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Scalp Reduction Surgery: Procedure, Risks and Alternatives

Katelyn Hagerty FNP

Reviewed by Katelyn Hagerty, FNP

Written by Geoffrey Whittaker

Published 02/10/2021

Updated 08/05/2023

Scalp reduction: a fun, knife-y way to reduce the amount of baldness on your head.

If you’re beginning to lose your hair and see signs of balding, you may have looked into surgical procedures to treat hair loss. Cosmetic procedures like grafts and reconstructive surgery can move skin and hair follicles from one place to another, but it’s not quite as easy (or safe) as clicking cut-and-paste on a computer.

Scalp reduction surgery — or alopecia reduction (AR) — is one such type of surgery to remove the parts of your scalp affected by hair loss and replace them with skin containing active, growing hair follicles.

Is this plastic surgery right for you? That depends.

Below, we’ll share as much information as possible to help you make that decision, including how scalp reduction works, how long recovery might take, the risks and alternatives you should know about.

Scalp Reduction Surgery Procedure

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

In other words, you cut away bald flesh and stretch hairy flesh to replace it.

The glaring problem with this is that it doesn’t actually increase the number of hairs on your bald scalp. Instead, scalp reduction surgery helps create the appearance of fuller, thicker hair by pulling hair where you want it — the same way you might button a jacket to cover a stain on your dress shirt.

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

A surgeon can make the cuts in a few patterns. The most common involve skin removal in an ellipse, three-way (also known as “rocket ship”) pattern, or an S-shaped or M-shaped pattern.

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.

There are four primary reasons you might have scalp reduction surgery:

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

  • The source hair is more resistant to hair loss. A second advantage of scalp reduction surgery is that the hair used to cover 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.

  • It’s safer than you’d expect. 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.

  • It can be combined with other techniques. These days, scalp reduction surgery is sometimes combined with other surgical procedures, such as hair transplant surgery, to allow for extra coverage and improved thickness in certain areas of the scalp with the use of donor hairs.

Scalp Reduction Candidate Requirements

So who makes an ideal candidate for scalp reduction? Honestly, the people with the worst hair loss — those who might otherwise feel too far gone. 

A good candidate for this surgical procedure:

  • Has extensive hair loss

  • Still has thick hair on the hair-bearing scalp

  • Still has lots of hair on the sides and back of their head and neck

  • Has tried other treatments and hasn’t seen results

Scalp reduction surgery is 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 guys with stable hair loss and dense hair on the sides of the scalp (the area used to cover the balding patch).

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.

What to Know About Scalp Reduction Recovery

Truth be told, scalp reduction isn’t the best option anymore because it can have a lengthier recovery than modern hair restoration options.

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

Here are a few things you’ll want to know about recovery before signing up for this procedure:

  • Recovery time, pain and outcomes from the surgery depend on how much hair loss you’re treating and how extensive the surgical work is.

  • You won’t be able to wash your hair the first couple of days, but by day three, most people can give their scalp a gentle scrub.

  • Stitches or sutures will typically be removed between one week and ten days after the surgery.

  • Common complaints are pain, feelings of tightness and throbbing sensations — all of which can be managed with pain medications.

  • Your stitches are susceptible to bleeding if you do strenuous activity, so no hitting the gym for the first few weeks.

  • Touch-up procedures may be necessary down the line, but generally, they’re less invasive and less intense than the initial surgery.

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Risks of Scalp Reduction Surgery

Scalp reduction surgery was very popular in the 70s and 80s. However, it 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. Heads up, fellas: The shape of the area treated with scalp reduction surgery can become irregular over time, leading to an unnatural appearance that’s often difficult to conceal.

  • “Stretch-back.” Stretch-back is a phenomenon in which the hair-bearing skin used for scalp reduction surgery stretches over time. It can result in a large, hairless area around the incision, often in the middle of the scalp.

  • Scarring. Since scalp reduction surgery involves surgically cutting away parts of the scalp, scarring is an unavoidable side effect. Luckily, scarring from scalp reduction surgery can be concealed under your hair most of the time. But some patients develop obvious scarring that’s clearly visible, especially if their hair is short or light in color.

  • Ongoing baldness. Though scalp reduction surgery can help cover up areas with hair loss, it doesn’t actually prevent more of your hair from falling out. So, yes, you may continue to lose hair after the surgery. And 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 — bleeding, infection and issues with the wound not closing or healing correctly can and do occur.

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Alternatives to Scalp Reduction for Hair Loss

We’re not saying scalp reduction should be a last resort, but it shouldn’t be at the top of your list, either. 

It’s certainly not first on any medical expert’s list. Today, this type of hair restoration surgery has largely been replaced by newer treatment options, such as hair transplant surgery and science-backed medications like finasteride and minoxidil.

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 them to your hairline, crown or other parts of the scalp with noticeable hair loss. This can be done with smaller strips of skin or even one hair at a time.

Early transplants were pretty infamous for their “pluggy” appearance, but modern hair transplant techniques usually create hairlines with a natural look and feel. 

The problem in most cases is cost. Hair transplant surgery isn’t cheap, and depending on the size of your transplant, your location and the surgeon you choose, a bill from $3,000 to $15,000 (or more) isn’t unheard of.

Want something more affordable? Medication might be the answer.

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 responsible for male pattern baldness. Research shows that finasteride is highly effective at preventing hair loss. For example, a long-term study in Japan found that over 99 percent of balding men who used finasteride experienced no worsening of their hair loss over the course of 10 years. Furthermore, about 92 percent of the men experienced an improvement in hair growth while taking finasteride. 

  • 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 the scalp in areas with noticeable thinning. 

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Is Scalp Reduction Surgery Right for You?

Although scalp reduction surgery was one of the hair loss treatments of merit in the past, it’s just not at the top of the charts anymore. 

You may have valid reasons to get hair grafts for your scalp — especially if a healthcare provider believes it’s a good fit. But the decision to go through with scalp reduction shouldn’t be taken lightly.

Here’s what to keep in mind when weighing your options:

  • It’s part of a whole solution. Scalp reduction surgery was one of the first mainstream surgical procedures for treating hair loss. Today, it usually works best when it’s performed in combination with hair transplant surgery.

  • It’s not for everyone. 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. Also, 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.

  • Other options are available for treating less extensive hair loss. Medications like finasteride and minoxidil can help preserve your hair and prevent further thinning. It’s best to chat with a hair restoration specialist to determine the best steps and treatment strategy.

Want more help with hair loss? We can assist. 

Hims offers finasteride online, following a consultation with a physician who’ll determine if a prescription is appropriate. Read our guide to learn how long finasteride takes to work for male pattern baldness.

We can also offer minoxidil foam, either by itself or with finasteride in our Hair Power Pack. Learn more about minoxidil in our guides to how long minoxidil takes to start working and minoxidil side effects.

7 Sources

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  2. Staff, E. (2023, May 10). Scalp reduction surgery for hair restoration. ISHRS. https://ishrs.org/scalp-reduction-surgery-for-hair-restoration/.
  3. Shiell R. C. (2008). A review of modern surgical hair restoration techniques. Journal of cutaneous and aesthetic surgery, 1(1), 12–16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840892/.
  4. Hair transplant recovery. American Society of Plastic Surgeons. (n.d.). https://www.plasticsurgery.org/cosmetic-procedures/hair-transplantation-and-restoration/recovery.
  5. Sattur S. S. (2011). A review of surgical methods (excluding hair transplantation) and their role in hair loss management today. Journal of cutaneous and aesthetic surgery, 4(2), 89–97. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3183735/.
  6. Yanagisawa M, Fujimaki H, Takeda A, Nemoto M, Sugimoto T, et al. (2019) Long-term (10-year) efficacy of finasteride in 523 Japanese men with androgenetic alopecia. Clin Res Trials 5: DOI: 10.15761/CRT.1000273. https://www.oatext.com/Long-term-(10-year)-efficacy-of-finasteride-in-523-Japanese-men-with-androgenetic-alopecia.php#Article_Info.
  7. Badri T, Nessel TA, Kumar D D. Minoxidil. [Updated 2023 Feb 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482378/.
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