Scalp reductions were first introduced in the mid-1970s as a way of treating an individual with a midline bald spot. Although several design approaches can be used, an elliptical approach is generally the most common.
Prior to the excision, a surgical balloon may be inserted below the scalp and filled gradually with liquid to improve the scalp laxity. With this procedure, an ellipse of bald skin is removed centrally in the crown area and the hair-bearing scalp on the sides of the head is stretched toward the middle to obtain closure.
Because scalp reductions do not allow for an upward and forward advancement of the entire scalp, they are not effective in treating patients who possess or have the potential for more extensive baldness.
Due to this inherent surgical limitation, as well as the aesthetic drawbacks, which include an excessive stretching back of the bald area and increased receding at the temples, the scalp reduction procedure is considered outdated for the treatment of moderate to extensive baldness. Newer hair transplantation procedures offer more predictable and better aesthetic results, and often require fewer surgical sessions.