Can you show me a donor scar following a transplant in a person with Dark Hair and light skin.
This patient had 1512 grafts about a year ago. He happened to come in the same day that I read your question. Take a look at his results scar when I pulled the surrounding hair up.
I was looking at your photos of the blog “Alas, Bald Again”. That is what I am considering. I have had about the same amount of hair transplants and in the same area. I want to have the transplants removed and not have any more work done. I was wondering if this could be done and be able to not have a bunch of scarring and divits left on my scalp? I had the work done about 14 yrs ago and wish I just would have went bald. Thank you.
You’re referring to: Alas, Bald Again.
Each case is different. Scars, plugs, pits, color changes in the skin of the plugs, cobbling of the skin — all of these things must be analyzed. This type of question is not an easy one to manage over the internet. I have many posts on this subject and this one shows a long cure time and an expensive process. Based upon a direct examination, I might be able to give you advice.
Have you considered, or would you consider body hair transplants to the scalp? I was a patient of yours once, but my donor hair is depleted. And since I have had 4 scalp reductions, you could not do the FOX (I believe its called) procedure on me because the folicals were stretched or deformed from the stretching of the scalp. I have resorted to having to wear a hair “system” because even if I shaved my head, the scarring from the donor area would be quite apparent.I am hoping for cloning or multiplication, but these seem to be far in the future, and I am not getting any younger. Do you have any ideas, or have you ever planned to experimetnt with body hair?
Thank you.
Body hair transplants have problems, including the long sleep cycles of body hair. That means that up to 80% of transplanted body hair is sleeping and not present at any one time. Body hair transplants therefore give you efficiency factors, possibly in the range of 20% — in other words, they do not provide much value. Before you go into way out treatments, come see me in Los Angeles, as Phoenix is not that far away.
(female) I have a small scar from a cut I got when I was younger. Hair doesn’t seem to grow there anymore, and I was just wondering if there is any procedure I could get to fill in this scar. It’s very small, but it bothers me, because it is on my part. It’s noticible when I want to part my hair down the middle. What can I do?
A small hair transplant into the scar should solve that problem. This is easy to do and should take under an hour (depending upon the size you call small) in a skilled specialized office.
I hate my look. I answered an ad in the newspaper when I was in my early 20s and very depressed about losing my hair. It was not bad then, just starting to thin in the front. The doctor’s sales guy came in and did a job on me, telling me that it was on special and that he would give me 50 free grafts on top of the reduced price and I would never have to deal with the balding again. I scheduled for surgery done the next morning. This was 8 years ago and have hated myself ever since. I did not see how bad they looked until the hair fell out in the front, all within a few months of the surgery. Now I just want to become bald. Can I do it?
My astute readers will notice that this is the 3rd blog entry I’ve made in the past week relating to this very issue (see also: Alas, Bald Again and Years After Transplant, I Want To Shave My Head ), but it is very important to drive home the fact that hair transplants are forever. I know that these deforming surgeries are what most people think that a hair transplant is, but based upon what I see in these pictures, I would expect that you had this 15 or more years ago, not 8. This is malpractice today and I believe even so 8 years ago. The way the doctor unleashed the salesman on you was downright immoral and I would report that doctor, at the least, to the medical board of the state. In California, the medical board takes responsibility to protect consumers against such behavior.
I think that going backwards and becoming bald may not be your best choice, because even if each of these plugs were removed, the scalp skin would then show the individual scars from each excision and the reflection of any light in the room would show the deformity. I suspect that the situation can be improved as shown in these articles and this patient example (see Dean’s Story link below).
You need a good doctor working with you one-on-one who has the experience to address YOUR needs. This requires both a very experienced hair transplant surgeon, one with good communication skills, compassion, and understanding. Then the two of you can work out what your real options are. For those readers who are seeing this scary picture, don’t think that this is the standard of care (take a look at what is the standard of care today in our Photo Gallery).
Note: This work was NOT performed by New Hair Institute. Click the photos to enlarge.
I had a hair transplant at 22 years old in Dallas. I have to admit, it did look pretty good to begin with. But after some years, I continued to lose my hair. Fed up with the look and not wishing to continue with surgery and the additional potential scarring, I decided to shave my head.
Turns out that I have the “head” for a shaved look and got many comments on how good the look was for me, leading me to wishing I had never done the transplants to begin with. To anybody else I will always say “try the shaved look first before going with transplants – it’s permanent!” But I’m definitely not knocking transplants. It’s just no longer for me.
My dilemma now is two-fold and from looking around at the various posts, I see that you’ve answered my questions in various forms, but I guess I’m not clear as to what I should do from here.
- I want to reduce the donor scar as much as possible. It’s wide from left to right, starting about the middle of my head – and noticeable (of course).
- Next, the pitting and scarring left on the recipient site is noticeable under flourescent lighting and bright lights (not necessarily sun light). Is there any way to reduce this scarring?
Are you able to “correct” this situation? Should I send photos?
Again, I understand that I can never get back to perfect form and, granted, it doesn’t look too bad as it is now. Yet anything to reduce the scarring would be helpful.
Thanks.
I always tell people that transplants are forever and that is why selecting a doctor and taking the time to make the right decision is something that can’t be taken lightly and shouldn’t be done when you are in such an emotional state. You need to have a long term plan and this should have been discussed with you when you started at the age of 22. As a rule, 22 year olds do not make the right decisions (there are exceptions, however), so good doctors do not do this surgery unless there are clearly indications and an excellent doctor/patient relationship is made.
You outlined the problem well. You might extract the grafts using FUE, or excise them if they are localized enough. The donor scar can be minimized, depending upon what you present with. Good photographs would help me so if you send them, please include many views with some good close-ups and mail it to me at at the address on the Contact page. Once I see your photos, I might be able to give you more information and suggestions, but now I have no way to tell exactly the extent of the problem.
hi dr Rassman, am considering having a megasession but am worried about the linear scar if I want to keep my hair short at the back. how long do you need to keep the hair at the back to hide the scar if I have 2500 grafts. is there anywhere on your website with pictures of the scar etc…
I always tell people that there is always a scar present, the key is to keep the scar as small as possible. 95% of people will have a scar smaller than 1/8th of an inch wide. Assuming that there is a 1/8th of an inch scar, any reasonable length hair will cover it (even hair 1/4 inch in length). With the newer trichophytic incisions (shown here), hair can be forced to grow out of the scar so that in 95% of people, unless you shave the head, the scar will barely be visible. Using special scar reducing techniques, scars are now far smaller than they ever have been and if you are the unlucky 5%, there are ways to solve almost any scarring problem you might develop.
Today we use a deep fascia closure to reduce skin tension (the number one cause of stretching of a scar). Megasessions in the hands of experienced surgeons who practice with these techniques to control scarring is an important consideration when selecting a doctor. I have always assumed that any scarring problem in my patient is my problem and I will often fix the scar at no cost to the patient, if there is such an issue.
I have had 2 transplants since 2000 and have noticed that I am losing more hair at the back of the head. My concern is that the scars left from the surgery will eventually be exposed if I continue to recede. I would say that they it is 2 to 3 inches away from the first scar. Is there anything I can do to conceal the scar? Is it time for another transplant?
Thanks
As long as the scar is in the mid region of the permanent zone, I don’t think that the scar will be revealed. That is assuming that the scar width is not excessive , though most wide scars can be managed with a corrective procedure. It’s difficult for me to even try to conclude where your recession will end since I haven’t seen photos or met with you, so you may want to get a second opinion and even a third to better determine if your scar will possibly be exposed in the future and what can be done about it.
Scarring from a strip procedure is a big concern of mine. What method do you use to close the donor area, and how noticeable would this scar be? For example, would my barber notice it while cutting my hair if he cut it to 1/2 inch length?
The person above is talking about removing a stip of skin for donor area harvesting, the common standard surgery for today’s hair transplant. Only about 5% of the population will have a scar wider than 2-3 mm on a single surgery. With a deep fascial closure and trichophytic incisions (see Techniques to Minimize Donor Area Scarring ) these numbers should show a smaller incidence. Even with a 2-3 mm scar, you should easily be able to cut your hair to 3/8th of an inch without being observable.
Hello Again Mr.& Dr.Rassman
We’re all in here thanking you for your salvation blog as am now going thru it on a daily basis.
I’ve this Revolutionary News for you which might be the long awaited Deliverence to many of us who have had Traditional Strip HT & left with a linear thin scar(hopefully) in the back making us feel so confined. Have you ever heard of a new innovative drug being developed by ”Renovo plc.” so called ”Juvista”, as mentioned it’s now in the PhaseII clinical trial & might see the light in the few coming years. It’s basically used during the surgery by being injected to the wound edges while suturing(i think) which will later lead to an almost scareless healing (GOD I HOPE THIS GONNA HAPPEN), please comment.
Juvista consists of recombinant TGFβ3. TGFβ3 is present at high levels in developing embryonic skin and in embryonic wounds that heal with no scar, but by contrast, is present at low levels in adult wounds that scar. Since the FDA has not approved of this drug yet and it still is in clinical trials, I will not comment much until further studies have been published. To get this drug to be approved by the FDA may take many years. In the mean time, please take a look at Techniques to Minimize Donor Area Scarring, which shows the modern techniques employed today (deep fascia closure and trichophytic incisions).
You can read more about Juvista here.
I read your article about the Trichophytic incision. Do you have photos of what this looks like?
The pictures shown below are of a patient who had a trichophytic incision on half of his wound and on the other side had a non-trichophytic closure. The side with the trichophytic closure has hair growing in the actual wound, making it less obvious. These pictures were taken 5 months after surgery, so the scars have not fully matured and a slight pink color still remains. The photos below are both from the same patient (right and left are exactly the same image), except the two on the left are unedited and the two on the right has a yellow highlight showing where the actual scar is, so that you can see clearly that hair is growing through it. I apologize because some of the hair from below the scar is obscuring the trichophytic set of photographs, but I believe if you look through the line of hair that is combed upward from below you will see the hair growing directly from the wound. I will replace these with better photographs from the next patient that comes in to the office. Click the images to enlarge.
The below photos show the non-trichophytic side.
For more information about Trichophytic closures, please see Techniques to Minimize Donor Area Scarring
I am 2 weeks post-op a 2400 FUT.The surgery was performed by a very reputable Dr. and so far I am very pleased with the results.The recipient area has healed well but I still have a very pronounced dark pink line at the donor site from ear to ear.The scar itself seems only about 1 or 2mm wide but the dark pink line is about 4 or 5mm wide and very noticeable.I went back to the clinic and the Dr. told me I wasn’t being aggressive enough with washing the donor area and advised me to use olive oil to soften the area and lift off the secretion.Is the secretion causing the wide pink line and when can I expect this to look less noticeable?
After two weeks, what you are describing is not abnormal. Some people keep a red/pink color to the surrounding wound. This will become better over the next few weeks. Sounds like you doctor is giving you reasonable advice.
I had a transplant procedure a few years ago and now have some grafts along the front of my hairline, an entire bald back (Norwood Class 7) and a raised scar in the back of my head where the transplated hair was taken from. I went back to the original doctor once, and he took out some of the grafts, but there is still pitting in the front and I need to wear a hair system to cover it up. How I hate that rug, I can not express enough. How do I go back to square one? Is that realistic? Am I trapped into having more transplants that I can not afford?
You asked about the skin deformity of the frontal hairline and about how realistic it would be that the small pits could be abolished. I think that it is unlikely that it can be completely taken away, but it would not be unreasonable to remove the present hair. Risks of scarring further is a real consideration as the smooth surface skin of a bald Class 7 patient will easily show any deformity by the glare of the light. The balding skin is atrophic, which means that it lost its normal texture, where small pores exist and the sebaceous glands wax the scalp. The normal skin is clearly different than the tissue paper thin skin of an advanced balding man. When something is done to an atrophic skin, it will never go back to its pre-surgical appearance. Some people ask about dermabrasion to smooth out the skin and I feel that this procedure would likely create more skin abnormalities and I would not recommend it, even though other doctors often do this.
As your goals are unclear and the amount of normal skin and hair is an unknown for me, I am assuming that you are a full, well established Norwood Class 7 patient, but I would suggest that you let your hair grow out a bit under the hair system so that a doctor can make a determination about your condition and patterned hair loss. To accomplish this goal, you will need to have your hair system converted to clips and away from the glues or tape you are probably using for the moment.
To remove the hair in the frontal hairline, an FUE procedure to remove the hairs in the frontal hairline is worth considering. To treat the scar in the donor area, you can either attempt to remove it with a surgical excision or fill in the scar with FUE grafts.
You can visit me for an extensive exam, or even send photographs as appropriate to improve our communication. Please do let your hair grow out under the hair piece after you convert to clips. Please also do not rule out a proper and complete transplant to get your original goals back as a consideration, but it would be a good idea to see patients at an upcoming open house event to make such an assessment. Whatever you do, take your time here to make an informed decision, something clearly you did not do when you started.
Hey,
I’m 18 years and of african descent. My problem is that I’ve noticed that whenever I get my hair cut (down to the skin) the hair on the right-forward side of my head grows slower than the left. I have noticed signs of possible hair loss in future but nothing like this, hardly even a horseshoe pattern.Also quite recently I was involved in an accident and got stitches on the boarder of my scalp (this was after I noticed thinning). I want to ask if this affects possible hairgrowth in the area. Thanks.
It is not unusual to have hair loss around the scar for a distance of a mm or two. Most of the hair around the scar should grow back within a year but there may be a small area around the scar that will not grow hair. Sometimes, people who are genetically prone to hair loss may find that a bad cut or accident on the head could start the process off and without any balding present, the sutures can produce some hair loss. It may just appear as thinning or it could advance to general hair loss. If the scar is too big and unacceptable to you, hair transplants into the scar can help, but the diagnostic mapping of your head is critical for you to define just what is going on.
Dr. Rassman:
I have approximately 110 plugs (from the late 1970’s) that were placed in the frontal hairline where your hair is receding according to your picture. Can the plugs be removed and not replaced without leaving obvious scars?
If not what is a viable alternative?
Yes, the plugs can be removed. There is no way that they will not leave some scarring. Each person is different with different skin types and skin textures that reflect light differently and produce different degrees of scarring. Plugs done in the 1970’s tend to have a great deal of skin taken with the hair. These skin discs will stand out because the flat nature of them with the associated scars, when placed into a smooth, rounded bald scalp, will reflect light such that the difference becomes very obvious. When you add the ‘plugs’ of pencil size hair in the normal scalp, attention is drawn to that area. Many times, if the plugs are lined up, they can be excised as a block, or they can be removed one by one. To determine the best approach, there is no substitute for a personal consultation to make the judgments that reflect your situation.