Scalp Reduction Surgery

Whether male or female, losing hair can be a frustrating experience. Hair is among the most valuable assets contributing to the overall look of both men and women, especially when you are young. Consequently, losing hair can be devastating and may even lead to poor mental health. Multiple studies have linked hair loss to lower self-esteem and confidence.

While there is no cure for hair loss yet, plenty of ways can help stop further hair loss and manage the balding areas. One such procedure is scalp reduction surgery. Also known as alopecia reduction surgery, scalp reduction surgery is a cosmetic procedure that can help with not only androgenic alopecia but also cicatricial hair loss. Thus, both men and women can benefit from this procedure; however, it is not for everyone. 

Scalp reduction surgery involves removing parts of the scalp with hair loss and replacing them with skin (also from the scalp) that contains hair. It is one of the oldest surgical procedures to treat hair loss (since the 1970s) and is useful for people with hair loss on top of their heads. However, it is not recommended for people with receding hairlines or frontal baldness. Here we discuss everything you need to know about scalp reduction surgery.

Scalp reduction surgery is not for everyone, and to be fit for the procedure, you must first meet certain criteria. For example, your doctor will recommend this procedure if you have one or more of the following:

• Too much hair loss and not having enough hair for other hair transplant procedures like FUE or FUT.
• Still have good hair on the sides and back of your scalp (donor hair)
• Have elastic skin that can be stretched to other parts of the scalp
• Have hair loss is due to aging or genetics

However, you are not a suitable candidate for this procedure, if:

• You have patchy hair loss 
• Your hair loss is temporary
• You suffer from chronic diseases like diabetes mellitus

Furthermore, your doctor can better guide you on who is a good candidate for scalp reduction surgery. So consult your doctor thoroughly.

Scalp reduction can be performed in an outpatient setting, which means you will not have to stay overnight at the hospital. The procedure requires general anesthesia, although sometimes local anesthesia may also be used. Here are the steps of this procedure:

• A healthcare provider gives you general or local anesthesia based on your requirements
• Next, your surgeon will cut out the balding part on your scalp.
• Then, the surgeon will loosen the skin with hair on your scalp (usually on the sides and back).
• They will pull the skin up to meet at the margins of the removed part and cover it.
• In the end, they will suture the flaps of skin to keep them in place. 

Scalp reduction surgery may be performed alone or with other hair transplant methods like FUT or FUE.

Before the surgery, your surgeon may recommend certain guidelines or minor surgical procedures. For example, your doctor may recommend a scalp massage a few weeks leading up to the surgery to improve skin laxity and flexibility. 

In addition, depending on your health condition and surgical requirements, you may need an additional procedure before your surgery. This additional procedure makes scalp reduction easy and effective and can be scalp extension or scalp expansion. 

In both procedures, certain devices are implanted under your skin four to twelve weeks prior to the surgery. These small procedures loosen and stretch the skin with hair and prepare it for surgery.

Scalp reduction is not a major surgical procedure, and you would be allowed to go home the same day. However, it still requires a period of recovery for your body to heal properly, usually between three to six weeks. You will need to remain in touch with your hair loss specialist during the recovery.

You will need to avoid any form of physical activity for two to three weeks. You should also avoid combing or shampooing hair for at least five to seven days. Some side effects of scalp reduction, like swelling, bruising, and numbness, are normal. However, if you experience severe complications, you must revisit your doctor.

As with any cosmetic procedure, you must also keep realistic expectations with scalp reduction surgery. For example, you may experience temporary hair loss following surgery. In addition, your hair may not look normal, grow in different directions, or be thinner. Consult your surgeon for further details on what to expect during recovery.

No surgery is free of risks; the same is true with scalp reduction surgery. You should always know the risk and complications of the procedure you are getting. In the case of scalp reduction, these may include:

• Infection, swelling, or bleeding at the incision sites
• Allergic reaction or improper healing
• Numbness or tingling 
• Scarring of the scalp
• Unnatural hair appearance
• Loss of skin elasticity, leading to scarring or hair loss
• Pain (in some cases)
• Necrosis (tissue death due to compromised blood flow) -- a serious complication

However, an experienced surgeon and their staff can minimize these risks and complications to a great extent. 

While it was once the most popular surgery for hair loss, it has now been replaced by modern procedures like hair transplant surgery. However, it still offers some unique benefits over other procedures. Some benefits of this procedure include:

• Quicker yet effective results 
• Hair is taken from the sides and back, resistant to DHT's effects. This hair continues to grow at the normal rate and does not get thinner unless the hair on the sides or back also begins to shed.
• Scalp reduction gives the appearance of a fuller head of hair for people with extensive hair loss, which is very convincing and aesthetically pleasing.

However, it is an old procedure popular in the 70s and 80s. Newer and better hair transplant techniques have been replaced as it comes with many disadvantages, such as:

• The unnatural appearance of the hair over time
• Stretching back of the hair-bearing skin over time, often affecting up to 50 percent of the area. It results in a hairless area around the incision site.
• Scarring of the scalp (almost inevitable) 
• Ongoing hair loss as scalp reduction does not solve the underlying, which exposes the underlying scar. 
• Risk of surgical complications (which is besides these disadvantages)

Scalp reduction surgery can cost between $3000 and $15000. Cost depends on many factors, such as your geographic location, your surgeon's experience, the kind of anesthesia you require, and, more importantly, the size of your baldness. 

While mild cases can cost as low as $3000, severe cases can go as high as $15000 or even more. Talk to your hair loss specialist to discuss more about the cost.

How many sessions does scalp reduction surgery require?

It depends on the severity of your baldness. Usually, your surgeon can safely remove a portion of about 2 to 5 centimeters of your scalp in one session. So if your bald area is more than 5 centimeters, you may need multiple sessions.

However, the additional minor procedures like scalp expansion and scalp extension can reduce your scalp reduction sessions to one. But you will also have to go to your doctor’s office for these minor procedures. As a result, you may have to visit your doctor more than once.

Are There Any Alternatives To Scalp Reduction Surgery?

Scalp reduction surgery is one of the earliest methods to treat hair loss in men and women. Since then, medical sciences have come a long way. Currently, many non-invasive and minimally alternatives are available for scalp reduction surgery. These options do not carry the same risks as scalp reduction surgery, with even better results.

Non-invasive options to treat hair loss include two medications, namely minoxidil (rogaine) and finasteride. On the other hand, a hair transplant is a minimally invasive option (minor surgical procedure). Hair transplant like FUE or FUT involves the removal of hair follicles from an area with high hair density and implanting them into the bald area. 

Does insurance cover scalp reduction surgery?

Unfortunately, insurance companies do not cover scalp reduction surgery because they consider it an elective cosmetic procedure. However, if your hair loss is caused by a medical condition, insurance may cover it. Talk to your doctor about your hair loss to see if insurance will cover the treatment or not.