Scalp Reduction as an Adjunct to Hair Transplantation: Review of Relevant Literature and Presentation of an Improved Technique

December 1980 in “ The Journal of Dermatologic Surgery and Oncology ”

Thomas H. Alt

TLDR An improved scalp reduction technique reduces the need for hair grafts and has minimal complications.

In the 1980 document, Thomas H. Alt, M.D., introduced an improved scalp reduction technique to be used alongside hair transplantation for patients with extensive baldness, particularly those classified as Hamilton and Norwood IV to VII. The method, which was applied to over 50 cases, allowed for the removal of a larger area of bald skin—averaging 4.5 to 6.0 cm in width—than previous techniques. The procedure involved wide undermining, serial relaxing incisions, and closure under tension, with postoperative steroids to manage edema and pain. The results showed a reduction in the number of hair grafts needed by 488 to 669, with minimal complications such as a perforated skin flap and hematoma. Scars were typically narrow and became inconspicuous, and patients experienced discomfort comparable to hair transplantation procedures.

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