Essentially, an Alopecia Reduction (AR) consists of the excision/removal of a portion of bald or balding area.  The normal laxity of the scalp is used to close the resulting gap. A narrow scar is usually all that remains after the procedure. Within a few weeks, the scalp will become loose again and, often, the bald area may be further reduced by additional ARs (Figures 24-25).

If one wants to transplant all of the frontal, mid-scalp and crown areas, most patients are strongly recommended that an attempt be made to decrease the size of the bald area with one or more AR.  ARs increase the probability of being able to transplant the whole (reduced) area before the supply of available donor grafts has been completely depleted.  Notwithstanding the preceding, some patients have enough donor tissue to cover the whole bald without the need for ARs—especially if they are willing to lower their hair density objectives.

In addition, many patients who are seen for correction of aesthetically unsatisfactory prior hair transplanting can benefit from having untransplanted areas —or lightly transplanted areas—excised instead of transplanting them and using up already depleted donor reserves.  (In the latter case, any excised “old” grafts can be re-used elsewhere.)  This approach maximizes the number of grafts that are available for filling in and camouflaging the spaces between the older grafts.