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This question,  asked on the Hair Restoration Discussion Forum, was answered by recommended hair transplant surgeon Dr. William H. Lindsey of McLean, Virginia:

Since modern follicular unit transplantation surgeries leave such little scarring in the donor area, why aren’t hair restoration physicians performing more scalp reductions in the crown? It seems like there is greater laxity in the crown compared to the donor area, meaning a lot of bald scalp could be reduced with minimal scarring?

My guess is that there are 3 reasons why scalp reductions aren’t occurring today:

First, scars can be a real problem and can potentially disfigure someone, even in the best of hands. Additionally,  tissue expansion really let us remove a lot of bald scalp, but very few men want to walk around with a balloon expander in for a month, when they can have a modern transplant.

Second, the surrounding hair can get pulled into an unnatural position.

Third, modern follicular unit grafting has greatly improved overall results with minimal potential complications.

Finally, using my landscape analogies that I use with patients: Imagine you have a farm that has a hill with no trees. It is easier to plant trees on the hill, than it is to grade the hill down to level so that surrounding tree’d land camouflages it.

William H. Lindsey, MD, FACS

McLean, VA

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Blake Bloxham – aka Future_HT_Doc

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

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