As recent as 10 years ago many physicians were performing scalp reductions. These are procedures where a large swath of bald skin from the crown was simply cut out and the skin edges were sewn together. The result left a large scar in the mid line of the scalp and what is commonly referred to as a “slot deformity”. That is, the angulation of the hair around the midline scalp scar changed direction to grow out from the scar looking like a large slit in the middle of the scalp. This procedure caused a great deal of scalp scarring, which changes the growth potential of the scalp where the scar is present. It also created additional tightness in the scalp which can further restrict the ability to harvest additional strip scars in these patients. Finally, because of skin elasticity, very often most of the benefit of the resection of the bald scalp is lost over time as the skin stretches back. What all this adds up to is that there is no longer a role for scalp reductions in current hair transplant procedures. There are still some older physicians performing these, but they are highly discouraged from doing so by the majority of the hair transplant community. Patient who have undergone pervious scalp reduction procedures need to be addressed differently than other typical patients and special care must be taken to address the possible issues outlined above. I have attached a photo of a patient who underwent a scalp reduction many years ago and you can see the midline scalp scar that is present.
All the best,
Marc Dauer, M.D.