Complications of Scalp Reductions

Abstract

Early problems with central sagittal scalp reductions are primarily medical and surgical. As they resolve with surgical experience, the cosmetic problems become more apparent. These problems and complications are outlined along with suggestions for prevention and correction.

A review of surgical methods (excluding hair transplantation) and their role in hair loss management today

“…Slack closures, careful dissection, staying in the right subgaleal plane, gentle handling of tissues and precision suturing all help to reduce complications. [41]…”

“…Stretch-back is re-expansion of the bald area after reduction (Norwood, Sheill and Morrison). [41] There is always some degree of stretch-back in AR and it varies from 10–50%. Pain (tight scalp feeling) initially is due to is due to tension in the wound but pain after three to five days postoperatively could be due to enlarging hematoma infection.…”

A New Technique for Curvilinear Scalp Reduction

“…The long‐term complications of these techniques have become increasingly apparent. The most common of these are stretch back of the reduced area, scar expansion or depression, permanent areas of alopecia surrounding the reduction scar and occasionally accentuating it, tissue necrosis, and prolonged periods of hypoesthesia 12–14 . In addition, if limited donor area is available, follow‐up transplants to eliminate or disguise the scar may be unsuccessful.…”

Punch Grafting the Crown and Vertex

“…In a recent review of complications of scalp reductions, Norwood and coworkers 4 cited a decreased trend in the percentage of patients receiving scalp reductions by one of the authors with extensive experience in both punch grafting and scalp reduction. Certainly, there are still many patients with extensive androgenetic alopecia with patterns falling into the Norwood‐Hamilton 1 types V and VI who, if they are suitable candidates with loose scalps as determined by bimanual compression of the scalp, 5 can benefit from prior scalp reduction before performing punch grafts.…”