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Scalp Reduction Surgery: Procedure, Cost & Risks

If you’re beginning to lose your hair, you may have looked into surgical procedures to treat hair loss and help you maintain as much of your hair as possible as you get older. 

Scalp reduction surgery, or alopecia reduction (AR), is a type of surgery that involves surgically removing the parts of your scalp affected by hair loss and replacing them with skin that contains active, growing hair follicles.

As one of the oldest surgical procedures for treating hair loss, scalp reduction surgery has, since the mid-1970s, been in use.

Although it was once one of the most effective surgical procedures for treating hair loss caused by male pattern baldness, scalp reduction isn’t very popular today. Instead, most men with hair loss opt for more modern procedures such as hair transplant surgery.

Nonetheless, scalp reduction surgery still offers advantages that may make it worth considering if you’re losing your hair.

Below, we’ve explained what scalp reduction is, as well as the basics of how the surgery works for you as a prospective patient. 

We’ve also listed the key advantages and disadvantages of scalp reduction surgery, as well as information on other surgical procedures and medications for treating hair loss caused by male pattern baldness. 

Scalp Reduction Surgery: The Basics

  • Scalp reduction surgery, now known as  alopecia reduction, was one of the first mainstream surgical procedures for treating hair loss. It was quite popular decades ago but has largely been replaced by more modern techniques.

  • Scalp reduction surgery usually works best when it’s performed in combination with hair transplant surgery.

  • Several factors limit the extent of the scalp that can be removed, including the flexibility of your skin and the amount of skin stretching that may occur following the surgery.

  • Not everyone is a good candidate for scalp reduction surgery. If you have thin hair on the back and sides of your scalp, or if you have near total hair loss (for example, a Norwood grade 7 pattern), scalp reduction surgery may not be appropriate for you.

  • Other options are available for treating hair loss. If your hair loss isn’t very extensive, you can use medications like finasteride and minoxidil to preserve your hair and prevent any further thinning.

What Is Scalp Reduction Surgery?

Scalp reduction surgery is a surgical procedure for restoring hair. It involves surgically excising (cutting away) the areas of your scalp with extensive hair loss, then stretching the areas of skin with dense, thick hair to replace the removed skin.

Put simply, the procedure involves covering the bald areas of your scalp (typically the hairline and top of the scalp) with the hair-bearing skin from the sides.

Although this doesn’t actually increase the number of hairs on your scalp, it helps to create the appearance of fuller, thicker hair. 

Compared to modern hair restoration techniques, scalp reduction is a relatively old procedure. It was first developed around 1977 and was practiced throughout the late 70s, 80s and 90s as a treatment method for extensive hair loss. 

As mentioned before, scalp reduction surgery isn’t for everyone. It’s generally recommended for men above the age of 40 with Norwood Grade 4, 5 or 6 hair loss (in other words, significant hair loss on the frontal scalp and crown). 

It’s also usually recommended for men with stable hair loss and dense hair on the sides of the scalp (the area that’s used to cover the balding patch).

How the Scalp Reduction Procedure Works

Several methods are used to perform scalp reduction surgery. The most common involve skin removal from the areas of the scalp affected by male pattern baldness in an ellipse, three-way (also known as “rocket ship”) pattern or an S-shaped or M-shaped pattern.

If you’re considering scalp reduction surgery, your surgeon will pick the most effective incision type based on your hair loss pattern, scalp laxity (how tight or loose your skin feels) and other factors. 

The principle behind the surgery is to remove as much of the hairless scalp as possible, while protecting and preserving your hair-bearing skin.

After removing the areas of skin with hair loss, the surgical wound is closed, covering the hair loss affected area and creating the appearance of a fuller, thicker head of hair. 

Scalp reduction surgery is sometimes combined with other surgical procedures, such as hair transplant surgery. Transplanting hair can allow for extra coverage and improved thickness in certain areas of your scalp.

Advantages of Scalp Reduction Surgery

Scalp reduction surgery offers several advantages. The biggest of these is that it can create the appearance of a fuller head of hair in men with extensive hair loss. Performed correctly, a scalp reduction can often create a convincing, aesthetically pleasing result. 

A second advantage of scalp reduction surgery is that the hair used to cover up the bald area of the scalp is sourced from the back and sides of the head. 

This hair is more resistant to DHT (the hormone that causes male pattern baldness) and is less likely to fall out in the future.

From a surgeon’s perspective, most scalp reduction procedures are easy to perform and have a relatively high safety factor. These advantages made scalp reduction surgery a popular option for treating hair loss prior to more modern techniques.

Disadvantages of Scalp Reduction Surgery

Scalp reduction surgery was very popular in the 70s and 80s. However, it’s declined in popularity as newer, better surgical techniques were developed for treating hair loss.

One reason for scalp reduction surgery’s decline in popularity over the last several decades is its lengthy list of disadvantages. These include:

  • An unusual shape to the residual bald area. Over time, the shape of the area treated using scalp reduction surgery can become quite irregular, leading to an unnatural appearance that’s often difficult to conceal.

  • “Stretch-back.” Stretch-bach is a phenomenon in which the hair-bearing skin used for scalp reduction surgery stretches over time. This usually occurs around the area of the incision made during the surgery.

    Stretch-back after scalp reduction surgery can be significant, sometimes affecting up to 50 percent of the area covered by hair-bearing skin. This can result in a large, hairless area around the incision, often in the middle of the scalp.

  • Scarring. Because scalp reduction surgery involves surgically cutting away parts of the scalp, scarring is an unavoidable side effect of this type of surgery.

    Most of the time, the scarring from scalp reduction surgery can be concealed under your hair. However, some patients develop obvious scarring that’s clearly visible, especially if their hair is short or light in color.

  • Ongoing baldness. Although scalp reduction surgery can help to cover up areas with hair loss, it doesn’t actually prevent hair from falling out. Because of this, if you’re prone to male pattern baldness, you may continue to lose hair after the surgery.

    If your baldness worsens after surgery, it may expose the scars from the scalp reduction procedure.

  • Surgical complications. Like other surgical procedures, scalp reduction surgery may lead to complications. These can include bleeding, infection and issues with the wound left behind by the surgery not closing or healing correctly.

Other Ways to Treat Hair Loss

Scalp reduction surgery was once a relatively popular treatment for hair loss. Today, it’s largely been replaced by newer treatment options, such as hair transplant surgery and science-based medications like finasteride and minoxidil.

Hair Transplant Surgery

A hair transplant is a cosmetic surgical procedure that involves extracting hairs from the back and sides of your scalp (areas resistant to DHT), then transplanting to your hairline, crown or other parts of your scalp with noticeable hair loss.

Since these hairs are less affected by DHT, they’ll continue to grow even if you’re genetically prone to male pattern baldness. 

Hair transplants can vary in magnitude. If you have extensive hair loss, you may need to have several thousand hairs harvested and transplanted. 

If you only have a mild receding hairline, a smaller transplant may be enough to completely restore your hairline. 

Although early transplants were infamous for their “pluggy” appearance, modern hair transplant techniques involve extracting and transplanting just a few hairs at a time, allowing for a hairline with a natural look and feel. 

Hair transplant surgery can be highly effective, but it isn’t cheap. Depending on the size of your transplant, your location and the surgeon you choose, you can expect to spend anywhere from $3,000 to $15,000 or more to undergo hair transplant surgery. 

Medications

Several FDA-approved, science-based medications are available to slow down or stop hair loss and stimulate the growth of new hair: 

  • Finasteride. Finasteride is an oral medication that works by preventing the conversion of testosterone to dihydrotestosterone (DHT), the hormone that’s responsible for male pattern baldness.

    Research shows that finasteride is highly effective at preventing hair loss. For example, a long-term study carried out in Japan found that 99.1 percent of balding men who used finasteride experienced no worsening of their hair loss over the course of 10 years.

    Furthermore, 91.5 percent of the men experienced an improvement in hair growth while taking finasteride.

    We offer finasteride online, following a consultation with a physician who will determine if a prescription is appropriate. You can also learn more about how finasteride works in our guide to how long finasteride takes to work for male pattern baldness.

  • Minoxidil. Minoxidil is a topical, over-the-counter medication that stimulates hair growth and slows down hair loss. It’s available as a liquid or foam and is applied directly to your scalp in areas with noticeable thinning.

    We offer minoxidil online, either by itself or with finasteride in our Hair Power Pack. You can learn more about minoxidil in our guide to how long minoxidil takes to start working and our guide to minoxidil side effects

Is Scalp Reduction Surgery Right For You?

Although scalp reduction surgery was a popular option for treating hair loss in the past, it’s far less common today due to its less-than-ideal results and risk of scarring. 

Instead, most people looking for a surgical option for treating hair loss use hair transplantation surgery, a procedure that involves harvesting hairs and physically transplanting them to areas with noticeable hair loss.

In addition to hair transplantation, FDA-approved medications like finasteride and minoxidil can slow down or stop hair loss, allowing you to gain control over male pattern baldness and retain your hair as you get older. 

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.