Hair Loss from Coronal Brow Lift Scar

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

I had a coronal brow lift in Feb. 2009. I had a wider than desired scar. I also had a spot the size of a quarter of permanent hair loss. The plastic surgeon who performed the brow lift has tried to do a scar revision by excising the scar. But I am 3 weeks post revision and I see where all along the new revision scar I have hair loss. The line where he cut is pencil thin, but I have hair loss in front of the scar.

Is this going to be permanent like before? I thought that maybe the staples I had in initial surgery were the problem. But he used sutures to do revision and I still had hair loss. Why is it that every time my scalp gets cut I have hair loss in front of the scar? And what can be done to fix this?

Thank you

This is a real problem. You must wait out the course (about 4-6 months) and then you will know if the surgery succeeded. I suspect that you will see that the scar is the same or worse and the hair loss may not go away. I see many female patients with this problem and end up transplanting most of them with good results.

Tags: brow lift, browlift, coronal brow lift, scarring, hair loss, hairloss

Does the Recipient Site Have White Marks Around the Grafts?

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

Dr. Rassman,

I have a question about scars after one has healed from surgery. Mainly the recipient transplanted sites. I know a doctor will puncture holes to put the grafts in. And my guess is that these holes will eventually have some form of scarring. From your past experience how visible are these scars if one shaves his head, transplanted area not donor area. Will there be tiny white spots on the transplanted area with little holes from the punctures?

My second question relates to FUE mainly from thick coarse arm hair to a missing patch in my lip area. From your experience how is the scaring like on the arm? Since a doctor would removing the hairs on the arm out with FUE. Would the arm area scar less than using FUE hair from the scalp? Let me know, since I am considering using hair from this area. Thanks

Third question, I noticed scars from a hair transplant are usually white. How well does this blend in for asians, from your experience? I am asian with very pale skin.

Thanks!

The recipient sites are made with slits which heal very well and leave no visible scar in most people. The donor area does have whitish scars that can be seen on close inspection if the head was shaved, rarely with the hair long.

I would use scalp hair though, not arm hair for your lip area (I assume you mean moustache). On the arm, I imagine the scarring would be more evident with less hair to cover it.

Tags: hair transplant, fue, bht, arm hair, hairloss, hair loss

Tight Scalp, Scarring, and Multiple Strip Hair Transplants

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

Dear Dr. Rassman:

If someone has their donor scar from ear to ear but only one side (left, let’s say) is very tight, probably due to a thicker strip being taken from that side. If that person is considering one additional strip procedure with the best close possible, is it best for the entire previous strip to be excised, including the already very tight side? If so, can the excision on the tight side be very thin while being substantially wider on the less tight side?

Alternatively, can only part of the previous donor scar (on the right side in this case) be excised, such as the final 1/3 of the strip on the right side? What would be most desirable option and what would be an appropriate time to wait before doing the second procedure? The patient in the case intends to have the second strip procedure be the last one, using only FUE or FUE squared after that as needed if additional hair loss/thinning occurs with aging and needs to be taken care of.

Thank you in advance for your advice.

Best regards

If the excision area is at least 6 months old, the laxity can be assessed. If the excision area is less than 6 months old, the laxity of the excision area will change the further in time you are away from the strip harvest. I never make an assessment of the donor area until at least 6 months have passed. As most second procedures are usually more than 8 months following the first one, this has rarely been a problem.

A second strip procedure puts a good burden on the surgeon to make judgments. If there is a large demand for more hair grafts at the second procedure, the degree of tightness will dictate what can be removed. I generally remove any scar along with hair if there is enough laxity and the width of the strip may vary depending upon the tightness of the scalp. Sometimes one side is tighter than the other so the strip width will be narrower on the tighter side.

The laxity issue seems to also vary with the individual. Most people will find that their scalp will return to its original laxity, but a small number of people will find that the scalp will become tighter with each successive procedure. In this later situation, the amount of scalp that can be removed will decrease with time. As the density also drops with each successive strip harvest, the combination does not bode well when both a tight scalp and a reduced donor density occurs in the same patient as measured 8 months following the first procedure. For those people with tight scalps, the FUE approach may be preferable to another strip harvest.

Tags: hair transplant, density, laxity, hairloss, hair loss, hair restoration, scarring

Filling in FUE Scars with Body Hair?

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

Hello Doctors!

I have a question about FUE and scarring. It seems that you use the same instruments to make both the donor excision as well as the recipient sites. Yet the recipient sites show no scarring. Where the small donor area punch marks are simply left open (and a scar forms from the skin healing over the small hole) I am guessing the fatty tissue keeps any perceptable marks from forming on the transplanted ares.

So, if you wanted to take it a step further, couldn’t you perform a body hair transplant on someone to fill in the FUE scars? Even if the body hair is not as cosmetically effective wouldn’t the “fatty tissue” from the BHT leave the donor area with no small white holes? Is my logic twisted?

A crazy hair question for the only people capable of answering it. Thanks for your time!

The recipient sites are not made with punches like those used for follicular unit extraction (FUE). They’re two different tools. We generally create slits for recipient sites with needles or tiny scalpel blades.

The white dot scar is the result of skin being removed along with the graft in the FUE technique, and it really would not be reasonable to fill these tiny holes with body hair to eliminate all scalp scarring. The ‘bulk’ of a body hair may be finer than the ‘bulk’ of your head hair. Body hair usually grows in single-hair follicular units while scalp hair usually has more than one hair in a follicular unit, making for even less ‘total bulk’ of the transplanted grafts. That is why it is important to be assessed for these many variables and their meaning to you.

Tags: follicular unit extraction, fue, scarring, hair transplant

Donor Scarring from Hair Plugs Done About 30 Years Ago

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

Thirty years ago I had 4 or 5 sessions hair transplant sessions done using the old punch graph method. For most of those years I was fairly satisfied. Lately that has not been the case. The appearance of corn rows is starting to show in the front and it is getting harder to cover up the donor area in the back. Twenty years ago I spoke to a specialist in Philadelphia who disappointed in the methods used in my procedures and he implied that I was not a good candidate for future transplants. If this is the case I would prefer to shave my head instead of continuing trying to cover up, which can only become more problematic in future years.

The scarring at the donor site is a concern. Are there any procedures to reduce this scarring? Thank you in advance for any information and/or advice you can give me based on this limited description.

We have routinely performed surgeries for men who are in your situation. You can read about one patient’s journey here and see some of my repair patients here.

As you undoubtedly know, everyone is different and unique so I really cannot comment on your particular case without examining you. Many patients who had 4-5 sessions of the old hair plugs have heavily depleted donor areas, and a skilled surgeon with experience in this field can often soften the plugs by harvesting the recipient plugs as well as redistribute some of the remaining donor area. If you want to explore options, please send me photos and set up at the least a phone consultation with me.

There is no simple answer to your problems, and each person must be evaluated one on one before recommendations can be made. This goes for both repairing/removing the “corn rows” and seeing what can be done about fixing the donor scars.

Tags: repair, hair plug, hairloss, hair loss, hair transplant, donor, scarring

Length of a Strip Scar

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

Hi Doctor, thanks for your site

I am keen on getting a hair transplant, but i am a little bit worried about the scaring that will occur.

I was just wondering, say i only want a small amount of grafts done, is it possible to get a procedure which will only produce a small scar in length, say one 5cm long on the back of the head rather than one from ear to ear?

Thanks in advance for your reply.

You need to talk with your surgeon, and ask these specific questions and convey your wishes. You do NOT have to have an ear to ear scar. There are options for hair transplantation, such as the FUE procedure, which produces no linear scar.

A shorter length linear scar (5cm long) is possible though, and would obviously yield less grafts than a longer strip. It all depends on how many grafts you are expecting or require. A 5cm length strip might yield anywhere from 300 to 600 grafts (depending upon height of the strip and the density of your donor hair), but this is a VERY general estimate and will vary with each individual.

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

What Happens When a Class 7 Patient Has No Master Plan?

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

BlueprintWithout a Master Plan, a Norwood Class 7 patient can be exposed to the worst of the problems in planning. An unfortunate example of this is a patient with a complex surgical history that I just saw who had three procedures with three different doctors over the past 10 years. His balding pattern was heading to a Class 7 and none of his doctors seemed to understand where he was going with his hair loss problem. This man had transplants that were spread all over in a most unnatural look, with areas left completely untouched. Some hair was placed in areas that should not have received transplants (they weren’t beneficial to the appearance), and he now has a massive scar in the donor area with no significant donor hair left. He asked I not post his photos here, but what are the options for a case like this?

  1. Use beard and body hair transplants to fill in the areas that do not look normal. Fill in the scar with beard hair transplants as well. Learn to use transplants as an aide to styling and hair length needs to be planned. I’m not a fan of body hair transplants (BHT) in the great majority of cases, but his options are extremely limited.
  2. Use cosmetic camouflaging such as Toppik or DermMatch.
  3. Consider scalp tattoos.
  4. Get a wig.

Some people still don’t get why a Master Plan is even important, so think of it as a surgical blueprint that plans for the worst case scenario of your hair loss progression. I can not stress the importance of a good Master Plan. Some doctors made a lot of money from this man, but did him no favors. And as I sound like a broken record, never forget — let the buyer beware!

Tags: hair transplant, bht, hairloss, hair loss, master plan

Hair Transplant Results with No Detectable Scar (with Photos)

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

This patient stopped by my office to show off his remarkable results from his single hair transplant less than 8 months ago of only 1336 grafts in the frontal area. Before photo on the left, after photo on the right; click to enlarge:

 

He also had no detectable linear scar as shown in the photos below. The absence of the linear scar really reflects the patient’s healing ability as much as the surgeon’s skills. I usually don’t take credit for great scars as I always do the same procedure with the same precision on every patient. Interestingly, we elected not to use a trichophytic closure on this patient and the donor scar is still undetectable. Some people just heal better than others. Why didn’t we use that closure technique? Well, he planned on having a 2nd surgery in the future, but his results were so impressive that he won’t need another procedure. Click the photos to enlarge:

 

Tags: hair transplant, hairloss, hair loss, scarring, hair restoration, patient photos

Help with Craniotomy Scar?

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

Hi there,

I’m hoping I can get some guidance on craniotomy scar issue I am having. I am a 27 year old male, and about 6 months ago I had a craniotomy for the removal of a benign tumor which was discovered shortly before the procedure. The surgery went well and all is good now health wise. However, I now have a 6″ long scar that is about 5/16″ wide in the back of my head.

I would now like to address how I can improve the aesthetics of the scar, as I prefer to keep my hair short. The good news is with longer hair (shown in the photo), I am able to cover the scar, but I’d really like to wear my hair shorter. I have visited 2 cranial plastic surgeons and one hair doc in the Bay Area, California. Here is summary of their recommendations on how to improve the scar:

– UCSF plastic suregon: Scar Revision and change scar to a zig zag shape.
– Stanford plastic surgeon: Standard Scar Revision. Advised against doing a zig zag as it would change hair growth directions and “make it look weird”.
– Hair Doc: Standard Scar revision and possibly hair transplant on scar if scar needs additional improvement.

Is it true that changing the scar to a zig zag shape would change the hair directional growth? If that is the case, why would the UCSF surgeon recommend that? Do any of you have any recommendations on the best way to improve aesthetics of the scar? My end goal is to not get rid of the scar completely, but to at least improve the aesthetics of it. I’d appreciate some feedback!

I really cannot give you good, personal medical advice via the internet, so I’d suggest if you’re interested you can see us at our office in San Jose or Los Angeles (the consultation is free). We have transplanted hair into craniotomy scars with very good success. Many of these patients have had scar revisions that failed to resolve the cosmetic issues. You may need more than one transplant depending on the case, the size of the scar, and the location of the scar. Dr. Pak recently performed a FUE/FOX transplant into a craniotomy scar where a zig zag attempt was made. Sometimes a zig zag revision can make the scar worse.

Ask your surgeons for examples with before and after photos. Maybe it will help disguise the scar, but it’s still a scar nevertheless. Hair transplants to the scar does not mean the scar will be removed, but at least there is hair growing “ON” the scar and if there is enough hair in the proper direction, the scar will not easily be seen.

Tags: hair transplant, craniotomy, scarring, scar, tumor

Using Toppik to Cover a Transplant Scar?

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

Hey dr. How are you on this fine day ?

i was just wondering on your opinion on using toppik to camouflage a transplant scar so buzzing hair down to a number 1 would be an option with the addition of the use of a trichophytic closure. would this be a viable route for someone who appreciates short hair?

ToppikI am fine. Thank you for asking.

Some people use Toppik, DermMatch, black marker, or even permanent tattooing with reasonable results. I am not sure if you already have a linear scar or are thinking of having a hair transplant and worried about a scar, but really, successfully camouflaging a scar on the scalp all depends on the scar itself. If the scar is wide (despite a trichophytic closure) a number 1 clipper haircut may still show it somewhat.

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

Transplanting Hair to Cover a Scalp Keloid?

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

I am an African American male age 46 with a keloid on the back of my head which resulted from two surgeries to remove it. Now I have a keloid the size of a strawberry which leaves a bald patch in my hair. Can a hair transplant or hair patch be put in that area to cover it for good? If so will it cause more problems in the future or no?

I often see patients that wish to cover scars (and keloids), but hair growth on this tissue can be less than optimal and patients often require addition surgery to increase the density of hair. In the end, the scar and keloid is still there, but it might be covered with the new transplanted hairs.

Transplanting into keloids, however, also runs the additional risk of making them worse. If you’re known to form keloids on the scalp, then having more surgery (like a hair transplant) could result in more of the same. You already tried to surgically excise the keloid on your scalp and it caused it to grow larger? I don’t think its worth the risk, though without an examination I couldn’t make a definitive opinion.

Tags: keloid, hair transplant, hairloss, hair loss, hair restoration, scarring

Why Aren’t There Photos of Donor Scars?

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

Sir,

I’ve always wondered why photos of hair transplant procedures never include a section of the donor area (elapsed over healing period)? I considered the transplant option years ago but I became very uneasy about scarring at the donor area. I have not seen one photo regarding this part of the procedure at any of the more reputable transplant provider sites. Why? Thank you for your insight.

It’s true that we do not routinely take scar photos, but we have posted photos of scars in the past:

Typically, donor scar will vary in each individual. It can be fine as a pencil-line or thick like the width of your picky finger (rare). Most scars are about 2 to 3mm in width. If you ever had a cut that needed stitches, you can use that as a baseline comparison. Some people are bad healers, some doctors use scar-minimizing closure techniques… so there are factors that can make scarring more or less severe.

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

Would Hair Regrow in a Scalp Scar?

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

(female) I’d had a bald spot since birth, possibly a birthmark and possibly a scar from my extraction. At 20 I had an stapled excision. Now I’m curious, Is hair meant to grow in the area where the staples were, or will there always be a bald line? Is there anything I can do to improve my chances?

The general concept you should understand is that if you have a scar where hair previously existed, regrowth in that area more than likely won’t occur on its own (though it can depend on how the closure method was done). However, transplanting hair into the scar should see growth just as it would if we put it on the frontal hairline area or on the tip of your nose. I’ve performed hair transplants procedures into scarred areas from head trauma, but I’m not sure how big of a bald spot you’re talking about and whether it’d even be worth having a transplant to fix it.

Tags: scalp, staples, hairloss, hair loss, hair transplant

Transplanting Body Hair Into Strip Scar from Previous Surgery

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

Hi! Been reading your blog for quite a while now. I know that you are against body hair transplants onto the scalp, BUT — I don’t want to have body hair transplanted anywhere but into my strip scar. The reasons I saw you give in the past for avoiding body hair transplants were because body hair doesn’t grow out very long, so it would be bad for styling. Well, I would like it transplanted into my scar so I can cut my hair much shorter than I currently can without it being noticeable.

I have looked at my chest hair, and they’re not curly. I plucked out a few and compared them to my scalp hair. They’re quite similar. Is this still a terrible idea? I honestly don’t want to FUE scalp hairs because in case this simply doesn’t work and I end up deciding to just say “Screw it…I’m shaving my head and i’ll live with a visible strip scar,” I would then also have to live with little white dots all over the back of my head. I know, they’re not supposed to be very visible, but I don’t want to add to more scarring on the back of my head. I really don’t.

It’s actually not a terrible idea. I am not against using body hair to repair a scar on the scalp, provided that you realize that the telogen (resting) phase is very long… which means only about 50% of the hairs will be growing at any point in time. I would want to evaluate you first if you want me to do this.

Tags: bht, body hair, hair transplant, scarring, scar, hair loss, hairloss, hair restoration, fue

Trichophytic Closure, Hair Transplant Scars, and Scalp Tattoos

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

Hey Dr. Rassman,

I must tell you that your blog has become an important part of my daily routine and can not thank you enough for your continual work on it. I know you probably have your reserves about this head tattoo procedure, but how about getting it done just on the scars from a HT procedure, it seems like a great way to cover up scars for people who want to shave their heads, especially on the sides and back, where you do not have to worry about losing hair. I am thinning on the top and receding and I am hesitant to get the procedure done on the top of my head in case i ever want to grow my hair out again and continue receding, but at least on my HT scar it makes sense? What are your thoughts? Thanks.

Tattoos can work if they are stippled so that they look like hair, but changes in color of the tattoo can be a real problem (imagine a green tattoo over time). As I understand it, most inks won’t change color, but from the few patients I’ve seen with a tattooed scalp that hasn’t been the case. Be sure to research the tattoo issue, as I’m not that informed about the various inks and methods.

I am not sure if you had a hair transplant and have a scar or if you’re considering a hair transplant and are worried about the scar. In either case, scars can be largely prevented most of the time, but if you have one, a revision of the scar (at least one attempt) should be made. Each case is different, so a good doctor is what you want to have. Ask your doctor about the frequency of scars and the sizes that he/she sees. Consider sending me a photo of your scar if you have one.

The photo below is a 4 year old scar after a single procedure of 2090 grafts done here with a trichophytic closure. There is a scar, but it is barely noticeable, typical of trichophytic closures in my hands. Click to enlarge.

 

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