Transplant Scars in Donor and Recipient Area

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

A couple of quick questions.

  1. I had several sessions of grafting done years ago and I have some of the comman pitting where the transplants are on my hairline. I just had two scar revisions done (3/06 ane 6/06) and the HT’s have not really started growing yet. Will microdermabrasion (“Diamond Tome”) to the top inch or so of my hairline hurt my hairs I currently have and affect the growth of the the new HT’s that will soon be growing in? I know you might not know to much about this but I just have a hard time trusting DR’s anymore and would really like your opinion.
  2. I was reading in your blog about a guy who always had stretching to his scars (everywhere on his body). You recommended his scar be closed by “sub-fascial closure below occipitals muscle fascia”. Do you have an article about that and/or what is that in lay mens terms :o) Does this also include undermining the scar? Do you use undermining for scar revisions?

Thank you for doing all you do for all the men who got butchered by the bad Dr’s out there.

  1. I do not recommend dermabrasion, as it produces a different quality of skin that shines and is a different color (less pigment) then the original skin, often making things worse than the problem you are fixing.
  2. In reference to your questions on scar repairs, please see Techniques to Minimize Donor Area Scarring. These scar techniques will not work on everyone, particularly those who have a tendency to stretch their scar because of the way they heal the wound. I can not predict this group from the rest of the population.
Tags: hair transplant, hairloss, hair loss, hairtransplant, scar, dermabrasion

I Have a One Inch Wide Scar from Hair Transplants

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

I have a one inch wide scar from hair transplants. What can I do to treat this scar? Can you help me?

There are genetic conditions that make some people prone to scar stretching. Diseases like Marfan syndrome and the worst of them all, Ehlers-Danlos syndrome, produce wound healing problems. “Ehlers-Danlos syndrome is a group of rare genetic disorders caused by a defect in collagen synthesis. Depending on the individual mutation, the severity of the disease can vary from mild to life-threatening. There is no known cure. Treatment is supportive. produce hypermobility of joints and may also be symptomatic of a serious medical condition that can impact the blood vessels of the body.” (source: Wikipedia)

The most severe of the conditions that stretch the skin has an incidence of 1 in 10,000 people. But everyone is not either black or white on the stretching scale. Some have less stretch than the most extreme cases, but more than the normal patient. With a 1 inch size scar, I would think that your scar could be caused by genetic factors, and if so, there is no surgeon who can make it better and you run the risk of making it even worse. The risk of worsening of a one inch scar is about 1:10,000 people, but in your case, I suspect that you may have some healing problem that could put you at a higher risk for scar stretching. The other factors that may have caused the stretch include the number of surgeries and the techniques that contributed to the scars that are now plaguing you. Without examining you, I can not be sure. Actually, even with examining you, there will be risks on the genetic side that I will not be able to anticipate.

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

Will Time Make My Donor Scar Smaller?

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

i recently had a hair transplant about 8 months ago and i’m not happy with the results and now i am left with a signicant scar on my head. would much rather shave but i am hesitate becuase of the scar. is there anything that i can do to not make the so visible. or will time make the scar smaller! thank you for your time!

There will always be a scar on every person who had a hair transplant if they shaved their head. I have had two hair transplants, and although few can even find my scar, I am sure that if I shaved my head I would have a smile on the back of it. Sometimes, during the first half year or so, scars may contract so they may become less obvious. Also in that same time frame, some scars stretch. After a year or so, the scars will be stable. My scar (only the one scar for two surgeries) measures about 2-3 mm in width and what there is, has not changed over the years.

Tags: hair transplant, hair restoration, scar, donor

Staples or Sutures? What are the Pros and Cons?

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

Dear Dr.Rassman,
I have been reading your blog for quite sometime and have a high regard for your opinions.
I’m considering a transplant and I have a question regarding the scar closure methods different doctors use. I have read they could use staples, sutures and dissolvable sutures. Could you please discuss the pros and cons of the three different methods. In your surgeries which would you prefer and why.

Thanks a lot for your time in advance.

I would have to write a textbook on the logic that distinguishes why one may be better than the others. Essentially, I use them all in different circumstances. I do prefer staples much of the time, because it is fast for the surgery and the staples allow blood to go between them, which in theory gives more blood supply to the skin edge. Sutures have a tendency to constrict the skin along the skin edge when they are use in a baseball type of way.

Tags: hair transplant, staples, sutures, closure

Scar On Head Received Immediate Medical Attention — Will Hair Grow Back?

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

I had a gash on my head about an inch and a half that required 7 stitches. I received immediate medical attention and I now have a scar on that spot. It is close to my hairline, will hair eventually grow back?

If the ‘gash’ repair produced a scar, then the scar will not grow hair back. If the scalp repair was done scalp to scalp, it may grow hair back. The direction of the scar has a lot to do with what it may look like. Front to back scars near the hairline tend to do worse than side to side scars at the hairline. As you are in Los Angeles, pay me a visit in my LA office and I can tell you that answer after examining your scalp and scar.

Tags: hairloss, hair loss, scar, stiches, medical

Does Donor Scar Thickness Depend On Patient Healing or Technique?

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

Dear doctor

i would like to know if the effect of Trichophytic Closure works better on a scalp that has never been operated on before, rather than on a scar revision?

In addition, the thickness of donor scar in each patient is varying, most is pending on each patient’s healing ability rather than the technique. If this is true?

Lastly I would like to know what is running suture closure technique?

regards

BaseballAny cut on the skin will produce a scar. The problem is in how to minimize the scar. Each time the donor area is harvested with a strip technique, the risk of scarring increases. To put it simply, there are two factors for scar formation. The first factor is dependant on the individual and how his/her body naturally heals. The second factor is dependant on the techniques that the surgeon uses to close a wound. I have seen bad surgical techniques that resulted in great, cosmetically acceptable scars, because the patient’s body healed exceptionally well, despite what the surgeon did. An individual’s ability to heal and form scars is difficult to predict and not completely understood, because it is determined at a genetic level, impacting the way your body lays down the healing infrastructure of a wound.

To answer your question on the trichophytic closure, it is dependant on the individual as long as the technique is good and the tension on the scalp is minimized. The prior scar would give an indication of how a particular patient may heal.

To answer your second question, you are correct in stating the width of the scar is dependant on the individual’s healing ability.

Finally, a running suture closure is what you see on a baseball stitch or the hem on your shirt, typical of the way a sewing machine creates a homogeneous stitch line. Different surgeons choose different closure techniques for different purposes. One is not necessarily better than the other, because each has its advantages and disadvantages in each and every patient so that is where the surgeon’s expertise comes into play. Wisdom in surgery is the sum of all of the knowledge that the surgeon has, as decisions are constantly made during a surgery that reflect the recovery and outcome of that surgical procedure.

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

Scalp Biopsy as Child Resulted in 2 Bald Spots on Side of Head

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

HI, I hope you can help me..im a 22 year old male and i have two bald spots on the sides of my head, one 4 times larger than the other. From what i can gather this is a result from a biopsy i had done when i was a baby due to pimples on the head. My mother took me to the doctor because they would swell up due to the chlorine in the pool. The doctor told my mother the hair would grow back and boy was he lying..to this day i have to wear black eyeshadow and keep my hair longer to keep it hidden..please tell me you know an answer to this..
thanks in advance!

Small scars on the scalp can generally be treated with a hair transplant with good results. It is dependant on the location of the scar, the size, your hair color & characteristics (wavy, curly, and straight). FUE is an easy way to treat small scars.

Tags: hair loss, hairloss, scar, repair, biopsy, fue

Taking Grafts From Side of Head for Small Scar Repair?

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

Hi, I was wondering, since my procedure only requires 50 grafts [scalp scar repair], do you think it would be okay for my doctor to make the incision to the side instead of in the middle of my scalp? Because I don’t want any scar to show when I have pig-tales or something. I forgot to ask this at my consoltation, although I doubt you would really be able to see it even if the incision was in the middle of my scalp, because the incision would be so small, and my doctor is using a trichophytic closure, so I doubt it would show anyways, but I just want to be on the safe side. Is the outcome any different if the incision is in the middle of the scalp or to the side?

Most people with a small number of grafts get an FUE harvest so that there will be no easily visible scar, no matter where the grafts come from. Alternatively, you could take the harvest with a strip from the sides, so that it could be parted in the middle without showing a scar. The FUE approach may be better. If you had your consultation here at NHI, please feel free to call 800-NEW-HAIR to schedule another consultation.

Tags: hairloss, hair loss, scar, fue, follicular unit extraction, repair

Trichophytic Closure Questions

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

When the strip harvest method is used, a linear scar is produced, but what if the doctor uses a trichophytic closure, would the scar be “virtually undetectable”? Would I be able to buzz-cut my hair without the scar being noticeable?

And also, does the number of hairs that grow through the scar vary by the person? And for my last question, if I felt the back of my head for the scar, would I feel it even if I couldn’t see it? (Would there be a bump where the incision was made)?

Good judgments in determining the size of the donor area is the best determinant of the size of a donor scar. When the incision is too tight due to the piece of excised scalp being too large, then the enemy is tension. The use of special closure techniques minimize the scars and the tension, but a bad judgment at the time of surgery can not be offset with a repair process.

The readers interested in the subject of scars, may conclude that special techniques can make the scar disappear. Many surgeons would like you to think that their wonderful skills guarantee that the scars on their patients are either non-existent or non-detectable. I believe that the only surgeons who have never seen scars from strip harvesting are those surgeons who have never done the surgery. If any surgeons give you this line, then that surgeon is not honest, for scars (much of the time) have little to do with the surgeon and much to do with the patient’s healing capabilities, when proper techniques are used.

The use of trichophytic incisions do not offset bad judgments or poor surgery, but when used, they can close the gap in a 2-3 mm scar that usually accompanies a donor wound. The scar will still be present even if it is covered by hair, and yes, you may be able to feel it.

Tags: hairloss, hair loss, trichophytic, scar, donor, closure, hair transplant, hair restoration

Transplanting Hair Into Scar Tissue

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

If you transplant hairs into a scar, is it true that the scar gets worse before it gets better?(does the scar stretch before the scar actually has hair growing)? If so, does it eventually get better?

Disguising a scalp scar with hair transplants is an ideal procedure that is often done at NHI. There are other factors involved such as:

  • the location of the scar
  • your hair shaft thickness and the scar thickness
  • the contrast of your hair color to your skin color to minimize the appearance of the contrast
  • the character of your hair (wavy, curley, straight)
  • the length of your hair (very short hair will require more densities than longer length hair)

It is not true that the scar gets worse from a scar transplant and then gets better, nor does it stretch from getting hair placed within it.

Tags: hair transplant, scar, hairloss, hair loss

FUE vs Hair Multiplication

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

Sorry to bother you about my small scar again, but I have been doing a lot of research about Follicular Multiplication, and I have read that it is a lot like FUE, except they do not extract the whole follicle.(So the extracted hair will grow back). I was just wondering if that might be an option for me, becuase I have a very small scar on my scalp, and I would really like to fill it in with a small hair transplant, but I am afraid that the transplant will cause more damage to my hair than the scar is to begin with.

I don’t know what to do, because it is so small, but it bothers me, and I would really just like to get it repaired, but I don’t want to cause any damage to the rest of my hair.

An FUE procedure will not damage your scalp or hair. Hair multiplication is experimental and probably will not work. There are a number of companies like Aderans and Intercytex trying to induce formation of new follicles. Most researchers would accept anything, whether it be follicular neogenesis or rejuvenation or stem cell yields, or anything that will make a new hair, any way it comes. Unfortunately, this technology is probably years away, still.

Why not just fix this small scar if it is so bothering and get it behind you?

Tags: hairloss, hair loss, hair transplant, fue, scar, hair multiplication, follicular multiplication

Doctor Said FUE Would Leave Detectable Scars

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

Hi, I am sixteen-years-old, and I just recently went to a consoltation with my parents to address the scalp scar, (non-transplant)that I had wrote about in a previous post. The doctor has been doing hair restoration for over 30 years and he seems to know what he is talking about. Well, my question is this, I went into the office thinking that he would recommed the FUE procedure to fill in this scar, but instead he told me he would be using FUT. He said that he would use a trichophytic closure and that the small scar he would make would be virtually undetectable. I asked him why he wouldn’t use FUE, and he told me that he performs this procedure, but he said that it would cost me twice as much and it would leave me with little scars that would be even more detectible than the trichophytic-closed scar. He said that my scar would require 50 unit grafts, and that this would be no problem. I just wanted to know your opinion. Does this doctor sound correct?

-P.S. My parents and I would really like to know, because we want to get the best treatment possible, and we need some advice. Thank-you

Either FUE or FUT will do the job. This doctor may not be comfortable with FUE, but it is not a procedure that produces any socially-detectable scars. In other words, FUE will not produce a noticeable scar (less than 1 mm punctate scars), versus a small, barely noticeable linear scar with FUT. The choice is yours. Although the FUE is often more expensive, I doubt that 50 follicular units would be an appreciable difference in costs.

As you are local to my Los Angeles office, if you and your parents are looking at options and would like a free consultation with an NHI physician, you can call 800-NEW-HAIR to schedule an appointment or visit the NHI site to request more info.

Tags: fue, follicular unit extraction, scar repair, hair transplant

Transplant Scar Width

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

Are all the modern hair transplants now performed with a scar that is 2 to 3 mm in width? If I felt around my head for the scar, would I be able to feel it? If I used mederma for the first 3 months or so, do you think the scar would be softer and smoother, and thus less obvious when you feel around for it?

Most scars following a hair transplant in the competent hands (your doctor is in that group) will fall within the 2-3 mm width upon healing.

I am not sure if Mederma really works since I do not have direct experience, but I do not believe that there is any harm to using it. You can read previous posts on Mederma here and here.

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

My Hair Transplant Scar is 6mm Wide

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

Hi,
I had a hair transplant done 3 1/2 months ago. The hair seems to be growing in good but is blonde and fine whereas the rest of my hair is thick and dark, I am told it will thicken over time. But the main problem I think I have is that the scar along the bottom is about 6 mm wide. Along the sides up to my ears it is only 1 mm or less. The doctor told me I have good scalp laxity and it should not have stretched like it did, but I think it was because he took the hair too low on my head and in that area the skin stretches as I move my head up and down. It is like he took the hair from my neck and not my scalp. Another concern is that the hair is finer and lighter that far down on my neck and I am worried if it is even going to be permanent.

What do you think I can do to repair this scar? The doctor offered to “repair” the scar but wont it just stretch again? Have you heard about hair being harvested too low, or is this not a problem?

Thank you very much for your time.

When donor hair is taken from the high neck (where it sounds like you are describing), it often scars. Some doctors mistakingly think that the neck hair is finer than the scalp hair and therefore intentionally take hair from the high neck. These often are flat scars that widen as you’ve described. From what you are saying about the rest of the scar, it is well healed without widening and this suggests that you do not have a problem with ‘stretch’. Removing these neck scars often leads to failure, so these may have to be transplanted to get the cover you need.

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

Tension in Donor Area After Surgery

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

How can you reduce tension in the donor area after a procedure. In other words, what can the patient do to ensure proper healing of the donor area scar?

Good judgments in determining the size of the donor area is the best determinant of the size of a donor scar. When the incision is too tight because the piece of excised scalp is too large, then the enemy is tension. The use of special closure techniques minimize the scars and the tension, but a bad judgment at the time of surgery can not be offset with a repair process.

Tags: hair transplant, donor scar, tension, surgery