This question was posed by a hair loss sufferer seeking hair loss help on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY. Dr. Beehner is one of our recommended hair restoration physicians. His professional answer is below.
What’s the deal with scalp reductions? I’ve seen that many recommended physicians on the Hair Transplant Network 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.
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 perform a hair transplant. 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 scalp laxity that you want in the donor hair for removing a couple of strips at the time of hair restoration 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.