When there is significant loss of hair on the crown of the scalp as well as on the vertex, an elliptical scalp excision can be performed to remove an area of bald scalp. This procedure can also be carried out in stages and is frequently recommended in conjunction with hair transplantation. It should be understood that surgical analysis for hair loss is highly individualized; each case requires different and varying approaches. Some patients may have scalp reduction along with hair transplantation; others are candidates for hair transplantation only, or for hair transplantation with scalp flap transpositions.