Answer:
The procedure is described in PRS 69 (2): 272-277, “Role of Scalp Reduction in the Treatment of Male Pattern Baldness” by Martin Bell. Scalp reduction is applicable to men with class 3 to 5 baldness. The author performs this procedure in the office, using a light narcotic pre-medication during injection of local anesthesia. Complete anesthesia is obtained by injecting 50 mg of 1% xylocaine as a ring block. The pattern of tissue to be excised can vary, but in most cases, the anterior axis is chosen because of greater scalp flexibility laterally. Undermining is done in the plane between the galea and the periosteum. It should be done extensive laterally, less so anteriorly, minimal posteriorly. The amount excised depends upon scalp flexibility and number of previous reductions, with 4 cm being acceptable at the first reduction.