Scalp Reductions Done Today?

Hi Doc! I’ve just about made it through all 800+ pages on the Balding Blog and have a couple of questions about scalp reductions. I know you and most hair restoration physicians discredit them, but are there ever cases where one could be performed? Assuming good scalp laxity, how much could be removed without causing the slot deformity in the back? Some physicians still list some form of scalp reduction on their site and I’m wondering what they do these days that won’t cause more problems later.

Scalp reductions are not the “gold standard” in treating male pattern hair loss, because the results are sub-optimal and you end up with a scar along the top of your scalp that will be visible with continued hair loss. Although I hate to use the term “never”, I will say that I can not imagine using scalp reductions on any patient today.

Now with that said, a few of the old timers that have judgments and experience with follicular unit transplantation may find an indication for performing a scalp reduction and it might be reasonable in their hands to do a few. If the scalp reduction is limited to no more than 1-2 surgeries, then the probability of a slot deformity would be minimal and the thinning of the scalp will also be minimized. Reductions also tend to lose their value over time (a term called stretch-back) and the patient would need to understand that risk.

I had 3 scalp reductions in 1992-1993 and my scalp became very thin and easily damaged by sun. I also had a full stretch-back, resulting in a return to the original balding pattern from before the first surgery. The medical-legal risk of scalp reductions to the doctor is not insignificant in today’s litigious society, so few doctors will face the legal risk with complications that were so frequent in the early days. In the 1980s, doctors would do these frequently because the money was good ($2,000-2,500 per procedure) and the skilled doctor would be able to do it in 15-20 minutes. So the attraction to do something so profitable was irresistible for many doctors, bringing out the larcenous side of those who had that tendency. Add to that the need for 3-6 surgeries in most people and that made the money look better and better for the doctor, so much so that they lost their sense of compassion for the patients who had the many, many complications of this procedure.

For more information, including the history of scalp reductions and photos, see here.