Alopecia Reduction was popular in past and was usually proposed as staged surgery for advanced baldness (stage 6 or 7). In stage 6 and & often the donor area is inadequate for providing sufficient number of Follicular Units for coverage of large hair loss area.
In stage 6 or 7, most of the Hair roots have died and few remaining hairs are of poor quality in the central scalp. So in 2-3 small procedures the central scalp skin with hair loss is serially reduced and the hairs on the sides (above the ears) are shifted more near the center of the scalp with each stage. Finally only a narrow strip and the hair line area is left for the last stage when the Hair Transplant is performed from hairs taken from the back side of the head to give the cover to the head.
Disadvantages:
Pain for few days post operatively
Tightness for few weeks ( increases by every sitting) due to tension closure
Midline scar (unless some other style is used for reduction)
Stretch back over next few months of scar due to elasticity of skin
The unnatural balding pattern of esp. crown area with change in natural whirl and direction of hairs
Reduced donor density for the future requiring bigger size of strip for the same number of hairs from the back of the head ( perhaps FUE is a better option here than a strip surgery)
Due to now tight donor skin (reduced laxity) the width of the strip has to be reduced and the donor density is less already therefore available donor hairs will reduce per strip.
A large number of potential donor hairs have shifted to the margin of crown area and they now are not accessible by the strip harvest along with the already compromised density of donor with limited available width of strip all make things more difficult to cover ( this hairs can be accessible by FUE although)
The donor skin tightness makes higher chances of donor complication for strip surgery
Usually the priority of coverage is in the front and hair line area but at the same time the midline scar of the crown needs to be covered in this case. This reduces the available hairs for the front.
The scalp reduction will also increase the number of procedure and the time required for the coverage.
The current method of Follicular hair Transplant unlike previous punch methods usually can cover the front and top of the scalp in majority of stage 6 or 7 baldness with limited donor hairs even without scalp reduction. With so many possible disadvantages once popular the procedure of scalp reduction has now taken the back seat.
If at all scalp reduction should be combined with FUE transplant rather than strip method
