Scalp-Reduction Revisited: A 10-Year Experience

Abstract

Micro- and minigrafting have become cornerstones of hair-restoration surgery. However, the vertex of the scalp may prove to be a particularly problematic area to address with a follicular-transfer technique. Minigrafting may yield an unnatural "pluggy" appearance, especially when the crown is viewed directly from above. Micrografting may not provide sufficient density for a large area of vertex alopecia. Scalp reduction with extender can close a large defect (<12 cm) rapidly over a few sessions and provide density to the crown area that is unachievable with conventional follicular-grafting techniques. This paper reviews the salient preoperative considerations required in selecting the appropriate candidate for scalp reduction. It then discusses the surgical design, implementation of an extender, and transposition z-plasty closure that the authors have used over the past 10 years to achieve a natural, rapid, and dense closure to the exposed vertex.