Severe Pain at the Donor Area Months After My Hair Transplant

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

Hello doctor. My question is an honest one and one that hasn’t been asked before.

I had a hair transplant 2 and a half months ago but I still have a lot of pain above the linear scar (when I press it) and also the sensitivity on the top of my head in terrible and is constant. It’s like my hair is being pulled. My surgeon said in 17 years he has no idea what is causing it and never had this problem before. There is also a gap of about 10mm where the scar is and said he said to me he can do a scar reduction in a year. I am so sorry I had this procedure done as the pain is not letting up.

It sounds like you may have a scar entrapment (nerves squeezed by scar) or damage to the occipital nerves in the scarred area. I have had patients report symptoms like what you’re describing when they had a nerve entrapment. Sometimes, a scar will form around the occipital nerves just from the strip surgery, or the nerves could be mechanically damaged, or even partially or completely cut.

Doctors who will examine you will look for something we call a Tenels’s sign, which simply produces some of the symptoms as the doctor taps the area above the nerve. Surgery is a last resort to fix the problem if it is just induced by the scar. If the nerve is cut completely, a surgery most likely wouldn’t help.

Tags: nerve damage, scarring, hair transplant, surgery, hairloss, hair loss

You Changed My Life By Repairing My Plugs — But Can I Remove a Donor Scar Completely?

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

Dr. Rassman,

I had many strip procedures in the early 1990’s that left my hair looking very “pluggy”. People would immediately look and my forehead at first meeting and continue to stare as though I was not even present. I wore a baseball cap everyday to cover up my hair everyday for 9 years (all the way through college, graduate, and PHD school). Luckily, I took a chance and made an appointment with you. You completely changed my life and helped rebuild my self-esteem.

After many corrective surgeries and reaching an amazing result due to you experience and craftsmanship, I have one last question regarding “reducing donor scar left from the strip harvesting.” Are there any other new options out there that could eliminate the donor scar through Trichophytic closures coupled with FUE, laser surgery, or tissue expansion that would allow me to shave my head if needed?

Thank you for the kind words and I’m glad I was able to help.

With respect to the donor scar, there are scar revision surgeries and even Scalp MicroPigmentation (SMP) to disguise the scar. I don’t know that you’ll be able to completely eliminate the scarring, but masking it or revising it would possibly be doable. With that said, everybody’s situation and needs are different, and I cannot give you a detailed personal consultation over the Internet without an examination.

Please call my office at (800) NEW-HAIR or (310) 553-9113 and we can set up an appointment to discuss your options.

Tags: hair transplant, repair, scarring

If I Have Another Strip Procedure, Will The Scar Be More Noticeable?

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

hello
16 months ago i had a hair transplant using the strip method which has left me a scar on the back of my head. if i was to have another transplant with the trichophytic closure procedure, would this problem of the scar not be so visible if i were to cut my hair shorter?

i would appreciate some advice just so i can be sorted out. kind regards

A second strip surgery in a person who had a sizable scar after the first surgery can produce an even larger scar the second time, but this is not always the case. There are times that a second surgery can reduce the scar from the first surgery. Considering the size of the scar, it might be excised and then closed with a trichophytic closure; however, the scar may return nevertheless.

One of the new and innovative ways to treat a hair transplant scar is with Scalp MicroPigmentation (SMP). See examples here.

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

Transplanting a Patient with a History of Keloids?

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

If I am prone to forming keloids is it still possible to safely undergo hair transplant surgery w/out forming additional keloids? And have you ever done a hair transplant on someone who has a history of keloids?

Many patients undergo hair transplantation despite a history of keloids, and most of them do well. Keloids can appear on the frontal hairline, but that is relatively rare. Keloid scarring is more likely to form on the donor scar, but the surrounding hairs will cover it so that it’s generally not a problem.

Tags: keloids, scarring, scar, hair transplant, surgery

Raised Scars from Hair Plugs

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

I was wondering if there is anything that can be done with raised scars on the top of the scalp from hair transplant plugs? I read there is a possibility of cortisone injections? What about just making the top of the head more dense with SMP?

Everyone is different, so there’s no exact solution I can provide without seeing you and getting a better understanding of your individual case. Special cortisone injections may help, but that depends upon what we are treating. If the elevations are due to the mass displacement of the old plugs in atrophic skin, then the cortisone shots might not help.

Hair transplants around the plugs (especially in the frontal hairline) does wonders for camouflaging them, correcting the abnormal hairline — and then even Scalp MicroPigmentation (SMP), when properly used in the right places, might help further.

I would have to see you to determine what can be done appropriately. Out of curiosity, how long ago was your hair transplant that you got the old plugs done?

Tags: hair transplant, hair plugs

Persistent Scalp Pain 5 Years Following a Hair Transplant

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

Hi,

I had a hair transplant 5 years ago. Some months after the procedure, I noticed some persistent pain and sensibility in my scalp, mainly in the scar and areas near it (example: where the eyeglasses touch my head). But it did not heal. The areas near the scar are extremely sensitive. I need eyeglasses to work but its impossible to use them (my astigmatism is incompatible with contact lenses), so my situation is very hard.

Some surgeons said that its necessary to remove the scar, because I could have some neuromas. The scar is very homogeneous, it is not wide, and the HT was made by a very experienced surgeon. He said that this never happened to his patients and has no idea of what happened with me.

I went to some pain specialists (psychiatrists) that told me to take amitriptilin (50mg/day) and pregabalin (Lyrica, 225mg/day). None of them had any effect. Other things I already tried are: laser therapies, topical capsaicin and local injections of corticoids. No results.

Now, the surgeons think that the only thing to do is to a surgery to completely remove the scar, like a new strip (very very thin) for hair transplant, without transplanting follicles. Do you think it is a good idea or the situation can become even worse?

I already did lots of search and some web sites and surgeons comment that it is possible (very rare) to have persistent pain after years of HT, but I never found suggestions of how to treat it.

Thank you.

You have risk no matter what you decide. Have you had injections of steroids into the painful part of the scar? I would need to evaluate you before giving you a recommendation. I’ve written before about nerve damage from a hair transplant in some past posts that might have some value to you:

Tags: hair transplant, pain, nerve, surgery

I Had a Hair Transplant with Trichophytic Closure Technique — What Does My Scar Show?

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

Dr. Rasmann

I want to thank you for all the information you provide on here to help educate everybody looking into a H.T.

I recently had a procedure using the trychophytic closure technique. I am 10 days out and the staples have just been removed. Is what I am seeing in the donor the hair that will permanently not grow? or is this just a result of the donor area being shaved and the hair still having to grow in. thanks in advance

Click the photo to enlarge:

 

Having a trichophytic closure technique used is not a guarantee you will have a nice, thin and neat scar. The photo isn’t clear and I can not tell what is shaved from what might be an early stretch of the scar. You will have to wait it out.

If you have a visible scar after 5-6 months, it can be successfully covered with Scalp MicroPigmentation (SMP). This is a great option and we have a photo gallery of examples here.

Tags: hair transplant, scarring, hairloss, hair loss

Can Someone Get a Strip Scar to Be Completely Invisible?

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

Hi Doc,

I have a question about FUT scar. I have heard so much about scar repair and removal, so I was just wondering why don’t people just get an FUT from a good surgeon and eventually (Once they feel they need no more surgeries and have effectively treated their hairloss via surgery) get the scar removed?? instead of having the many dots of FUE?

Basically my question is it is possible to get the scar removed or made invisible completely (by putting fue grafts in it or some other technique like SMP) for the majority of people??….so that they can shave their head if they wanted later without indication of surgery ..??

There is no such thing as scar-less surgery, no matter how skillful a doctor may be. Even FUE surgery can leave significant scarring that look like thousands of whitish dots. The key point is any cut on the skin will leave a mark and each person heals differently.

In other words, it is not solely about the surgeon or a technique used. It is just as equally the individual patient’s body and the way it heals/scars.

Tags: scarring, hair transplant, scar

Can I Transplant Pubic Hair to My Scalp If I Have Limited Donor and Otherwise Thin Body Hair?

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

i have a question about pubic hair transplants. i would like to use this hair because i have limited donor and very thin body hair. i was told the only way to remove this was by incision. i do not want a scar in this area. i would take hair from this area in a heartbeat if fue’s could be done. are fue’s possible in this area? thanks for taking my question

I have done pubic hair to scalp transplants before — a couple of them were with FUE, and most with a small strip. Scarring should not be a big problem, depending on the amount of grafts that are removed. All surgery produces some kind of scarring, though, even if it is minimal or barely detectable. The quality and character of your pubic hair might not be what you want to appear on your scalp, but that is up to you.

If you are looking to give the appearance of thicker hair, there is an alternative with Scalp Micropigmentation. Take a look at some photos of SMP in use with thinning hair and see if this applies to your problem.

Tags: pubic hair, hair transplant, hairloss, hair loss

I See Redness Above and Below My Strip Scar from 20 Years Ago (with Photo)

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

Dear Doctor Rassman,

First of all, thank you for your blog, it’s a huge source of information. I had a hair transplant over 20 years ago. It has not given me the result I was (naively) looking for. This is why I want to shave my head with a no guards clippers. Then I am looking to fill my scar with SMP to hide it. I took photos today as part of the consultation but I noticed I have small squares of reddened skin above and below the scar. Do you have an idea what this could be and would you have any advice to maybe soften it? You have my permission to use my photo.

Thanks and all the best

And thank you for allowing us to publish your photo here. Click to enlarge:

 

We routinely perform Scalp Micropigmentation (SMP) at our office on a daily basis for the type of scars you have. In fact, most scars we see are worse than the one you show. I’m not sure why you’d still see any redness around the scar if you had your surgery two decades ago, though. A topical hydrocortisone might reduce the redness, but you should talk to your dermatologist about this.

If you would like more information on having SMP done, you can call our office at (310) 553-9113 or (800) NEW-HAIR for a consultation with a doctor. And for those interested in seeing a before/after example of SMP done over a strip scar, here’s one such patient:

SMP

Tags: hairloss, hair loss, smp, pigment, photos

Does Closing a Strip Scar Cause the Crown to Be More Visible?

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

Does the crown stretch when closing a FUT scar?

Hi there – First off I would just like to thank you for providing this excellent resource. I just have two short questions related to FUT scars:

1) Firstly, I know you have answered this in the past with hairlines, however since the crown is within inches of the incision site above the prominent bone, does it slightly move/stretch downwards towards the incision site once the scar is closed?. For example… I have some thinning in my crown but im lucky in the fact that it doesnt dip low at the back so its not very visible unless looking from above my head. If I had a strip procedure would this thinning crown be more visible from the back because the skin has been pulled down to close the strip wound?

2) Secondly, I believe avoiding strenuous exercise is recommended for about a month after the procedure to avoid scar widening, but is general head tilting and looking downwards in the weeks after surgery ok in terms of putting stress on the scar?

I would be most grateful for any response you have for the above questions. Kind regards.

Strip scars placed in the true donor area in the back of the head should not impact the location or the size of the crown area. Strip surgery takes up laxity that is there at the time of the surgery. Bending your head should also not impact the crown area.

I have never been sure why we tell the patients not to lift heavy weights. If there is a pull from the muscles, it comes from the trapezius muscle, which inserts below the scar at the base of the skull. I still tell the patients not to lift heavy objects, but I am not certain there is any value to the advice.

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

My Last Hair Transplant Was Over 2 Years Ago and the Scar is Still Pink

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

Hi,
I have had 2 successful transplants, the last being about 28 months ago. My scar is still a light pink colour. My scars usually take a long time to fade, so I think this is probably normal for me. Is it possible to use lasers get the scar to fade as I would like to get SMP into the scar. Or alternatively, can you get SMP and then reduce the scar redness with lasers, or would this likely cause the SMP dots to fade too?

Thanks!

If you let your hair grow out to a reasonable length, the pink color of the scar will be covered. That’s the easiest solution, really. Was your scar pink for a long while after your first hair transplant?

You may just have to wait it out. You can try topical hydrocortisone (a small dab spread over the scar) for up to to 7 consecutive days, then pull back for two weeks and try it again. This might work to lessen the pinkness.

Tags: scarring, hair transplant, hairloss, hair loss

After I Had a Scar Revision, the Area Is Very Itchy

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

I had 3 FUSS transplants over a decade. It left a wide scar. I had a scar revision. It resulted in a liner revision line. However after the scar revision, 5 years later, I have bouts where the scalp area is really itchy. It ceases in a day and then restful for awhile

1. What causes this?
2. What can one do?

thanks for the tip and your powerful website!

You can try an over the counter hydrocortisone treatment in small doses 3 times a week or once a day, whichever relives the itching. I can’t say a scar revision and scalp itch are related — at least, it’s not something I’ve heard of before. If it continues, I would see a dermatologist.

As an aside, we are no longer doing scar revisions, but rather offer Scalp Micropigmentation (SMP) as the treatment of choice for scars. Most people who have scar revisions still have significant scarring, and SMP literally wipes out the appearance of the scar.

Tags: hairloss, hair loss, scar reduction, smp, itch

Big Problem – Dealing with Unmanageable Scars

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

The pluggy hair transplants of the 1980s and 90s, and even the strip surgeries in the years following that, caused considerable scarring in some percentage of patients. Few of them complained unless their donor area was depleted from multiple surgeries so that long hair would not cover it. Even today, scars from follicular unit extraction (FUE) are causing problems for some patients who have had donor area depletion. I’ve seen a few men for consultations recently that have shown a see-through appearance at the back of their heads, asking us what they could do to help make this less noticeable, and prompting me to write this post.

The best solution for unmanageable scars was introduced by us in 2010 — Scalp MicroPigmentation (SMP) — and it can be effectively used to camouflage scars so that they can be made undetectable. Scars are more of a problem when patients have multiple surgeries, each surgery adding to the amount of scarring.

In the past, we have recommended scar revisions with variable success. Usually the scar would be reduced following the revision, but the biggest problem we found with this solution is in the patients who get poor scarring after strip surgery, get it because that is the way they heal. So when trying to repair it, we found limited value with occasional good results, but always leaving some level of detectable scar. There are people like me (three strip surgeries and no detectable scar) who heal very well, but there are some that aren’t as lucky. Treating these scars with SMP seems to always work regardless of the patients tendency to scar.

We’ve posted some outstanding results in the treatment of scars of all types and this is usually what happens to all patients, not the select few shown on this website.

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

Can I Have Several Smaller Scars Along Langer’s Lines Instead of 1 Large Linear Scar?

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

Dr.Rassman/Dr.Pak,
Is it possible for an FUT patient:-

– to have several small (5cms) donor-strip scars rather than the normal one large scar, and would such scars heal better if they followed Langer’s lines?
– to have donor-strip scars incorporated into existing scars (in permanent zone)?
– to have, using your experience and artistry, donor-strip scars with the appearance of naturally-occurring scars: the normal scars that most people receive from the everyday knocks and bumps of an active childhood/adulthood (falling out of trees, falling off bikes, sport injuries, fisticuffs, etc.).

I appreciate that all surgery inevitably leaves scarring and even with the standard of your work some compromise is necessary. But, perhaps like many men, I’m uncomfortable with the thought of having scars that are so obviously due to hair transplant surgery – even though such scars can be covered by wearing longer hair and/or camouflaged by SMP. However, if the scars could be disguised as accident-related scars much of the anxiety of having FUT surgery would be removed and, within reason, any amount of scars would be acceptable.

Thank you.

Multiple small scars were offered in the past, all placed horizontally in Langer’s lines (the lines in the skin where collagen fibers are naturally oriented). Some were significantly less detectable; however, they may not be very efficient if a lot of hair is needed (as in the Norwood class 6 or 7 patients) and multiple small scars often have some hair loss associated with them.

I frankly do not know of any doctors offering this approach. If for any reason, you are a person that widens scars, this approach would leave your head full of scars.

I had three strip surgeries all in the same place for my balding crown, but only one scar remains that is so small, few can see it. In my situation, having only one scar was the right decision and I did not need Scalp MicroPigmentation (SMP), as I did not need to hide what was already hidden.

Tags: hair transplant, scarring, scars