The potential “down side” of Scalp Reductions.
While a scalp reduction can produce an immediate decrease in the size of a bald spot it is not without drawbacks.
For some patients their skin stretches back over time and the bald spot again grows larger.
Reduced Donor Density and Elasticity.
Also since the scalp on the sides and back has been pulled up tighter the elasticity (looseness) of the skin in the donor area is typically reduced, as is the hair density. So while the hair on the sides (the lateral hump) has been elevated and less grafts are required to fill in the remaining bald area, there is a reduction in the amount of donor tissue and hair that a surgeon can safely remove from the sides of the donor area.
However, if the patient chooses to do a hair transplant, the posterior donor area remains very available as the elasticity is not effected in this area. This is especially true of the mid-line reduction which also has the least impact on circulation and sensation.
Scarring and Slot Deformities.
When undue tension is used in the suturing of the incision, scalp reductions can produce large visible scars in the top of a patients head. The scalp can also be painful even weeks or months after the procedure. If the occipital nerve is damaged a permanent numbness can develop.
In addition, patients may develop a “slot deformity”, which is an unnatural appearing indentation along the scar or they may develop a slot defect which is an abnormal hair direction. With a slot defect the hair tends to be perpendicular to the incision and appears as a permanent part. This defect has been also described as a “parting of the seas”.
By using galeal or anchoring sutures the indentation can be avoided. A physician who does a reduction should know how to correct the hair direction by using a technique developed by Dr. Patrick Frechet of Paris, France.