Surgical reduction of alopecia

In 1987, Scott Wilhelmus, MD, reviewed the effectiveness of surgical scalp reduction for treating advanced male-pattern baldness, specifically in Hamilton and Norwood categories IV to VII. The procedure, which involves removing parts of the bald scalp, was presented as a complement to hair transplantation, offering immediate improvement in hair distribution. Wilhelmus stressed the importance of careful patient selection, excluding type VII and those with sparse hair, and planning, including the design of the frontal hairline. The document credited Blanchard and Blanchard with recognizing the cosmetic benefits of the procedure, which had been performed on over 100 patients. It also discussed preoperative preparations like scalp massages and tissue expanders, and postoperative care to address complications. The conclusion emphasized that scalp reduction is a complex art that requires a thorough understanding of the patient's facial and cranial structure for successful outcomes.