Scalp Reduction

Androgen alopecia, so called male baldness, is one of the most common types of hair loss and despite the name affects both men and women. Around one in three men have some form of hair loss and it also affects a growing number of women. It can start at different ages to varying scope. Hair generally becomes thinner with age. People have different feelings about it, and for many it becomes more of a problem as more hair falls out.

Scalp Reduction

If you are struggling with hair loss, there are surgical hair replacement options available that may work for you. Scalp expansion, flap transposition, and scalp reduction surgery can reverse the effects of hair loss by restoring hair-bearing scalp to create a fuller head of hair. Depending on the type and degree of hair loss you are experiencing, follicular unit hair grafting may be utilized in conjunction with these techniques to improve the appearance of the hairline and overall hair growth pattern. When performed by an experienced surgeon, surgical hair restoration provides a proven hair loss remedy that can bring back your hair with remarkably natural results.

Planning your surgery

The Consultation

During the consultation, your surgeon will talk to you about the changes you would like to make in your appearance. He will explain the different options available to you, the procedure itself, and its risks and limitations.

He may also take “before” photos, and give you specific instructions to prepare for surgery, including guidelines for eating and drinking, smoking and taking or avoiding vitamins, supplements and medications.

Be sure to tell your surgeon if you have had previous hair restoration surgery, if you smoke, or if you take any drugs or medications (including aspirin). Also tell your doctor if you have a tendency to form large scars or keloids.

Take this opportunity to ask all the questions you have about the surgery, and ask to see photos of the recent patients, before and after surgery. Learning everything you can about your options, risks and benefits is the key to making an informed decision.

Scalp reduction surgery involves the surgical removal of parts of the already bald scalp, followed by the stretching of the parts of the scalp, which still has new hair growing on it. After stretching, the scalp is then moved to a higher position on the head. This procedure may be recommended at the same time as hair grafting in order to leave a smaller bald area, which then needs fewer hair grafts afterwards to cover it. Good candidates for this procedure are patients with excellent hair on the sides and back of the scalp that can be stretched upward to cover the bald scalp that is to be cut. In addition, the patient must have thick hair to be grafted as this hair will be stretched and so it needs to be strong too.

The Surgery

Scalp reduction (permanent solution)

Scalp reduction is normally performed using local anaesthetic in the scalp, along with a sedative to help to relax you and reduce anxiety. Usually, a portion of the scalp, two to five centimetres wide, can be removed in one session, and the remaining skin is then stitched back together. Newer methods of scalp reduction may also be used: these include scalp expansion and scalp extension and are explained below.

Scalp expansion (permanent solution)

With a scalp expansion, balloon-like devices called tissue expanders are implanted under the sides and back of the scalp where the hair is still growing. These are gradually inflated over a four to twelve week period, resulting in an increase in the amount of loose hair bearing tissue as the skin stretches. The following scalp reduction surgery creates a greater amount of loose bald skin than would be possible if it hadn’t been stretched before surgery.

Scalp extension (permanent solution)

Scalp extension involves the use of a surgical device, made of two rows of hooks connected by elastic bands. This device is placed on the under surface of the scalp during the first scalp reduction procedure. Over a one-month period, the tension in the bands gets tighter which constantly and gently pulls upwards on the hair-bearing tissues. This loosens and stretches the scalp. This allows for another, and usually greater, scalp reduction to be done.

With scalp extension, a faster series of scalp reductions can be done within a 30- to 90 – day period. In the past, some scalps could not be reduced at all and those that could be reduced often took a year or longer for the procedures to be completed. The treatment is much quicker now!

Scalp extension has some of the benefits of scalp expansion, but causes less discomfort and deformity. However, the amount of tissue stretch is generally less than can be achieved with scalp expansion devices.

Hair transplants (permanent results)


Hair transplants are the only treatment for hair loss which gives permanent results. During a hair transplant, the patient’s existing hair follicles are moved from the back of the head to the bald area. The hair follicles at the back of the head are genetically conditioned to remain in place all a person’s life. The hair follicles stay in place and continue to produce new hair even after a transplant, therefore giving lifelong results. With today’s methods, we can achieve a natural result without signs of a transplant. Old methods which resulted in a”doll-hair look” are not used at Australia Plastic surgery. The hair follicles are moved one by one which changes their natural form.

Natural hair growth can also stop for other reasons, e.g. after an operation on a tumour, following an accident, after certain skin conditions or after a burn. This condition can usually be treated with a hair transplant with good results.

Other treatments (temporary solutions, effect wears off once treatment stops)

Laser (temporary solution)

Laser stimulates the bottom of the hair, increasing the scalp’s blood circulation and providing more blood to the hair follicles. In some cases, laser can waken dormant hair follicles, which start producing hair again. The hair can become thicker and stronger and sometimes new hair can be produced. To achieve a positive effect using laser, the treatment has to be repeated several times a week. The effect wears off once treatment stops. Treatment with laser can be combined with a hair transplant and medication for hair loss.

Medicines (temporary solution)

Medical treatments are often used to stop hair loss. In some cases, there have even been signs of new hair growth. However, the effect wears off if treatment is stopped, which means that we recommend lifelong treatment to maintain the desired effect. Medicines can be combined with a hair transplant and/or laser.

Regaine (temporary solution)

Regaine or minoxidil is a liquid liniment used locally on the area affected by hair loss. The lotion is best applied in the morning and at night, and is used to stimulate hair growth and minimise further hair loss. The treatment is suitable for both men and women.

Propecia(temporary solution)

Propecia or finasterid is a prescribed treatment for hair loss in the form of a tablet taken once daily. It’s used to stop hair loss and stimulate new hair growth. If the treatment is stopped, any positive effect wears off with 6 months and after 9-12 months; the patient’s hair will have reverted to its original state. It has not been proven to have any effect on bald patches and advanced baldness. Propecia should not be used by women.

After Treatment

Patients normally experience swelling and some numbness for the first few days following the procedure. Because the skin needs time to soften, tightness in the scalp is also common for several months after the operation. Scabbing is also common. Both scalp reduction and hair transplant are done under local anaesthetics.

You will be going home on the same day, the wound on the scalp require no dressing after the procedure.

The scalp will remain numb for 12-24 hours, after that you will require simple analgesia.

A follow up appointment will be arranged in 7-10 days after surgery.

You will need to avoid: sun exposure for a week and any strenuous work that may contribute to increase in your blood pressure.

Getting you back to work and normal activities

You should be able to slowly resume normal daily activities over the next several days.

Shampooing and combing should be avoided for at least 5-7 days.

Most patients will be able to return to work within 3-5 days following the procedure.

Strenuous activity should be kept to a minimum for 10 days.

Most patients who decide to undergo scalp reduction are pleased with the results.

While there may be some scarring around the incision, it is normally covered by hair. A hair transplant procedure can be used to better cover the scars.