ABSTRACT
One of the most common adjuvant procedures in male pattern alopecia surgery is scalp reduction (1). The most common techniques include (1) median reduction, (2) paramedian reduction, (3) Y-plasty and its modifications (2,3), (4) ellipse with M-plasty (4), (5) bilateral occipitoparietal flap advancement technique (5,6), and (6) scalp reduction utilizing tissue expanders (712). No matter which technique is employed, the objective is the same: to approximate two wound edges that are under tension. The most common technique to relieve this tension and allow the wound edges to be approximated precisely has been undermining. Occasionally, even with extensive undermining, the wound edges will not approximate. It is in this situation that the pulley suture becomes a valuable tool (13).
