This procedure is normally performed using a local anaesthetic in the scalp, along with a sedative to help to relax you and reduce anxiety. Usually, a portion of the scalp, two to five centimetres wide, can be removed in one session, and the remaining skin is then stitched back together. Newer methods of scalp reduction may also be used: these include scalp expansion and scalp extension and are explained below.
Scalp expansion
With a scalp expansion, balloon-like devices called tissue expanders are implanted under the sides and back of the scalp where the hair is still growing. These are gradually inflated over a four to twelve week period, resulting in an increase in the amount of loose hair bearing tissue as the skin stretches. The following scalp reduction surgery creates a greater amount of loose bald skin than would be possible if it hadn’t been stretched before surgery.
Scalp extension
Scalp extension involves the use of a surgical device, made of two rows of hooks connected by elastic bands. This device is placed on the under surface of the scalp during the first scalp reduction procedure. Over a one-month period, the tension in the bands gets tighter which constantly and gently pulls upwards on the hair-bearing tissues. This loosens and stretches the scalp. This allows for another, and usually greater, scalp reduction to be done.
With scalp extension, a faster series of scalp reductions can be done within a 30- to 90 - day period. In the past, some scalps could not be reduced at all and those that could be reduced often took a year or longer for the procedures to be completed. The treatment is much quicker now!
Scalp extension has some of the benefits of scalp expansion, but causes less discomfort and deformity. However, the amount of tissue stretch is generally less than can be achieved with scalp expansion devices.