The good candidate for scalp reduction is a man who has full hair on the back and sides of the head that can be stretched upward to cover the area where bald scalp is surgically removed. A small number of hair transplant grafts may still be needed to cover residual bald areas.

Scalp reduction may, in some patients, be preceded by scalp expansion. A thin plastic envelope is inserted under the scalp and gradually inflated with saline over a period of time. As the envelope inflates the scalp expands in response to the inflation. When the envelope is removed, there is an excess amount of bald scalp available for removal and for “stretching” hair-bearing scalp upward.

Scalp reduction can be associated with postoperative complications of scarring, stretch-back of the bald area, and the creation of an unnatural appearance called a slot deformity.

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