Wide Scar After Transplant

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

I had a hair transplant using the strip procedure 18 months ago. The scar in the donor area is 5mm to 7mm wide. Unfortunately I can’t cut my hair shorter than grade 4.5. Can you please tell me what would be the best option to reduce the scar. I am also thinking of having about 1000 grafts transplanted in the previous transplant area to gain more density and cover up the thin patches. Do you suggest the 1000 grafts should be taken while removing the existing scar together in order to achieve a smaller scare? Please guide me with the best options.

Thank You

The answer depends upon many variables, such as:

  1. donor density
  2. scalp laxity
  3. the surgical dynamics and wound tension at the time of the last surgery
  4. the techniques to be employed at the proposed surgery
  5. the skill of the surgeon

Your goals should be reasonable and you should go with the opinion of your surgeon if you trust him/her. The scarring may or may not be the fault of the surgeon. It could be the way your body heals. Many times I would do both a scar revision and an additional transplant all included in one step. Special care would be given to minimize risks of recurrence. See:

Tags: scar, scarring, hairtransplant, hair transplant, density, healing, heal

FUE Scarring, Healing, and Other Questions

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

  1. will FUE transplanted grafts grow in donor strip scar tissue?
  2. Do you recommend GraftCyte for healing of graft recipient sites?
  3. If a person wanted to have as much hair as possible and not care about having any hair at all on the back and sides of thier head, simulating a rock musician look or marine type cut. Can one successfully FUE that entire area artistically and move it all to the top?
  4. would the tiny dot scars left by the FUE punch eventually be able to tan or blend as not to be too noticeable in person?
  5. And finally if one is nearly totally bald on top – say a 5 vertex – how many grafts will give a thick head of hair on top, not the 50% theory but rather full density, 8000 10,000 or more?

thank you

I will answer your diverse questions in the order you wrote them:

  1. Yes, and it is a good method of revising scars of the scalp and can also be used for bad scars in donor area.
  2. Yes, GraftCyte contains copper peptide with a mild cleansing effect and we recommend using it for post operative patients who have a tendency to hold on to the red color after the surgery. It may enhance the healing of the recipient and donor area (claimed by the manufacturer) and it may be helpful to control scabbing and crusting of incisions.
  3. This is not practical and I doubt that any doctor would do this. We generally FOX-test most of our patients and the result dictates whether the patient would be a good candidate for FUE procedure or not. We do not recommend FUE for the patients with negative FOX (having high transaction rate).
  4. The scar of FUE is usually not noticeable, but it is there and does not contain pigment cells (as a rule) so the hairless spot will be noticed by discriminating eyes if the scalp is shaved.
  5. As a general rule, you need 3000+ grafts (about 6000 hairs if you are Caucasian with average density), to cover an area of the size of an adult hand with a reasonable density. For more density, for those with dark hair and light skin, or very fine straight hair, a redo procedure may become necessary.
Tags: fue, hairtransplant, hair transplant, hairloss, hair loss, healing, scar, pigment, graftcyte

Can Eyebrow Hair Grow Through Scar?

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

I have a four inch skin lacerasion on my forehead. The skin was cut very deep and stitched back together. The scar extends right under my right eyebrow. I was wondering if my eye brow hair can still grow under the skin that was torn by the accident and stitched back together.

Hair may grow in the scar. I have performed eyebrow transplants in people who had terrible facial deformities with considerable success. Hair transplants work well at hiding scars when properly done in the hands of an expert.

Tags: eyebrow, transplant, hairtransplant, hair transplant, scar

Revising Scalp Scar from Non-Transplant Surgery

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

I am sending this message, wondering about scar revision surgery on the scalp. I have extensive scarring from a surgery when I was younger. I was born with a hairy nevis on my head and had to get it removed…all this happened before I could remember. I now have been living with the scars ever since. The doctor who did the surgery did a great job because the scarring isn’t terribly bad. It’s probably about a 1/4 inch (maybe smaller) in size and runs pretty much the length of my scalp forking off in the front and back, with the front fork being considerably smaller than the back one. I am 20 years old now and have been wanting to have something done about this ever since grade school when kids would make fun of me when i got my hair cut short. I know it’s not possible to completely remove the scar but after all the strechting that has been done to my scalp is there anyway to “hide” it better with some sort of surgery/hair transplant??? What about z-plasty???

ALL surgical cuts will leave a scar (as it did on your case). A Z-plasty is an elegant approach to reduce the size of the scar, but you will still be left with a Z-plasty scar. In either case, a hair transplant procedure works wonderfully when transplanted into such scars, but before I point you in that direction, you need to have an expert look at the scars and examine your head. Please send pictures and I would be happy to review your case (please reference this blog posting when sending the photos).

Tags: scar, surgery, repair, z-plasty, hairtransplant, hair transplant

I Scalped Myself!

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

In the summer of 05 I scalped myself by running my head into a porch. The flap was sewn back on and I experienced hair loss a month later. The majority of the hair grew back, however on the left side the scar was still quite prominent. This past summer (july of 06) I had scar revision surgery. The doctor used a gentle type of cauterization and staples. A month after surgery hair around the scar fell out. Some is growing back, however currently the bald area is worse than it was before surgery. My question is how long until I know whether the hair will grow back or not? And is there anything I can do to help it grow back? I’m a female and almost 23 years old. Thanks.

Hair usually does not grow back on a scar or on the edges of a scar – especially after cauterization. The best way to deal with your scar is to minimize it as much as possible (as you have done). Wait out a full 6 months to see the final result and then you may need a follow up with a small hair transplant along the scar, or possibly another revision of the scar. Scar repairs of the scalp are a real art, so I hope that the doctor who did it had considerable experience with scalp scars. Between the doctor’s experience and good surgery, you should have a good idea on what the results are after 6 months or so. We routinely do these type of procedures at NHI with great results. You may consider sending pictures and I would be happy to look at them for a better assessment.

Tags: scar revision, scar, scalped, scalp, hairloss, hair loss

2 Months Post-Operative Trichophytic Closure (with Photos)

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

I thought it would be nice to share a 2 month post surgical donor wound (still a bit light pink) with hair growing out of the wound from a trichophytic closure. By the 4th months, this wound will become virtually invisible.

For more information about the trichophytic closure technique, see Techniques to Minimize Donor Area Scarring.

Click the photos to enlarge.



Tags: trichophytic, closure, hairtransplant, hair transplant, photo

Filling in Linear Scar from Previous Hair Transplant

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

I have had a previous hair transplant and had a line scar that I wanted to fill in using your FOX procedure. Is this possible?

Thanks

Yes, it is possible. If it is a line scar only (1-2mm size), then a trichophytic type of incision may work better. I would like to see the scar. If you can send me a photo, that would help — please take the picture with a ruler next to the scar to help determine size. Or, if you’re local to California and you can make it to one of my offices, that would be even better.

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

Trigrowthic Suturing Technique

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

Dear Dr. Rassman,

I’ve asked you this question before but had not received an answer. I recently read about a so-called new “trigrowthic” suturing technique that promises to leave no visible scarring post strip op. Have you looked into this procedure before and is it to be believed? Thanks.

“What’s in a name? That which we call a rose
By any other word would smell as sweet.”

–From Romeo and Juliet (II, ii, 1-2)

The use of trichophytic closures have been around for years — in fact, that closure has been used in plastic surgery for more than two decades. The hair industry adopted it recently as a standard of wound closure. You could change its name and correctly say that you invented that name, but it would be improper to say that you invented the procedure. The doctors you have referenced here are recycling techniques under a new, original name and as such, if they are claiming inventiveness, then they might be deemed dishonest.

There is NO such technique that can provide results with no visible scarring. ALL cuts on the skin will leave a scar and the scarring is unique to individual patients. Some patients have minimal scarring, while others have more scarring — it is dependent on their genetic makeup, which no one can tell with just a physical examination. Some of our patients heal well and have very minimal scarring that is hard to detect with a regular hair style, but even these patients will have a visible scar if they shave their head bald.

We routinely use a trichophytic closure which I assume is similar to what you have read. For more information about the trichophytic closure, please see:

Tags: trigrowthic, trichophytic, hairloss, hair loss, hairtransplant, hair transplant, closure, wound, scarring

Scars from FUE

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

I may have heredity loss or loss as the result of medication. I just wanted to confirm that the Fox procedure does leave tiny scars at the donor area (where the hair is taken from)? Also, does the fox procedure also leave tiny scars where the hair is implanted. Please review and let me know of your thoughts.
Thanks in advance


1 Year After FUE – Parted
1 Year After FUE – Shaved

 

At the point where the follicular units are removed, there may be small punctate scars, but not at the recipient site, as the skin is trimmed once the grafts are outside the body. The skin disc that was removed in the FUE from the above photo were created by a 1mm punch, today the punch size measures 0.9mm. Trimming of the excised FUE grafts are critical to minimizing the transplantation of skin for the recipient area, which is clearly not the objective. When these FUE grafts are trimmed, the skin disc is reduced to 0.1-0.2mm in size, thereby minimizing scars at the recipient site.

For more on FUE / FOX Procedure, please see:

Tags: hairloss, hair loss, hairtransplant, hair transplant, fue, follicular unit extraction

Hair Transplant Scar in a Shaved Head

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

I have a question, I recently read one of your posts, and it said “In all patients, a scar will be seen if the head is shaved 100% of the time”. But is this really true, if the surgeon:

a. used a trichophytic closure
b. if there is no access tension
c. if the patient takes good care of the scar(ie-scar products..ect) and
d. if the patient has good healding capabilities.

Wouldn’t all these things make the scar almost non-detectable especially if the scar is hidden with the tricho-closure? And if you buzzed your hair, but you had it camoflauge from the special closure, than mabey it wouldn’t show as much?

My comment still stands as written. You asked, Wouldn’t all these things make the scar almost non-detectable? Using a buzz cut would be fine and probably not detectable. I was talking about shaving the head completely, which will always show at the least a fine line. The trichophytic closure puts hair into about 2 mm of wound, assuming that it stretched 2mm, but even with hair in the wound, the skin that stretches 2mm will show with shaving the head. I have some patients with buzz cuts, one who comes to my Los Angeles open house events regularly to show that yes, you can get a buzz cut. Our next Los Angeles open house is this coming Saturday, October 7th from noon to 2pm. If you’d like to RSVP for the free event, please call 800-NEW-HAIR.

Tags: buzzcut, hairloss, hair loss, hair transplant, hairtransplant, scar, trichophytic

Can Trichophytic Closure Technique Remove My Scar?

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


As you can see in the picture I have had 2 HT strip scar procedures. I always liked to cut my hair short with a 1# guard but after 2nd HT scar (top one) I cut hair with 2 guard and it’s still visible. Right now I don’t know if I should get another HT but I do want repair work.

If I go and get the Trichophytic Closure Technique can my old scars be removed? How can this be possible?

How about body hair transplants into my old HT scars?

Will I ever be able to cut hair close again with a 1# guard?

Thank you

No.

All cuts will produce a scar.

The worst doctor with the worst technique can operate on one patient and have a great result with minimal scarring. Likewise, the best doctor with the best technique (using Trichophytic closure, etc) can operate on another patient and have a poor result with wide scarring. In other words, everybody heals differently and some people are more prone to scarring.

Generally a Trichophytic closure technique will benefit 1mm of the scar margin. So if you have a 5mm width scar, a Trichophytic closure technique will make it look more like a 4mm scar. It is obvious that the wider the scar is, the less benefit will be obtained by the Trichophytic closure.

At NHI, we offer free scar revision to our former patients. Sometimes we are able to achieve an improvement, but as stated earlier, there will always be a scar.

Body hair transplants are not considered a standard of care in my opinion and are still controversial because of their long dormant stage and growth cycles.

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

Microdermabrasion for Pits in the Skin

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

Reference the blog you put on your website from Sept 13, 06 “Transplant Scars in Donor and Recipient Area“.

If you don’t recommend microdermabrasion for getting rid of the “pitting” look from the old micro/mini graft HT’s, how might I get rid of that?

Thank you.

Honestly, if what you want do is worse than doing nothing, why do something at all? Here’s an article from HowStuffWorks.com about microdermabrasion that explains, essentially, how it works.

I do not have a good solution to the pitting problem in many situations. I would have to evaluate you first-hand to see if I had a solution for you. There is no clear-cut answer for everyone in this predicament.

Tags: microdermabrasion, dermabrasion, pit, hairloss, hair loss, hair transplant

Hair Growing Through Scar Tissue

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

(female) can hair grow under the skin due to a scar? i have a scar on my forehead in my hairline. about 4 years ago i went bald around the scar and since then my hair has only grown 2 inches, if that. i also had surgery around the same time as well. due to the lack of minerals and electrolytes in my body after surgery i then had an irregular heart beat which almost took my life. could this just be a chemical imbalance?

Yes, hair can grow through a scar. You asked about ‘under’ a scar, but I do not understand what you are asking here. If you had a nutritional cause of hair loss, then if it is corrected and it still has not grown, then you might want to look into a hair transplant to put healthy hair back. Before you would undergo any surgery, you want to be sure that you are healthy.

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

Do I Have Any Donor Left After My 10 Hair Transplants?

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

From 1998 to 2004 I had about ten transplant surgeries done,and each time I had between 200 – 300 grafts done. After having read your blog the last few months, I now wish I would have had fewer surgeries, and more grafts done at those times. For the most part I am pleased with the results that were achieved, but I would like to have one more transplant surgery to hit those last few problem areas. Is there any way for me to tell if there is any donor area still available? My scars have appeared to have healed well. Since the last surgery I have moved 1500 miles from where my doctor is located, so if I am to have any additional work done I will need to locate a new doctor. I would appreciate your thoughts, and I really enjoy this forum you provide. Thank you.

Your situation requires an in-person examination to learn the opportunities and risks for more hair transplant surgery. The distribution of the scars and the width of the scars will probably dictate what can be done in one more surgery. I have an airfare reimbursement program offered to those traveling from out-of-town (see NHI Travel Program). I would be happy to talk with you over the phone to define your problem and goals.

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

Strip Size

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

Do all doctors in southern California take out a strip that is 2-3 mm wide? Any good surgeon knows that if you take out a strip wider than this, you have a greater risk of scarring from the access tention, right?

No, you are not correct. A strip 2-3 mm will not yield any significant amounts of hair. I often take out a strip of 1.2 cm or greater if I need the supply of donor hair. Wounds that are closed under tension may stretch, but that depends upon your healing characteristics. If a doctor makes a cut into the scalp without removing any scalp and just closes the wound with stitches or staples, a scar will still happen.

  1. In scar-forming patients, it will scar. The more scar-forming the patient’s tendency is, the greater will be the scar.
  2. In normal patients (95% of the population) it will form a scar less than 2-3 mm wide, with or without any skin removed (this is my guess, as I generally do not cut into normal people’s scalp just for the fun of it).
  3. In about 10% of patients without any scalp removed, it will form a scar 1mm wide (I am guessing this as well).
  4. In all patients, a scar will be seen if the head is shaved 100% of the time.
Tags: hair transplant, hair restoration, strip, scar, scarring, hairloss, hair loss