What About Scalp Surgery for Hair Loss?

"Scalp reductions" or "lifts" consist of cutting out bald skin from the top of the head and stretching the hairy "sidewall" up over the crown. Some doctors are even doing complex surgery to take strips of hair from the sides of the head, swinging them into the front, and stitching them in place. While these might sound like good ideas, they should be weighed carefully in view of the new techniques. To completely understand the change in medical thinking, you need education as a hair transplant doctor. But as an overview:

The front of any natural hairline is very complex and wispy, with a critical forward-leaning hair direction. It can't be imitated by a dense "flap."

The new hair transplantation is very labor-intensive and needs a team of expert technicians to painstakingly reconstruct the frontal hairline. Some of the old-style doctors haven't been able to put together the collective expertise to do the new transplants.

Severe and visible scarring is common with incisional scalp surgery.

We now know what happens to the scalp over the long term, after more natural hair loss occurs. It very often looks terrible five to ten years later! I must put it in these terms, for the doctors who persist with this surgery are ignoring the long term for a short term result. The scars and the subsequent hair loss patterns are frequently awful looking.

These aren't just my opinions. Dr. Mario Marzola, for example, is internationally famous among hair transplant doctors. He has specialized for decades in scalp surgery and has a surgical procedure named after him, the "Marzola Flap" and "Marzola Lateral Lift." At an international conference, he showed photo after photo of his very bad results after five to 10 years. With great courage and honesty he said, "The Marzola Flap and the Lateral Lift are dead. I believe they should not be performed again. I have stopped performing them." And as Dow Stough, M.D., former president of the International Society of Hair Restoration Surgery said, "A significant number of scalp reduction patients are dissatisfied, regardless of the surgeon. I believe that those surgeons who deny this fact spring from the ostrich-with-his-head-in-the-sand syndrome. They simply don't want to know the down side."

The unnatural effects of scalp surgery are often obvious even to a lay person. Men who wear hats to conceal their baldness will frequently wear hats after scalp lifting to conceal their postsurgical look.