Dear Dr Rassman,
I recently had about 420 grafts put into a scar that was about 10mm wide and 100mmlong. Some of the hairs that were implanted in there (this is from about 4 months ago) are still in there. They haven’t grown, and are just sitting there..they are bent as well, where the growth has stopped. What does this mean?

Also, I keep getting scabs in the scar tissue where the hair was implanted. Would this be because my body is trying to remove those hairs that have not shed(but not growing), and does hair that grows in scar tissue cause the scar to scab, when breaking through the scar? Also, I was told i’d have to wait 18-24 months before most of the growth. Do you agree with this?

thank you

First and foremost, I would go back to the doctor who performed your surgery for a recheck. He/she should be able to answer your questions more specifically as it relates to a procedure they were a part of and know more about your overall health.

On average, it takes 6 to 12 months for hair to grow. Hair growth in scar tissue tends to be slightly slower than in non-scarred tissue, and in general, it is thought that hairs transplanted into scars do not grow as well as hair transplanted to normal scalp/skin. There is no study to prove one way or the other if that is true, though. In a few cases where I transplanted a small number of grafts into a scar and counted them at full growth, 100% of what I put in grew.

Dear Dr. Rassman,

In one of your previous posts, you said that a scar from a strip surgery will be at about 80% of healing after 6 weeks. From that logic, I wonder if keeping the staples longer after a strip surgery (for 6-8 weeks, rather than the usual 14 days for instance) would help in getting a better scar…

I know that for practical and cosmetic reasons, keeping the staples longer can be problematic for many people, but in special cases where there is more tightness due to past surgeries (or a history of enlarged strip scar) wouldn’t this be a good solution to help getting a finer scar?

Or, would this in return create other problems such as:

1-skin growth around the staples?
2-Train marks?
3-Shock loss around the scar?

Thanks for your help

Scar formation and wound healing is not that simple. Aside from the technical aspect, everyone heals differently and scars differently. Leaving staples in for about 10 to 14 days is what we generally do. We leave the staples in for up to 21 days in some patients. Sometimes leaving staples in longer will cause the familiar Frankenstein or train track marks (as you state).

In the end there is no universal solution to closing a tight scalp. One solution does not fit all patients and it is up to the physician to address it on his/her individual basis. I know this may not be what you are looking for, but it points to the fact that sometimes there is just no specific answer. Leaving the staples in for 6-8 weeks will cause undo pain in most patients.

Hello Dr.Rassman,

Is it true that during the second transplant, the physician can cover the first scar that was caused by the first transplant? I would like to do a second procedure but do not want to have multiple scars as well as one BIG scar. Also, is it true that a scar from the transplant will be visible as the person ages and the hair in the back of the head gets thinner? One last question, can shock loss (loss of hair due to transplant) occur for already transplanted hair when a person undergoes a second transplant.

Thank You for your time

The state of the art today is to limit transplanted scars to just one, even with multiple surgeries. If, for any reason, the scar gets wider (5-10% of people) then a single scar can often be corrected in a special surgery that addresses the need for a scar revision. Some surgeons go into untouched areas of scalp and intentionally produce a ‘step ladder’ set of scars which accomplishes two things: (1) a higher yield of hair, and (2) more dollars for the doctor’s pocket. I generally believe that step ladder scars produce a more unsightly look and can not be fixed easily while a single scar is easier to manage in the long term.

I personally had two hair transplant surgeries 16 years ago and you can barely see my scar and it has not changed (as typical) since the last surgery that had been done.

Your last question addressed shock loss in previously transplanted hair. It is very, very rare and if it should occur (less than .01% of cases) it always returns.

How come some people’s scarring on the back shows up so noticeably, and others don’t? Does it all depend on how many grafts you use?

Scarring is a complex problem related to:

1. The healing properties of the patient
2. The size of the strip
3. The techniques used at the time of the surgery
4. The skill of the surgeon

We are all different, so assuming you compare 100 of my patients (where I did all of the surgery) that only received 1000 grafts, for example, the variation in healing will become evident, assuming that the exact same technique was used on each closure.

When I performed general surgery and did an appendectomy, I used to brag how wonderful my scars were, and how you could rarely find them. That was the case in 19 out of every 20 patients. The 20th patient would be excluded from my bragging. Get it?

I look at pictures of other patients that have a strip scar and my seems to stand out a lot more than the ones I see. Even if I shave my head on the longest of length it shows up. Is there anything I can do to make it smaller, like having it redone for a tri-stitch?

Without seeing you it is difficult for me to tell you what to do. There are scar revisions that can be performed with trichophytic closures that might help you. For more on that, see:

• Techniques to Minimize Donor Area Scarring
• Where’s the Scar? Hair Transplant of 1807 Grafts (with Photos)
• Result from Trichophytic Incision (with Photo)

The problem is that in some people who stretch scars, the scar tends to return… so that is a risk in undergoing a scar revision surgery.