Bill Burr, a hilarious stand-up comedian, has a segment when he discusses face lifts as well as hair transplants. The routine focuses on hair transplants which were done a few decades ago and how bad they were compared to the current procedures. This is even more true for Scalp Reduction Surgery which is another method of addressing hair loss, especially when it occurs on the crown of the head. This procedure is done on both men and women and is one of the more intrusive surgeries with regards to hair restoration.
What is Scalp Reduction Surgery?
Scalp Reductions, Flaps, Lifts, Rotations, and Extensions are procedures which use existing areas of the scalp to augment the balding areas. These can include the removal of the balding area and stretching the scalp, cutting out areas of the scalp and replacing them into the balding areas, and cutting part of the scalp, although leaving a portion still attached for the blood supply, while manipulating that piece and applying it to the balding area. This is not your typical FUE (Follicular Unit Extraction) procedure, but one that is more invasive and difficult.
Scalp Reduction Surgery is the most popular of all the scalp surgeries. In some ways it is like a facelift, although it focuses on the top of the scalp. The basic procedure is to cut away the blading area on top of the scalp and to pull together the sides of the scalp which contain the hair and to suture them. Because the scalp is somewhat pliable, the procedure is not as difficult as one might think. This procedure is perfect for those who do not quality for a hair transplant because of the large area of hair loss and best for those who have loose skin.
The downsides consist of the original hair and scalp stretching back to its original position, which will return to the original look. Because of the stretching and tension, scaring can be more visible while there is also the chance of infection and nerve damage.
Scalp Expansion Surgery
Similar to the Scalp Reduction Surgery, Scalp Expansion Surgery follows the process of reduction surgery, although the scalp is stretched for between 4-12 weeks prior to the surgery. A balloon is inserted under the scalp and inflated while affording time for the scalp to stretch. This makes the removal of the balding area easy while suturing the two sides of the scalp. It is less traumatic for the “donor” area while providing more time for the hair cells to acclimate.
The drawbacks are the same as reduction surgery, although 2 surgeries are needed for this procedure. There is also a higher chance of infection because of the 2 surgeries, and you are stuck with having a balloon inserted under your scalp prior to the surgery, which in all cases is not too attractive.
Scalp Flap Surgery
Scalp Flap Surgery is another procedure using flaps of the scalp but is more complex and comes with more risk. This procedure takes an existing piece of the side of the scalp and attaches it to the front of the scalp. The process includes inserting a balloon filled with saline into the donor area for 2-3 weeks, to stretch the scalp sufficiently. After this, the balloon is removed, and the stretched area is cut and maneuvered into position on the front of the scalp. An area of approximately 2 inches is left uncut to provide continuous blood flow to the transplanted area.
The most serious issue with having this procedure is the risk of the flap tissue eventually dying resulting in a very large and unsightly scar. Another major problem is the angle of the hair on the top of the head. Because of how the flap is taken from the side, the hair growth will be reversed from its original direction and look unnatural. The hairline can be very prominent, although a micrograft can be used to blend the hair and give it a more natural look.
Scalp Extension and Scalp Lift Surgery
These next two procedures, Scalp Extension Surgery and Scalp Lift Surgery are procedures which come with serious risk and in some instances, disavowed by certified and highly-reputable institutions and doctors. The extension surgery requires putting a device (not FDA approved) underneath the scalp which contains hooks and elastic bands to stretch the scalp. The device is left under the scalp for approximately one month which can cause serious infection and cause seroma under the scalp. Again, this device is not approved by the US Food and Drug Administration and should be approached with caution.
Scalp Lift Surgery seems to be the scourge of the Hair Transplant community and has been highly criticized by surgeons of all stripes. The procedure entails removing most of the scalp from the head and separating the muscle and tissue form the scalp. This involves tying off the occipital nerve and arteries. The scalp is then woven in a way to reduce the balding area while bringing the high growth area together. This procedure is not something we recommend in any situation and would advise seeking alternatives which we will address below.
What are the alternatives to Scalp Surgery for Hair Loss?
Any hair transplant surgeries where the scalp is manipulated should be avoided and only done as a last resort. If you qualify for any of the above-mentioned surgeries, then chances are that you are eligible and healthy enough to undergo an FUE Hair Transplant. The FUE procedure is much less invasive with a proven track record and with much less risk.
For those living in the UK, Ireland, France and other European countries, the best option for an FUE procedure is Hungary. Only a short and inexpensive flight, Hungary is on the top list of medical tourism throughout the world. At a fraction of the cost, approximately 70%, you can undergo a quality procedure which provides a natural head of hair and steers clear of the very invasive and risky scalp surgeries.