I’m Wondering If My Strip Scar Is Bigger Than Most

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

Hi Doc,
Have a question on my strip scar. I can shave the sides with a #8 guard and can still see my scar, do you think its a little bigger than most. I also have light hair. Had my procedure done at [name removed].

Everyone has a linear scar after a strip hair transplant, but some tend to have wider scars than others. Normal scarring in 95% of first time hair transplant patients is under 2-3 mm. Scars are produced by a combination of:

  1. surgical technique
  2. healing properties of the patient
  3. tension on the wound

Don’t be too hard on the doctor, for as you can see from the above list, you are more likely the cause of the scar from healing properties. The medical group you used does good work. I am sure their surgeons are all well qualified and fully capable of performing the strip excision.

Tags: scar, strip, hairtransplant, hair transplant, scarring, healing, tension, wound, donor area, hairloss, hair loss

Will a Trichophytic Closure Still Leave a Noticeable Scar if My Hair Is Cut Short?

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

Would you generally advise transplanting hair to the temple area where no hair is currently there? I’m thinking this can maximize the chances of a fake look? Am I right?

I read about the trichophytic closure technique — if it only covers 1mm of scar area, then would that leave a NOTICEABLE average of 1-2 mm of scar area still visible if hair is cut short (2 with guard, that is)?

Yes, it may. Scarring is highly variable with different individuals. You can have a doctor with poor surgical skills perform a procedure without a trichophytic closure and still have a great 1mm scar. Or you can have the best surgeon using a trichophytic closure and have a wide noticeable scar. 1-2mm is considered a great scar and it may still be noticeable with a very short hair cut. A #2 guard may hide the 1 to 2mm scar, but this also depends on your hair color, scar color, scalp color, hair coarseness, hair waviness, etc. As you can see, there are many variables.

Tags: hairloss, hair loss, hairtransplant, hair transplant, trichophytic, closure, scar, scarring

Years After My Transplant, I Shaved My Head — How Can I Make the Scar Less Noticeable?

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

Hey Doc,
I just shaved my head about 7 years after having transplant sugery and everyone loves how it looks. I just want to know what the best solution is to make the scar in the back (middle) of my head and behind my right ear less noticeable?

Depending on the size of the scar and its location, you may be a candidate for a scar revision surgery or hair transplant directly into the scar.

Tags: hairtransplant, hair transplant, scar, revision

When Will My Donor Scar Not Be Visible?

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

I have had a recent HT in Nov 2007 and now having problems with haircuts. I have tried a number 2 shear and number 3 shear haircut with both showing the donor area scar for weeks. I was told that a number 2 was fine but obviously not. How long will this donor scar be visible for males that like to wear their hair shorter.

I do not know how wide your scar is or where your donor scar is. You may have a wider than average scar. You may or may not be a candidate for a scar revision surgery if the scar is wide. You may have temporary telogen effluvium on your donor area that may make the scar more visible and if that is the case, it should reverse in 4-6 months. There are many variables that I cannot readily answer without examining you. You can send me photos of your scar with a ruler next to it so that I can appreciate the degree of scar widening (please reference this post when sending). You should see your surgeon who performed the hair transplant surgery and discuss your concerns with him/her.

Tags: hairtransplant, hair transplant, donor, scarring, scar

Scalp Indentations After Cortizone Shots

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

What causes the indentations to the scalp after the cortizone shots?

Anything injected into your body can potentially cause a reaction and scarring (scalp indentations). When steroids are injected into the dermis, it may cause loss of dermal fat, which could cause the indentations you are talking about. I have seen such indentations in people who have had scalp injections by doctors who believe that steroids have value for balding patients.

Tags: scalp, indent, indentation, cortizone, injection, shot

Juvista for Healing Hair Transplant Scarring?

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

I know this is years down the line, but when Juvista comes out, do you think that Juvista combined with tricho closure on HT scars (either after the process or in a revision) will allow men to cut their hair down to a 1 grade or even to the skin without the scar being too obvious? I know your response would be conjecture at this point, but it would be interesting to get your thoughts.

RenovoThe scarring may be reduced, giving it a better ability to blend in (without being hyper- or hypo-pigmented or raised), but the hair will not grow on the scar. Scarring is very individualized. Even under the worst case scenario without a trichophytic closure, some people heal great and are able to cut their hair really short without visible scarring in the donor area. How well you scar is also a genetic factor (much like hair loss) and there is only so much you can do.

If Juvista does as it sets out to (eliminate scarring with a simple injection at incision site), it could be great for a percentage of those that it works for, but the drug just failed in its most recent clinical trial. Read Renovo, Shire Developing Anti-Scar Drug and Bad news on drug rocks Renovo for more.

So, the short answer to your question is… probably not.

Tags: juvista, renovo, shire, scarring, hairtransplant, hair transplant, scar, healing, trichophytic, closurep

Scalp Stitches from Sports Injury — Will My Hair Regrow There?

/by William Rassman, M.D./2 /,

I recently had a sports injury on right above the hair line in the center of my scalp. Six stitches were put in and later removed. it has been over a 2 months now and very little hair growth has occured since the injury. The scar is about an inch long vertically and about 1/4 inch wide. I was wondering if there were any ointments or other treatments other than a hair transplant that I could use to encourage hair growth. Thank you in advance for your timely response.

Based on what you describe, I doubt hair will grow on the 1″ x 0.25″ scar, and while there are no medications or products that will cause hair growth on this tissue, hair transplanted into the scar will work in most cases. A small scar like what you are describing should not cost a lot to get it fixed. First, I would wait out a period of 6 months before concluding that it is a permanent problem. Without examining you, I can not tell.

Tags: stitches, scalp, scar, injury, hairloss, hair loss

Cut My Head on a Shelf — Will I Lose Hair Around the Wound Now?

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

Dear Sir,

This may sound a trifling worry compared to some of the scenarios that I´ve glanced at,so I shan´t be long. This morning I cut my head on shelf at home, removing a section of scalp with hair in it. I´m unsure how deep it is, though the bleeding was not particuarly profuse and stopped after pressure was applied. I´m worried that the skin and hair particles shan´t heal and growback, and fear a small bald patch occuring. Do you have any advice or information that could be helpful? Many thanks
Best regards

ShelfMy advice to you would be to go see a doctor to make sure there are no foreign bodies embedded in the wound and make sure there is no infection occurring. From the timing of this post, the window to have it sutured will be too late (>24hrs). If your injury caused separation of the edges of the scalp, your wound may heal with a scar, producing a small bald patch. If that bald patch bothers you, you can always get a small, minimally invasive Follicular Unit Extraction (FUE) hair transplant to cover it. If you see a doctor, he/she may determine that closing the wound may still have value, but the longer you wait, the less likely will be this scenario.

Tags: hairloss, hair loss, wound, injury, shelf, scalp

Advice from Someone That Has Had 9 Procedures

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

Dr. Rassman,

I’ve had lots of procedures done; I’ll say at least 9 since 1995. I’m 41 now. I know that’s a lot. I’ve had at least 4-5 done at one center, then about another 4 done at a well know hair transplant center here in DC. I’ve even had gaps of up to 4 years between procedures because of money issues. I’ve spent at least over $20,000.00 so far. I was never given a “Master Plan”. Every person only evaluated me, then asked, “How many are you looking to get right now?.” Me being new to transplant never really realized that once you start the process, you should, in my opinion, every year get as many grafts put in as you can afford. Well, I had really bad scarring in the back going across from one side to the other which was corrected a bit. My head of hair is not nearly as full as I would want it. Actually, right now it’s still very thin in spots here and there. Sometimes I’m just so depressed about it. Don’t make the mistake like I did. If you go for transplant procedure, get another job, work part time, anything to get that head full of hair. Too many procedures, cutting, stitching, etc. spells trouble. I know.

One of the groups did a great job of reducing my scarring in the back of my head. I was also told that in a couple of years ago that lab grown hair follicles will be available. Do you agree? I’m at that point where I feel this would be my last and only alternative.

You have a tragic story. You were not placed on this Earth to give doctors money every year to get hair moved and to manage scars on your head.

The only patients that have had over 4 procedures with me are those that were very, very bald (9,000+ grafts) or very, very obsessive (I fondly call them my ‘hair addicts’). Most people should be completed with 1-2 procedures. Informed consent requires doctors to tell you what is in store for you, what you can reasonably expect a hair transplant will do for you, and when it will be completed. That is the doctor’s moral and legal obligation and the fact that you did not have that happen, means that you must have been victimized from hopping around to different doctors. You should have held your original doctor accountable for finishing what he/she started (in a perfect world of course). I know, unfortunately, that many people who go to doctors that are not responsible or accountable are caught in a difficult position. My suggestion is that you consider going to a doctor who will give you the real scoop as to what, if anything, you can expect going forward. If you need repair work on the scar, that doctor should be able to let you know what is in store for you. As you are on the east coast, may I suggest seeing Dr. Robert Bernstein in New York. He and I literally wrote the book on repairs.

I want to also comment on your hope that soon, hair will be grown in a lab to solve the hair supply problem. I am sorry to burst your bubble, but I don’t believe that will happen in any reasonable timeframe to get you the extra hair you may need. Many doctors are promising lab grown hair in a few years, but the ignorance by these doctors seems pervasive on this subject. My opinion is that we will not see lab grown hair for more than a decade from now. So for the readers who are postponing decisions on hair transplants to wait for lab grown hair, you need to ask yourselves if you really want to wait until you are 70 years old to get the more youthful look.

Tags: hairloss, hair loss, repair, scar, hairtransplant, hair transplant

I Had 3 Procedures and Now I Want to Shave My Head

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

I have had 3 procedures over the past 9 years. My total transplant count was in the range of 5000 grafts. I have had very poor results in terms of density.

I am ready to shave my head and have seen photos showing what I should look like with ashaved head. I am happy with the look. I know that my donar scar will be visbible but I am ok with that. My question is regarding the liklihood that my recipient area will be detectable as having had grafts when shaved bald. I have no visible scarring there that I can see but am still concerned about this. Can you or anyone else offer some guidance/comfort so that I can proceed. This has been an enormous daily battle for me for many years. I have considered going to a hair transplant specialist and asking for some type of magnified examination of my recipient area, but other than than Im not sure how to know. I have hair up there but its too thin too really work with. Any feedback would be greatly appreciated.
Thanks

I really cannot give you much assurance, since I haven’t seen your hair transplant or your scars. Some hair transplants may leave some degree of scarring in the recipient area that may be detectable when you shave your head. To be honest, the only way to tell is to go for it — but before you do this, you should sit down for a face-to-face with a doctor who is experienced in this type of problem and examine your options in detail, one on one. I would be pleased to do this with you and it is may even be worthwhile for you to come to Los Angeles where I will personally evaluate your situation. Considering all of the money you paid for what you describe as poor results, the cost of such a trip is nominal.

Tags: los angeles, hairtransplant, hair transplant, scar, hairloss, hair loss

My Transplant Doctor Suspected an Infection After Surgery, Now I Have Dead Skin Areas

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

Hi, after recent hair transplant, I had severe swelling in my donor area and the Dr had to cut off a some of the sutures on the 7th day as he suspected an infection. Antibiotic ointment and medication has helped heal the donor area, but I am left with an area of dead skin, where there is no hair! This is on an area about 2cms wide and 5cms long, just on top of either ear. My Dr says that he can fix it by re-doing the scar in a few months or optionally by transplanting some hair in these areas, again after a few months. In your opinion, which is a better option? Your advise will be sincerely appreciated. Thanks and regards

You describe an unfortunate, but a real and relatively rare complication with the surgery. I am not clear if what you refer to as “dead skin” is really “skin necrosis” or hair loss seen around the donor wound on the scalp that is not necrotic. Small areas are easy to treat, large areas can produce problems. You should bond with your doctor on what is going on and get comfort from him/her on the plan for you over the next month or two. I suspect all hair transplant doctors have had some scalp healing problems at one time or another. Assuming that the problem is minor and you have bonded with your doctor, the best advice I can give you is to be patient and let time work in your favor. While it may be an inconvenience, if this is just hair loss in the donor area and it is not too extensive, the hair you lost may come back after 6-10 months. If you really have a wide necrotic area, then clearly waiting without adequate physician management is not the correct course. Without seeing you I can not make a firm recommendation other than for you to connect with your doctor and follow his/her advice, or get another opinion if you can not or do not wish to continue the relationship with him/her. In discussions, you should ask about healing, timelines, a worst case scenario, etc..

Tags: hairtransplant, hair transplant, infection, dead, scar, scarring, hairloss, hiar loss

Using Permanent Cosmetics to Disguise the Tiny FUE Scars?

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

Many are concerned about the aspect of small dot scarring after an FUE procedure. Would micropigmentation (permanent cosmetics) be helpful to disguise these tiny scars? If so, what would the methodology be to be most cosmetically effective. I think if this were an option to disguise any scarring, hair transplants would not be as scary to proceed with.

Follicular Unit Extraction (FUE) scars do occur, but they should be minimally detectable with any length of hair (1/4 inch). I do not have experience with permanent cosmetics other than tattoos, which have problems associated with them, including changing color. Actually, a change in hair color over time will impact visibility of permanent cosmetics.

Tags: fue, hairtransplant, hair transplant, scar, scarring, permanent, cosmetic, tattoo

Bald Spot After Accident With Hair Clippers

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

About 4 months ago my fiance had bought a pair of clippers at our local walmart so he could cut his own hair. (which he had done for many years) Well somehow in the middle if shaving the back of his head, the clippers pulled his hair and took a nice big chunk out of the back of his head. Ever since then there has been a bald spot a little bigger than a half dollar on the back of his head. The spot just won’t grow back! What can he do? Thanks..

ClippersOuch! I assume by “chunk”, you mean a bit of scalp. If that’s the case and hair and skin came out, that is certainly not good. I have no way of knowing either way if it’ll grow back though, as I haven’t seen the wound (depth, size, etc). If it does not grow back, he may want to transplant hair it if it is large enough to be noticeable.

Tags: clipper, hairloss, hair loss, scalp, accident, scar

I Had 3 Procedures About 16 Years Ago — I Want Them Fixed

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

Hello Dr. Rassman and staff.

1st – Thank you for this Q/A blog. I am sure it benefits many people and speaks well of you and your organization to take the time to help people with their situations.

I will not bore you with a long story of my situation and contempt for the HT doctors out there (not so much the procedures, rather the blatant lies as to the outcome to expect), I am sure you have heard them all. I will try to keep it short and to the questions. I did search most if not all previous posts, but none seemed to directly hit the mark on my questions. If you can, please forward your thoughts:

Desired goal:

Shaved head with as little evidence of past misguided decisions. No desire what so ever for further surgery, even if given an iron clad guarantee that it would give full coverage and a great result.

Current Situation:

  • 42 y/o male
  • 3 “procedures” in 1991 in 3 consecutive months
  • Mini and micro graphs – approx. 240-300 graphs total
  • 3 scars in donor – approx 1-1/2 to 2″ in length
  • these scars feel slightly raised, particularly on ends
  • Can not tell the width of the scars, but appear to be fairly narrow (Not pencil thin as promised)
  • Continued loss after HT, probably a NW 5/6

Recipient area:

  • Darker coarser hair in “V” shape, all alone in front of bald head
  • Some dimples, approx 5 to 10
  • No raised graphs
  • slightly pink color at many of the graph sites
  • Wear a hat all time, so no tan skin in this area, very white and greater contrast for the pink and the coarser hairs present.
  • When I shaved a test area in the recipient area, the skin surface seems to show little dark marks with the pink still present

Questions:

  1. Can the raised scars in donor area be cut out and reclosed using a more aesthetic plastic surgery type closure that would truly leave a pencil thin and flat scar. Other scars on my body heal very well, thin and flat. These other scars even take on some what of a tan.
  2. I assume that the majority of the dark marks in the recipient area is the thicker, darker hair below the skin surface showing through. I believe laser removal of this misplaced hair would remove the majority of these marks – with the hairs gone, would that eliminate the majority of the pinkness also? If not, what can be done to address the pinkness?
  3. What affect do you feel the laser hair removal, a tan and microdermabrasion, if needed, would have on these marks and the over all skin appearance.
  4. If microdermabrasion is recommended, what negative effects can this or even laser hair removal have on the recipient area? Could I end up more scarred? Could the recipient area end up not taking a tan like the rest of the head?

I realize a lot of answers are dependent on ones own body and its ability to heal. I am looking for general outcomes as I find I usually fall with in “normal” ranges of just about everything. If these are questions you can and will address, but would like to see some photos, please let me know and I will obtain some pics of the recipient area in varying lights.

Again, thanks to you and your organization. I suspect that your group is genuine and in the field of HT, that is truly rare.

I would have to see you, or at the very least, I’d need to see some good photos as a starting point. Of course, I will keep your photos absolutely confidential (as a doctor this is not only a moral obligation, but a legal requirement under California law). If sending, please reference this post. Then we can talk over the telephone and discuss the matter. Face-to-face meeting is much more preferred though for your situation.

What you are looking for may not be possible. What you want is not standard and I would not want to represent anything that is not reasonable. The use of hair removal lasers can cause loss of pigmentation and microdermabrasion produces permanent changes on the skin quality. In other words, I don’t want to be adding to your suffering. Just from your questions, the caution I must give you is “buyer beware” and to suggest that you do your research before you start any process. There is no price for honesty and integrity and had you known what you were getting into 16 years ago, you would be in a better place. Normal balding is not freaky, as it is the norm for half of the male population to some degree.

My heart goes out for you, but it sounds like you need a personal consultation and even pictures won’t be the same as a one-on-one meeting between us. I look forward to hearing more from you and offering my assistance.

Tags: hairtransplant, hair transplant, hairloss, hair loss, microdermabrasion, laser

Can I Flatten a Keloid in Donor Area?

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

i had hair transplantation in 2001. I had only two small patches to cover them but during the surgery i shed too many hairs and now i have a large scar at the back of my head and also have kind of wounds in some of the transplanted areas where scab is formed and i keep scratching those areas(what to do to get rid of these wounds). The scar at the back is like a small Keloid, is there a war to get it removed or flatten with some steroid injection? Also tell me if i can have hair transplanted on the area from where strip was taken so that i can keep short hair and that area remains covered. If it is possible hair from which part of the body will be taken as i dont want to donate hair from the back of my scalp. Chest hair, shoulder hair etc will do the job. Thanks

Wow, this is pretty complicated. I really can’t give a proper response without at least pictures and I may need to even see you directly to see precisely what needs to be worked with.

Keloids may respond to steroids directly placed into the keloid if it is relatively fresh (past few months). Some people are keloid formers. You can always do FUE for hair transplants. Flattening them does not usually work. In your case, using body hair is a possibility.

Tags: keloid, hairloss, hair loss, hairtransplant, hair transplant, donor, scar