Scar from Hair Transplant Looks Like a Zipper

/by William Rassman, M.D./0 /,

I went in for my second HT yesterday. When I asked the Doctor if my first scar was normal he said, “it was very thin” but, the stitches left marks and it looks like a zipper? (You know, the thin line marks you see on top and bottom of the main horizontal scar line). He said that’s very rare. Is it? and if so, is there a way to eliminate that if I had another HT in 6 months or so with your group of Doctors?

ZipperThe zipper effect means that your doctor placed the suture far from the edge. That will produce the zipper effect. There is no practical solution other than if you have another transplant and remove the “zipper” along with the hair you need for the transplant. There are techniques that avoid the zipper effect, which most doctors use today.

If you’d like to come to us it can probably be eliminated, but I’d have to see you first before promising surgical solutions. If you opt to go elsewhere, you’ll obviously want to be sure that your surgeon does not do the same thing again next time.

Tags: zipper, hair transplant, surgery, scarring, scar, hairloss, hair loss

Got a Cut on My Scalp a Week After My Hair Transplant

/by William Rassman, M.D./0 /, ,

I had a graft procedure 7 days ago. I hit my head and caused a small cut about the size of a pencil eraser where I had transplants. Will I lose the grafts in the area?

It would be unlikely to lose grafts 1 weeks post surgery, however, if the skin separated that distance and healed on its own, it will develop a scar in the area. I am sure you have seen many men with these small scars in their heads that came from such injuries.

Tags: hair transplant, scar, injury, hairloss, hair loss

Remedies for a Bald Spot I Got from an Infection?

/by William Rassman, M.D./0 /,

Hello. When I was in 7th grade I contracted an abscess on the back of my scalp resulting in inflammation and pus and as it healed it left a bald spot. I thought it was from the dirty wrestling mats but never knew exactly where i contracted it. I am 29 today and hair still does not grow in that spot. What are some remedies or things i could do to grow hair back in this spot.

It would depend on the size of the spot to see if it could be excised. A hair transplant would solve that problem. I highly doubt medication would help you in a case like this.

Tags: infection, bald spot, hairloss, hair loss, hair transplant

Getting Shock Loss on Sides of My Donor Scar

/by William Rassman, M.D./0 /, ,

At 4 weeks post op i have significant shock loss on the donor area primarily just behind each ear where the loss is. Not so bad in middle but still some. Is it normal for more loss behind the ears and will it grow back?? Is that area more prone to shock loss than the middle of the back of the head.

Thanks

Sometimes the donor area can experience hair loss from the stress and/or tension from the surgery. Unlike the shock loss in the recipient area, the hair loss in the donor area should grow back in a few months to a year. I would follow up with your surgeon and have him/her further evaluate it.

Tags: shock loss, shockloss, hairloss, hair loss, hairtransplant, hair transplant, donor, scar

Goodbye Wig! A Hair Transplant Repair Case (with Photos)

/by William Rassman, M.D./0 /, , , ,

This patient came in last week, a few years after having 709 grafts taken from a very depleted donor area. Half of the grafts contained just one hair. Getting those 709 grafts was a challenge, as his scalp was tight and the donor area heavily scarred. Because of the anticipated poor yield, I elected to spread the grafts over an inch from the plugs (forward) creating a loosely built thin hairline. When he allows his hair to stand up rather than pull it back as shown here, the results are even more spectacular. This patient gave up his wig and is thrilled with his result. We will try to do another procedure with up to 700 grafts in the recipient area to thicken it, but that will be even more of a challenge because the scarring is very bad and the density of the donor area is very low and he knows it.

Many of what I will call the “normal transplant patients” we perform surgery on today who have not had the old type of plugs, may look at pictures like those shown here and get very frightened. I understand the fear that gets invoked by these patients, but some of my most satisfied patients are those who walked around for years and found that people never looked into their eyes, only to their hairline. This man is an example of a patient where just a small change had a major impact on his life, allowing him freedom from a wig he despised to cover a pluggy look he hated.

Click the photos below to enlarge.

Before:

 

After:

 

Tags: hairtransplant, hair transplant, hairline, repair, photos, hairloss, hair loss

Can I Shave My Head Bald After FUE?

/by William Rassman, M.D./0 /, ,

Well I am black male and currently shave bald. I want to continue to shave bald. I am thinking of FUE to give me some hair in a thinning area. I have few questions: What does the donor area look like when you shave bald after FUE, does it show scarring? I mean razor bald like MJ. Is it worth doing?

I’m confused as to why you’d want a hair transplant only to shave your head bald. All wounds to the scalp will cause some scarring. With FUE, the scars are tiny dots, instead of a straight line scar like that of the strip transplant and they may have a white color to it that would show up after healing an FUE donor area. With dark skin, that might be a problem and one way to tell that is to have a test FUE session done of just 2-4 grafts and assess the healing at 3 months. These tiny scars allow you to keep your hair very short without noticeable scarring if the whitish scar does not appear, but that being said, completely shaving your head may make these scars visible. Again, a test is worth a try.

Tags: fue, scarring, scar, hair transplant, hairtransplant, hairloss, hair loss

Hair Growth After Transplanting Hair Into Scar Tissue

/by William Rassman, M.D./0 /, ,

Dr. Rassman I want to first thank you for maintaining such a top notch site. I have a question for you regarding transplanting hair into scarred tissue. I recently (4 months ago) had hair transplanted into a 1 and 1/2 inch long scar running front to back. I am seeing very little growth…if any. What seems to be present are a few graft which never fell out and have continued to grow. I am aware that growth in scar tissue may take a little longer than if it was to be transplanted into virgin scalp, however, to put my mind at ease I was wondering in your expert opinion, what is a reasonable timeline to expect growth in the scar? Thank you very much in advance for your reply.

It’s only been 4 months, so seeing a little growth is completely normal. I tell all patients to wait for a full 8 months before judging the hair transplant results. You just have to be patient.

Tags: scar, scarring, hairtransplant, hair transplant

Scarring Acne and Hair Transplantation

/by William Rassman, M.D./0 /,

First off, excellent blog. What a fantastic resource!

I’m in my late 20’s, have never had a HT procedure before, and I’m considering a strip procedure in the near future. I have read that people with scarring in the recipient area might be at risk of experiencing poor growth/yield of transplanted hair into that area. (discussed on another forum somewhat here: hairlosshelp.com )

Though mostly clear today, in the past I have had acne at my hairline and behind it (on the scalp), sometimes in hard cystic form. Some of this acne may have caused some scarring at my hairline and behind it, though it is difficult to notice any visible scarring on my scalp. I do have acne scarring on some areas of my face from cystic acne, and it appears that the cystic acne led to a loss of fat or collagen in some areas, given the depressed look of the scarred areas. I also have some pitted scarring in my temple areas (where the hair is also receding), which is an area where I hope to have hair transplanted.

Could acne scarring from cystic acne affect the growth of transplanted hairs in the recipient area (e.g. hairline, scalp or temple area)? Or, when people talk about the risks of scarring in the recipient area, are they mostly talking about scarring possibly resulting from incisions made during previous HT procedures’ (or even the result of grafts from previous HT procedures being removed or extracted)? I read in a message (found in the thread I linked to above) that scarring in the recipient area could inhibit blood flow and hinder growth of transplanted hair.

Have you ever heard of acne scarring leading to poor transplanted hair growth? Also, if acne scarring could pose a risk to transplanted hair growth, is there anything that one can do before surgery to try to minimize that risk, other than try to prevent any further breakouts?

Thank you for any information!!

I have not heard of a one to one relationship between acne scarring impacting hair transplantation. If there is any active acne present, it could well have an impact. If you are concerned, you can have your doctor perform a small test transplant into the scar and see what grows. Using a FUE (follicular unit extraction) technique for a quick procedure will take less than 10 minutes. It is not unusual for me to do test transplants on a limited basis in people with scarring alopecias. Wait a full 8 months and then you will know what the risks are. As I can not examine you, I can not really render an opinion at this time.

Tags: scar, acne, alopecia, hairtransplant, hair transplant, scarring, fue

Picked Off Scabs 4 Days After FUE

/by William Rassman, M.D./0 /,

I was wondering if after having a FOX procedure if you pick off the scabs from the donor area will this cause more significant scarring. I took off a scab 4 days from my procedure and it looks like it left a dimpled hole. I wonder if this will heal?

It is never a good idea to pick at a wound, as it creates the opportunity for infection. If you have eschar/crusts at the donor site from the FUE procedure (which is usually the case) you can wash them off with a good shampoo and a surgical brush. I don’t know what the dimpled hole is without seeing it, but hopefully it healed up for you.

Tags: scabs, hair transplant, hairtransplant, fue, wound, crust

Repairing a Dent in the Scalp at the Hairline

/by William Rassman, M.D./0 /,

I have a severe scar beginning at my ( receding ) hairline. It is a prominent scar, probably 1 1/2″x 1/2 inch. Obviously no hair grows there and I cannot completely cover it. The injury that caused the scar also took a little “tissue,” meaning there is a slight indentation.

My question is this: Is there a procedure where someone could “reconstruct” the damage? Perhaps by taking a mold of the scar, a piece could be made and have hair implanted. And if so, could this “piece” be safely adhered to my head? I am open to suggestion as well. Thanks.

It would be best for me to see what you look like by sending photos of your hairline and the scar (reference this page). Scars at or just behind the hairline are relatively easy to fix with hair transplants. Sometimes the scar can be partly excised as well (though unusual), but without seeing it you have tied my hands. I have repaired many frontal hairline scars.

Tags: hairloss, hair loss, dent, scar

Brain Surgery Scars, Burr Holes, and Hair Transplants

/by William Rassman, M.D./0 /,

Dear Dr. Rassman, I have two burr holes on my temples from an operation when I was a baby. My temples receded to a mature hairline whe I was 25 & the scars are now visible (I’m 32). I don’t suffer from hairloss & seem to have the same hair as my dad who still has a full head of hair at the age of 60 (temples slightly receded). I was considering a HT to get back to my original hairline & cover the scars. I was wondering if the holes in the skull underneath could be a problem during the operation. Is there any danger (I don’t know how deep the needles go)? Thanks!

I have performed hair transplants on many post brain surgery scars and burr holes. Skills in such a situation is critical in placing hair into scars or burr holes to be sure that it does not penetrate into the brain. If the normal hairline will cover it, then this is a wonderful solution to the problem.

Tags: trepanation, trephination, burr hole, brain surgery, brain, scarring, hair transplant, hairtransplant

Revising a Donor Scar with a Tight Scalp?

/by William Rassman, M.D./0 /, ,

I have hair transplant done 2 years ago about 2000 grafts, however I have a donor scar that runs from ear to ear and wider than 1 cm since the skin got constantly pulled. My head skin is very tight,so i am wondering what can I do to fix this ? I want to cut my hair short in the back. Should I transplant hair from other part back to the donor area or any other solutions?

thanks.

You should start doing scalp exercises (see video) and then try to get a surgeon to perform a scar revision surgery with new techniques that are available today. These do not always work, because your body has a new baseline after you have a surgery. You can also try transplanting hair to the scar using the FUE technique, which will work if a revision of the scar does not work. None of these methods are perfect, but they can minimize the look of the scarring. You need to see a doctor to discuss these options for your specific needs and expectations.

Tags: scalp, donor scar, revision, scarring, hair loss, hair transplant, hairtransplant

Can My 2 Year Old Son Have Hair Transplanted into Scalp Scars?

/by William Rassman, M.D./0 /, ,

what age is ok to have hair transplant? i have a son who’s 2 years of age and he has two scars on his scalp about 1 centimeter (diameter) each…

thanks..

It might be traumatic to do it now. I would wait until he’s older and if this becomes a social issue, then it is something to consider. I have performed surgery on children, but most don’t care until they approach their teenage years when looks are important to them. I would not suggest this is something you should pursue at this time.

Tags: hairtransplant, hair transplant, child, age, scar

Seborrheic Dermatitis After a Hair Transplant

/by William Rassman, M.D./0 /, ,

Hello Doc. can you please answer this question please. Can a flare up of seborrheic dermatitis during the growth period (3-9 months)following a hair transplant procedure,in the recipeint area(itching,redness,swelling, etc..) lead to poor results of the transplant?? Also if the scar from a strip harvest is still pink and tender 6 months after procedure, will it always be like that or will it eventually toughen and turn all the way white? thx

Seborrheic dermatitis should not impact hair growth from a hair transplant. Scars can be judged by their width, and scars that are greater than 3mm may cause a problem. The pink color is usually gone in less than 6 months, but it can be delayed. The pink color has really more to do with the way your body heals the scar (appearance) than on the actual strength of the healed wound at six months.

Tags: hairtransplant, hair transplant, seborrheic dermatitis, hairloss, hair loss, scars, scarring

Using Couvre to Mask Linear Hair Transplant Scar (with Photos)

/by William Rassman, M.D./1 /, , , ,

Hello Dr,

First of all,,,a Fantastic/helpful blog. I am 50 years old. I visited 10 different hair transplant surgeons and decided to go with a doctor in Northern California. I think you hit the nail on the head, when you say ‘you have to feel RIGHT about the surgeon’. I did an FUT for 3000 grafts about 1 month ago, and everything has gone great. We just have to wait and see now as to what will be the outcome. :)

I wanted to contribute ‘something’ to your blog,,,so I decided to send photos of my scar before and after application of a masking black lotion (COUVRE). It takes 1-2 minute, it will not come off with water and it is practically invisible from about 12″ away. The photos were taken by my wife. I keep my hair at 1/4″ length (I know I can go to #2 clippers and still mask it good). I send these photos for folks whom are worried about having the surgery and wanting to keep their hair short.

Now to my questions. I am on Propecia (4 months now) and Rogaine. I also have the laser comb, but I am hesitant to use it, fearing it might damage the ‘babe grafts’. What do you recommend to your patients regarding this scenario. I truly believe the comb works, not as much as the hype, but it DOES work (for me anyway). The question is, can it hurt the newly transplanted/asleep grafts :)

My second question is related to a comment my surgeon made prior to surgery. I asked, what percentage of the grafts are normally expected to survive. The reply was 113-120%!!!! It was explained by my surgeon that they do not believe in ‘dense packing’ of grafts in a CM2 and by inserting no more than 40 grafts (or was it 40 hairs?!), it insures the growth of all grafts + some regeneration of already dormant follicles!!! I found that pretty interesting, what is your opinion on this?!

Thanks again for all your great help on the blog, keep up the great work

CouvreMasking/concealing agents like Couvre can work “miracles”, as your photos demonstrate. There are two surgical solutions that also work well:

  1. Follicular unit extraction (FUE) into the wound will put hair into the scar, or
  2. A trichophytic closure could wipe out much of the wound if the laxity is good enough

The telogen count is about 10% of hairs, but as these telogen hairs grow back, others fall out so I would not expect more than 100%. I have read such studies and they are clearly flawed in their methodology. You can’t believe everything you hear or read. Nonetheless, thank you for contributing your photos and allowing me to publish them! The results after the Couvre look great. The photos are below; click to enlarge.

 

Tags: concealer, masking, couvre, hairloss, hair loss, hair transplant, hairtransplant, photos