hair loss was like before the scalp reductions (nw5?) but with a few thousand grafts in that triangle bald area could turn out pretty good doc/donor/elasticity dependant

 

No, they used to do that (inflater bags) in the old days. And yep, I will be doing about 2700 grafts in that area to take care of it. I have "average" elasticity according to Ron Shapiro and pretty good donor hair.

[Dr. Michael Beehner]

I performed my last scalp reduction 10 years ago, but did many of them my first 10 years before that. The one writer is correct, you felt like a miracle man when you held that "before" Polaroid next to the "after" one and proudly gave the patient copies. But a few months later they always stretched back to some extent. Nine years ago I did a study on 11 consecutive scalp reduction patients and found that the stretchback percentage was around 40%. For example, if you removed a 5cm wide area of bald scalp, a few months later the side-to-side measurement would be as if you only removed 3cm instead of 5cm.

There are several other negatives also. While 80% of them had wonderful scars that were virtually impossible to see later on, the other 20% could shine in the night almost and were devilish to camouflage with grafts.

One of the biggest negatives is that it thins the scalp and in my opinion compromises the blood supply for the scalp for when you transplant it. Many patients who had a couple of reductions would have a paper-thin scalp when you felt it.

And finally, it takes away from the laxity that you want in the donor hair for removing a couple of strips at the time of transplanting later on.

All that having been said, there are still unique situations in which I would offer one, and in fact have offered one on two occasions, but neither patient took me up on it.

Mike Beehner, M.D.

[Dr. William Lindsey]

I think Dr. Beehner is correct on his statistics and thoughts. I did a bunch of scalp reductions in my fellowship. With 2 layer closures there is not alot of stretch to the scar, but the bald scalp will definitely stretch SOME. Varies person to person.

 

I still repair a fair number of scalp cancer defects, the same technique is used really, just differing parts of the scalp, and there is virtually never a problem.

 

But, as I have posted elsewhere, I think that the malpractice risk, which is quite low with hair, goes up significantly with scalp surgery...probably a result of flap procedures from the '90s. I think they are an OK alternative in select cases, but I have not offered one this century.

 

Dr. Lindsey McLean VA