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Scalp reduction surgery and flap surgery are procedures that are done for immediate gratification. It’s actually the only way that you can really get a lot of hair very quickly. In the scalp reduction what happens is you actually surgically remove the bald spot from the back here, and then sew the area together. However, we really don’t do this procedure anymore because what happens is it can bring the hair in an artificially arranged direction, and also there’s stretch backs. You get a scar across this area and then you get the skin will stretch back ultimately and leave more of an opening. In the past, when we used big grafts, or the plugs, you wouldn’t have enough grafts to cover the whole head so you had to think of another option. But with today’s techniques of follicular unit extraction and follicular unit transplants it’s not necessary, and it’s really not appropriate to do the scalp reductions.
The other procedure is a flap or a rotational flap, and very few people do this today as well for similar reasons that we just talked about. A flap is where you’re actually going to take tissue and rotate it around, and immediately give people a lot of hair on the hairline right away. What happens is the hairs all go backwards, and so it gives you very thick hair in that front zone but it’s going in the wrong direction, and then what happens is if you continue to have male pattern baldness you’re going to lose behind that and get gaps. You’re going to have thick hair, then an area that’s gapped, then thick hair again. So it really doesn’t give you quite that natural result over time. Another thing is that there’s greater risk. For example, since that’s a flap, if the flap doesn’t take, you’re going to have a big scar and bald tissue running across the top of your head.
So, with today’s techniques of follicular unit extraction and follicular unit transplants, it’s really probably not appropriate to do a flap or to do a scalp reduction.