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About Face

Chapter Ten Hair Transplants Types of Male Pattern Baldness Surgery Punch Grafting Flaps Scalp Reduction Scalp Expansion

Scalp Reduction

Scalp reduction surgery literally reduces the area of bald scalp on a patient’s head. In most cases, the scalp is malleable enough that hair-bearing skin can be stretched and brought together; the bald skin in between is cut out. This is ideally done before other procedures like flap surgery or punch grafting as it reduces the amount of area that has to be treated for baldness. Scalp skin is much thicker and tougher than you might imagine, and it has few nerve endings, so there is not much pain associated with scalp reduction, though some patients experience a kind of tingling sensation for up to six months after the surgery.

Scalp Expansion

Sometimes the patient’s scalp is too tight for the conventional approach to scalp reduction. In this case, we have to stretch the skin first before pulling it together. The Face Book has a succinct account of the procedure: “In this procedure, the surgeon implants a deflated balloon under the skin of the hair-bearing scalp. Twice a week, sterile water [known as “normal saline” - a saltwater solution] is injected into the balloon, stretching the skin slightly. A pulling feeling may be noted for a day or so, but then the skin relaxes. Injections continue over a period of six to eight weeks, until the desired expansion has been achieved. Then the balloon is removed, the bald area cut away, and the newly stretched hair-bearing scalp used to cover the area.”

With this technique, more crown scalp can be removed, which means that less hair is needed to cover the bald area. Quite rightly, The Face Book passage ends with the advice: “If you require tissue expansion, take along a large hat and a sense of humor.” Patients are a frightful sight with two bags growing out of their head during the later stages of the procedure, but the means to the end are worthwhile.

Each of the surgical procedures for treating male pattern baldness has attendant complications. There is always the slim possibility that punch grafts will fail to “take”, or that hair follicles within the grafts won’t grow. (This is especially true with the new micro-grafts of a single hair follicle; the root of the follicle is more easily damaged in such a small graft.) And, as I described, the very end of a long flap might die, despite precautionary delayed surgery. (This is especially true with patients who are smokers because smoking affects the micro-circulation of the scalp skin.) However, if it does, a surgeon can do repair work to retain the new hairline with some punch grafts and smaller flaps.

All such surgery might cause a patient to bruise and swell around the eyes and behind the ears, though the swelling will subside in about two weeks. During this time, the patient should avoid any activity that would place a strain on the affected area, especially if it has been punch grafted. (The grafts can pop out with vigorous combing, for example.) After flap surgery, a turban-style bandage must be worn for a couple of days, and if any stitches have been used, they will be removed about a week after the operation. Within six weeks, most patients should be able to resume all normal activity.

There is very little pain associated with plastic surgery for male pattern baldness, just the tingling or tight sensation I mentioned earlier.

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