Conventional scalp reduction techniques involve the undermining of bald skin, inducing the problems of stretch-back and slot formation in the majority of patients. Conversely, extensive scalp-lifting, a relatively new technique, never undermines bald skin; therefore, the problem of stretch-back is minimal and slot formation is reduced. This procedure, however, is more intricate, owing to the undermining down to the hairline of the nape. Because not all cosmetic hair replacement surgeons desire to perform this more intricate surgery, the author takes many of the principles of scalp-lifting and applies them to the scalp reduction procedure. With the application of these principles, many of the problems of scalp reduction surgery are significantly reduced and other aesthetic aspects improved.