Reducing Donor Scar

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

This blog is very informative. I have had transplants in the past, which look very natural (in my opinion). My concern is with the donor patches in the back. I would like to get more transplants, but the patches become noticable when my hair is short and any more bare spots would be obvious. Is there a surgical method/technique to minimize these blank spots? Thanks for the information.

I have addressed this question many times. This is a problem more of the past than of the present. See: Techniques to Minimize Donor Area Scarring and Trichophytic Closure Photos.

You need a Master Plan developed to deal with scars and the need for hair in maximizing the value of the remaining donor hair. Scars can be dealt with in most people using the techniques described in the referenced blog entries above. After you read them, call me at 800-NEW-HAIR or write to me again if there are unanswered questions (be sure to reference this blog posting).

Tags: hair transplant, scar, donor, trichophytic, surgery

How Many Follicles Required to Fill in This Scar?

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

Hi, I was just wondering about how many follicles would be needed to fill in an inch long and a few mm wide area of scalp?

Tootsie PopHow many licks does it takes to finish a Tootsie Pop? In other words, I couldn’t tell you how many grafts would be required just by the simple question you asked. It depends on what you mean by a few millimeters — two, three, five?

It would also depend on:

  • 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)

Generally you can achieve a good cosmetic effect with about 20 to 40 follicular units per square centimeter, but that number does not reflect the local skin dynamics or how the surrounding hair may lay.

Tags: scar, hair transplant, hairloss, hair loss

Grafts Growing in Scarred Tissue

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

Does a graft always have the potential of growing? Even in an area of scarred tissue? Or where a hair has been extracted?

If the scar tissue is healthy scar, it will support follicular units. Healthy scar actually bleeds when cut. Scars often have a rich vascular network, but some skin grafts (split thickness grafts) and burn scars may not have enough vascular support for a hair transplant. A healthy graft will grow anywhere it is placed when the blood supply is adequate. For example, a follicular unit placed on the end of the nose will grow to pony tail length.

Tags: hair growth, scar, hair transplant

Reducing Visibility of Transplant Scar

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

Dr. Rassman,

I had 1 hair transplant procedure 2 years ago. I am only 22. I feel like the propecia is not working and I am ready to shave my head, but I want to reduce the appearance of the scar from the procedure. I am currently using Mederma. Are there any other products you could suggest to reduce the visibility of the scar? Thanks!

If you had only one transplant procedure, you should not be facing a significant scar. I am bothered not only about your scar, but your age. What drove you to have a transplant at 22? A good, honest, and competent transplant doctor should look at your scar and advise you. Consider sending me digital photos and maybe I can help, but send me photographs of your entire head as well (your photos will be kept confidential and will not be shown on this site). As well, please reference this blog posting when/if sending the photos.

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

I Want My Donor Area Repaired So I Can Shave My Head

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

Dear Dr. Rassman,

I am looking to have the donor area from an earlier procedure eliminated so that I could wear my hair extremely short or shaved.

Please let me know what you recommend.

Thanks in advance.

All cuts on the skin will produce a scar and most cannot be completely eliminated. Scars can certainly be minimized depending on the individual healing characteristics so that short hair is a reasonable option. At New Hair Institute (NHI), we continually strive to incorporate scar minimizing techniques in all our procedures and will tackle repairs of scars if they are there. Please refer to Techniques to Minimize Donor Scarring. Your original hair transplant surgeon should be able to address your scar. If not, I would be happy to meet with you in person or by phone to discuss your options.

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

I Want to Lift Weights 2 Weeks After Hair Transplant Surgery

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

Weightliftingregards doctor, my question is i have had a my surgery 2 weeks ago and have my staples removed I am going to wait a month to lift heavy waits but I am still concerned that it might be too soon and will stretch the scar and if so how much will it stretch or bleed. Really worried about that. and will working out heavy affect my grafts?

Working out will not impact graft growth, just the risk of scarring in the harvested donor area (assuming you had strip harvesting). I tell my patients that they can run a marathon in 7 days, but hold off anything that works the trapezius muscle as it might potentially stretch the scar in the back of the head.

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

Donor Scar Healing After Transplant

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

I had roughly 2600 grafts done 5 weeks ago. Although the donor scar has healed on the ends, the middle part of the scar right at the back of my head hasn’t healed and is a little weepy.

Is this normal? Typically I heal very well after injuries, etc.

Thank you.

If part of the scar is weepy (wet) then go back to your doctor. You could have an infection present. Wet wounds in a scar 5 weeks after any surgery is not normal.

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

Can a Hair Flap Be Removed?

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

i had the hair flap surgery, done back in 1989, when i was around 25, my question is , can the flap be removed from the head??. to be honest i look kind of silly, with this thick hair in the front that grows in the wrong direction…thank you for your time…

To learn what this person is asking about, read more about the flap.

The flap can be reversed, but the scarring is high and it may not answer your needs. There are many ways to manage such a flap. See an expert and be careful that you do not make another mistake. You don’t want to go down a one way street the wrong way.

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

Will FUE Scars Be Noticable?

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

If I get the FUE procedure, to fill in the scar on the side of my head, will the fue scars be noticeable? I do a lot of television commercials and stuff on TV, so I really need it to not be detectabe, because I constantly have people doing stuff with my hair, and parting it in all sorts of ways. What I’m trying to say is, will the fue scars really be detectable if I want to have braids or my hair up? My agent actually told me I should get this scar repaired, and I really want to find the best, and I heard you are one of the best, and I’m really worried, becuase I don’t know what to do.
(The scar is not that big at all but my agent is bugging me about it).
PS- I got it when i fell against a desk when I was five. :)

Many doctors claim their expertise in Follicular Unit Extraction (FUE). Thank you for the complement. You may want to read the first article on the follicular extraction technique, which I co-wrote and was published in 2002 — Follicular Unit Extraction: Minimally Invasive Surgery for Hair Transplantation.

All incisions on the skin will produce a scar. However a FUE scar is so small, it would be virtually undetectable especially among your scalp hair. Furthermore, in covering up your desk accident scar, FUE would be an ideal technique from its minimal invasiveness to its fast healing times.

If you are interested you should set up a consultation so that the entire procedure can be explained in detail. You may also be interested in coming to one of our monthly open house events so that you can potentially see a patient who has had a FUE procedure.

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

Having a Second Hair Transplant

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

Hi, I have good hair on the side and back and I think I would be a good candidate for the transplant. I also still have fine hair on the top of my head still. I wanted to know how thick will it grow out? How come you never see people on the hair websites that have really long hair? Does it not grow that long? Will the scar show when I go swimming after my hair gets wet? Does Biotin Vitamins work for thinning hair, does it grow hair? Is it possible to hair a second hair transplant if the remaining hair falls out on top? Do they cut the donor from the same area? Will hair grow out of the scar? How far off is hair cloning?

thanks

  1. We have many patients who grow their hair long — I wouldn’t say they are the majority, but there is certainly quite a few. As to why they aren’t shown on any websites, I guess because those patients with long hair didn’t sign photo releases to appear on the sites. I really wouldn’t know. But what I do know is that the transplanted hair grows just like the rest of your scalp hair.
  2. The scar should not show after swimming, but I can’t make any guarantees as the results of each patient could be different.
  3. Biotin vitamins do not work to make hair thicker or reverse the effects of thinning from genetic hair loss. Scars should not be a problem, but there is a 5% risk of some scarring in a single first session (scars greater than 3mm), slightly higher risk in subsequent sessions. Transplanted hair from the first transplant does not fall out in the second transplant, in fact, it is hidden well by the first one. Any second session is taken from the same place as the first donor strip is taken from, keeping the wounds in the same place. This best controls scarring risks. Scars can be created so that hair grows out of the scar (see trichophytic closure).
  4. Hair cloning may not appear on the scene in my working lifetime (10+ years). See the Hair Cloning category.
Tags: scar, hairloss, hair loss, hair transplant, vitamins, long hair

My 16 Year Old Daughter Has A Small Scar

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

I was wondering if I could bring my daughter in for a consoltation, because she has a small scar on her scalp that she would like to get filled in, and we were just wondering what kind of treatment options there are. It is a very small scar, but it seems to bother her a lot, and I just want her to not worry about it anymore. She is only 16 but she is begging me to set up a consoltation. Would this be okay, or is she to young?

She is not too young and I would be happy to see her. Hair transplants work very well for scalp scars. The FUE technique works well here. That means that there will be almost no pain for the transplants or after the transplants are done.

Tags: scar, child, hair transplant

I Want To Use Leg Hair To Fill in A Small Scalp Scar

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

(female) Hi, I just wanted to say that I really appreciate the feedback you gave me about filling in the small scar on my head. I do however have another question. Since the scar on my head is so small, and I really don’t want to damage any further follicles on my head, is it possible to extract a few hairs from my leg or the back of my leg, and use it to fill in the scar? Because the hair on my legs doesn’t really differ from the hair on my head. And if transplanted, would the hair grow the same length as the rest of the surrounding hair?

Leg LampLeg hair has longer sleep cycles (as does most body hair) than scalp hair and that means that most of the hair is in its sleep cycle and not showing its presence. If you transplant 10 leg hairs and watch them grow, only about 2-3 of them will be evident at any one time (the others are there, but in telogen phase). Body hair also grows at different rates and it may not grow to regular scalp hair length. Furthermore, leg hair does not have the same quality and caliber as your scalp hair. More importantly, even if leg hair transplantation works, are you willing to live with a surgical scar on your leg?

The traditional FUE procedure (on the scalp) is a better solution and the hair is exactly the same quality that exists around it. In addition, it has only a 10-20% sleep phase at any one time. Although your idea sounds interesting, it is not a worthwhile endeavor.

Please see Transplanting Chest, Leg, and Thigh Hair for more.

Tags: leg, hairloss, hair loss, scar, scalp, female, woman, women, bht

Stretching Wounds and Scars

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

How will these new wound closures you discussed in this blog impact people who have scars that stretch? I have scars that stretch every place I have had a surgery, including my hair transplant scar.

A trichophytic closure will not work if the wound widens more than 2-3 mm, because the hair growth from the trichotomy will only grow up to 2-3 mm from the edge of the wound where the trichotomy was done. The stretching may be helped by a sub-fascial closure below the occipitals muscle fascia. The tension reduction of such closures has value in reducing the wound size, but not necessarily in obliterating it. You might have some form of Erlos Danlos Syndrome (see here, here, and here), which comes about from defective collagen by its very nature. The story of EDS is not black and white, for I believe that some people have small amounts of this defective collagen and these people are the ones that may get stretching of the scars. In such situations, even the sub-fascial closures will not work, because eventually the body must heal the wound and as the sutures dissolve, the value of the sutures that hold the wound together will decrease over time.

Scars are at times a price one pays with surgery. For strip harvesting, this could be a price you will pay. If you have FUE harvesting (Follicular Unit Extraction), then this stretched scar problem should not become an issue with regard to your healing, as there is no large line scar to stretch.

Now with that said, putting the scar issue in perspective, the scar only exceeds 3 mm in about 5% of cases. If that happens and it bothers the patient, then I make this my problem as well and we work to solve the problem with whatever it takes.

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

Transplanting into Donor Scar

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

Hello,
I had surgery with NHI back on 01/24/2002, no problems, then had more grafts placed by a surgeon closer to home about 1 year after. Having been a trauma nurse for 6+ years, I told him to please be very careful around the donor area as there was not much elasticity. Post op had very bad infxn and after 10 days of oral abx I now have very large scars at the donor areas behind both ears and have to wear my hair long to cover these scars.

Since this is already heavily scarred, can anything be done to place hair here?

Yes, I know, I should have just gone back to you to get my second one done. Thanks

You are more than welcome to pay us a visit and we’ll see what we can do. We can address the scar and also transplant into the donor area if that is what is needed. There may be a better solution, but until I examine you, I can not render an opinion. It is interesting to note for the readers of this blog, I have not seen an infection in the donor area for more than 10 years. As you may know, we are an accredited facility through the AAAHC and during the last accreditation process we were told that amongst accredited facilities we were in the top 1% with regard to the incidence of infection. I believe that we are the only accredited hair transplant facility in California and possibly even the entire USA. This accreditation process inflicts the highest standards on its participating facilities and includes many if not most of the hospital-level outpatient surgery facilities in the nation.

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

FUE Scars

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

Do FUE procedures form scars?

Yes, there are scars anytime the body is invaded by the surgeon, or any time you cut yourself. The scars come about when the edges attempt to close the gap. The FUE scars are circular, so the size of the scar somewhat reflects the size of the wound. To answer the question appropriately, let’s talk basic math and then convert the math to logic.

The chart here shows the size of the cutting punch and compares the size of the wound that is created. The scar reflects the size of the wound.

 

Diameter Area % change from smallest wound size
0.75mm 0.44mm square (baseline)
0.9mm 0.64mm square 44 % larger than 0.75
1.0mm 0.79mm square 78% larger than 0.75
1.5mm 1.77mm square 300% larger than 0.75

 

The reality of these number are that the 0.75mm leaves almost no scar, because the edges co-apt and there is minimal secondary healing as the scar fills from below as the side skin grows over it. With all of the wounds from strip harvesting, the scars are long and the wound is much larger. Such ‘line’ wounds can be seen when the scalp is shaved.

The 0.75mm wounds are impractical, but the 0.9mm wounds are the standard used in my practice. So in answer to your question; scars are related to the size of each wound. The smaller the wound for FUE (for example), the smaller the instrument used by the surgeon, the smaller and less noticeable will be the wounds in their final healing phase. Please see this previous post, Size of FUE Procedure, for discussion on actual yield rates. If only a needle is used (like the one you get with a flu shot) I sincerly doubt that you will ever find the scar with the naked eye.

Tags: FUE, hair loss, hair transplant, hair restoration, hairloss