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Scalp
laxity and scalp reduction suitability
Scalp reduction is one method of surgically treating baldness
used by a minority of plastic surgeons. In essence it simply involves
cutting out the bald skin, pulling the hair bearing sides of the
wound together and sewing it shut. It is a very quick method of
removing bald areas on the scalp. However, for this to be done
successfully there needs to be enough laxity in the skin for the
sides of the wound to be pulled together.
In the planning of a scalp reduction the surgeon needs to examine
the skin properties for its laxity, or moveability. A few people
have very tense scalps, the skin cannot be stretched or moved much.
These individuals cannot undergo a scalp reduction as the surgeon
would be unable to pull the sides of the wound together to sew
it closed. At the other end of the spectrum there are a few people
who have very lax, moveable skin. These people can readily undergo
scalp reduction.
To get a rough idea of scalp skin laxity is pretty easy. Simply
pinch the bald area of skin in the center of the bald spot with
you fingers and see how much skin you can squeeze between your
fingers. If you can actually pull skin up and away from the scalp
then you have a very lax scalp skin and scalp reduction could be
an option for you. However, most people can’t actually pull
much skin away from the scalp with their fingers, but they can
squeeze the skin between their fingers. A scalp reduction is possible,
but as the skin is not so lax the surgeon can only cut out a limited
amount of skin in each procedure. However, you can undergo multiple
procedures over time. So the surgeon may remove just 2-3 cm of
skin in the first procedure and then another 2-3cm in a second
procedure. In the clinic, one method used by some surgeons to determine
suitability for sclap reduction is to place two small dots with
a felt tip pen on either side of the scalp, across the bald area
of skin, with a measured distance of 10cm apart. The skin between
the dots is pushed together using thumbs and index fingers. With
the skin squeezed together the distance between the dots is measured
again. As a rough rule, whatever the width of skin is between the
dots when they are squeezed together is about one half the amount
of skin that can be cut out over 2-3 scalp reduction procedures
(Bosley 1980).
Using this approach with the two dots 10cm apart and pressed together,
the degree of scalp laxity, and so suitability for undergoing scalp
reduction, has been classified into five categories.
Category 1 – the skin is compressible by 0.5cm or less.
Category 2 – the skin is compressible by 0.5cm – 1.0cm.
Category 3 – the skin is compressible by 1.0-1.5cm.
Category 4 – the skin is compressible by 1.5-2.0cm.
Category 5 – the skin is compressible by more than 2.0cm.
People in category 1 are not suitable for scalp reduction and
those in category 2 may not be suitable. Category 3 defines the
degree of scalp laxity that the vast majority of people have. A
width of up to 3 cm can be removed in scalp reduction procedures
in these people. People in categories 4 and 5 have relatively lax
skin. A width of 5cm and maybe more can be removed from those individuals
in category 5 with very lax skin.
For those in category 3 where rather more than 3 cm width of skin
needs to be removed it is possible to increase the amount of skin
that can be removed by using skin expansion of extension. Most
often this is accomplished by inserting a silicone balloon under
the skin and filling gradually over several weeks with saline.
This stretches the skin and so when the balloon is removed and
the scalp reduction is done the stretched skin can be easily pulled
together. Depending on the nature and duration of the skin expansion
or extension 20-50% more skin can be removed in a scalp reduction
compared to scalp reduction without skin expansion/extension (Stough
1995). However, this approach is not popular as it involves the
individual having a visible lump on their scalps for several weeks
prior to the scalp reduction.
Scalp
laxity and scalp reduction suitability references
- Bouhanna P. Multifactorial classification of male and female
androgenetic alopecia. Dermatol Surg. 2000 Jun;26(6):555-61.
PMID: 10848937
- Bosley LL, Hope CR, Montroy RE, Straub PM. Reduction
of male pattern
baldness in multiple stages: a retrospective study. J Dermatol
Surg Oncol. 1980 Jun;6(6):498-503. PMID: 7391326
- Nordstrom RE.
Scalp kinetics in multiple excisions for correction of male
pattern baldness. J Dermatol Surg Oncol. 1984 Dec;10(12):991-5.
PMID: 6501691
- Ayres S 3rd. Hair transplantation for male pattern
baldness: aesthetic considerations and current status. Head
Neck Surg. 1985 Mar-Apr;7(4):272-85.
PMID: 3988532
- Bell ML. Role of scalp reduction in the treatment
of male pattern baldness. Plast Reconstr Surg. 1982 Feb;69(2):272-7.
PMID: 7054796
- Stough DB, Spencer DM, Schauder CS. New devices
for scalp reduction. Intraoperative and prolonged scalp extension.
Dermatol Surg. 1995
Sep;21(9):777-80.
PMID: 7655796
- Nordstrom RE, Raposio E. Scalp extension--a quantitative
study. Dermatol Surg. 1999 Jan;25(1):30-3. PMID: 9935090
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