Repairing scalp reductions

The potential problems caused by scalp reductions were recognized early in the history of their use, but it took several decades for these problems to be fully appreciated by the majority of hair restoration surgeons. Fortunately, scalp reductions have been performed with much less frequency in recent years. Scalp reductions have the undesirable effect of simultaneously causing cosmetic problems and depleting the donor supply needed to correct them.

Simply stated, they are a hair loss solution that alters the balance between supply and demand. They increase the demand for hair by producing scars in the top and crown that must be camouflaged, alter natural balding patterns and change hair direction, all without significantly adding coverage to the front of the scalp. They diminish supply by decreasing donor density and scalp laxity, thereby reducing the amount of hair available for the correction.

These problems can be partially addressed by the "hair conserving" technique of microscopic dissection, but after multiple scalp reductions, with even the best techniques, full correction is often not possible. Specific patterns of repair, such as the "hockey stick," used for treating patients who have low donor supply, are particularly useful in patients with low donor supply because of scalp reductions or scalp lifts.