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(Figure 11-1. In a scalp reduction, balding skin is excised from
the top and back of the scalp. The sides of the scalp are brought
up and the area is sutured together. Scalp reduction scars are present
across the top and back of the scalp making them difficult to hide.)
Scalp reductions involve the surgical removal and then closure of
slices of balding skin from the top of the scalp. There are many
variations and designs, but the concept remains the same. At first
glance, the surgical removal of the bald skin seems like an ideal
answer. It is quick. There is no waiting for transplants to grow.
There is also a whole other side to the story, however. No matter
which design is used with these excisions, scars will be placed
on the patient’s head in an area very likely to show. Unless
the surgeon is able to entirely remove all of the bald skin, a scar
will be visible directly on the top of the head. If the surgeon
is able to completely remove all the bald skin, it will likely only
be after multiple procedures. Patients must not forget that male
pattern baldness is progressive. A scalp reduction patient had better
hope Propecia or Rogaine is able to stabilize his baldness, because,
if it does not, he can anticipate that scar becoming more and more
visible. Just like with transplants, there is a limit to what can
be removed from a scalp before there is no laxity remaining. Once
the scalp is tight enough—no more scalp reductions and possibly
no hair transplants.
But that is just the beginning of the scalp reduction problems.
Frequently, the scar on top of the head will develop “stretch
back”. The surgeon may have sewn it together flawlessly, but
because the wound is under tension, it will be prone to develop
a wide scar after it heals instead of a fine line. Thus, the patient
gets a wide, white line that may develop a depression along its
length. Because the wound will likely be sewn together under some
tension, he should anticipate significant pain for a few days.
As the hair is brought up from the sides to close the excision of
bald skin at the top of the scalp, the patient will notice problems
with hair styling. The hair that has been brought up will be angled
away from the scar. This leads to the development of what we call
“parting of the Red Sea”. The scar will lay between
two edges of skin in which the hair angles directly away from the
scar. This makes normal styling of the hair and hiding of the scars
difficult, if not impossible.
 Figure
11-2. As the hair from the sides of the scalp is pulled
towards the top of the scalp with scalp reductions, the hair
next to the scar angles away from the scar leading to a “parting
of the Red Sea” pattern. |
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