Baldness surgery--reduction versus flap

Often when confronted with extensive bald areas on the superior and frontal regions of the scalp, we need to elevate very large and long temporo-parieto-occipital flaps (TPO). Even when generous undermining is undertaken to close the donor site, we frequently finish with hypertrophic scars and absence of hair follicules. In order to prevent this complication we have previously reduced the bald area by resecting hairless portions and covering, posterior in one single stage, the anterior area with a small flap.