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This question comes from a member of our Hair Loss Social Community and Discussion Forums:

Several years ago, I underwent a follicular unit transplantation (FUT) procedure that, unfortunately, resulted in a significant “strip scar.” Now, I’d like to undergo hair transplant scar revision and I’m wondering what options are available?

In my opinion, hair transplant scar restoration (currently) breaks down into three categories:

1. Undergoing a scar revision procedure

During a scar revision procedure, the previous “strip scar” is excised in the same manner as strip removal during a follicular unit transplantation (FUT) procedure. After the scar is removed, a secure closure, likely a trichophytic closure, is utilized and the new wound, presumably, heals with less scarring. The most significant “down side” associated with this procedure is the potential for another unacceptable scar if the patient is prone to scarring. However, most talented hair restoration surgeons should be able to create a better closure and greatly improve upon the original scar.

2. Filling in the scar with grafts via follicular unit extraction (FUE)

During this procedure, grafts are extracted (via the follicular unit extraction process) and implanted directly into the scar. Although this procedure does not result in a second FUT scar, implanting grafts into scar tissue (which is generally thick and plagued by poor blood supply) can result in a lower yield and inability to fully camouflage the scar.

3. Camouflaging the scar with scalp micropigmentation (SMP)

Recently, recommended hair transplant surgeon and follicular unit extraction (FUE) specialist Dr. Sanusi Umar shared a presentation about leg hair transplants (body hair transplant) at the 2011 American Society for Dermatological Surgery (ASDS) annual meeting.

As a hair restoration surgeon, Dr. Umar is well known for his ability to successfully extract and implant hair grafts from alternative (non-scalp) sources during extreme hair transplant repairs. Although he’s frequently utilized body hair grafts from the beard, chest, and armpit regions, the ASDS presentation focused on the use of leg hair grafts during hair transplant repairs.

To demonstrate the validity of these grafts, Dr. Umar presented a repair patient who underwent a 1,000 leg hair graft procedure. Utilizing hair solely from the patient’s legs, Dr. Umar repaired a harsh, unnatural hairline created during a previous hair transplant surgery.

Two years after the repair procedure, Dr. Umar showed the leg grafts recreated a soft, natural hairline and permanently transformed the patient’s appearance. According to Dr. Umar’s blog, the leg hair graft’s natural fine caliber and ability to create a “soft,” gradual appearance makes them an ideal choice for transplant repair procedures.

Congratulations Dr. Umar!
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Blake – aka Future_HT_Doc

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

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This hair restoration article was written by recommended hair loss physician Dr. Carlos Wesley, who is recommended on the Hair Transplant Network.

Factors Influencing Postoperative Hyperesthesia (Discomfort)
in Hair Restoration Surgery

Summary

Background While esthetic outcomes in hair restoration surgery (HRS) have improved markedly since the advent of follicular unit transplantation (FUT), various undesirable sequelae persist. We investigated the technical and demographic variables that may contribute to the frequency of postoperative hyperesthesia.

Methods A multicenter retrospective chart review involving 552 patients undergoing HRS from 1999 to 2009.

Results A total of 19 patients (3.4%) reported postoperative hyperesthesia in either the donor or recipient area of their scalp. Although many trends emerged, one variable significantly influenced the rate of this neurosensory symptom. While no patient who had all previous and current HRS sessions performed entirely within the same investigated surgical practice (n = 42) experienced postoperative hyperesthesia, 14% of our patients who underwent prior HRS by a physician outside of the investigated surgical group (n = 35) developed this complication (P = 0.0404). The amount of intraoperative electrocautery to maintain hemostasis (P = 0.0897), degree of tension upon donor wound closure (P = 0.3044), and extent of donor wound edge undermining (P = 0.4420) influenced the frequency of this sequela to a lesser degree.

Conclusion These results suggest that physicians planning repair sessions on patients who have undergone prior HRS by a physician at a different surgical center should include the specific caveat of increased incidences of postoperative hyperesthesia in their preoperative consultation.

According to the American Society for Aesthetic Plastic Surgery, the facelift, (rhytidectomy), is the sixth most popular elective procedure performed today.

Although the procedure is very common and usually offers significant cosmetic benefit, it is associated with one infrequently discussed side effect: the post-operative loss of “sideburns” and hairline distortion in female patients.  Females who undergo this procedure often consider surgical hair restoration to correct this.

During the facelift procedure, an incision is made in front of the ear (in the temple/sideburn region) and extended into both the hairline region and the area further behind the ear itself. Afterward, the skin is separated from the deeper tissues, tightened, and pulled until taut. Although this maneuver pulls the skin tight and creates a more “youthful” appearance, it also results in an excess of tissue that must be excised.

Unfortunately, because the initial incision is made in the sideburn and hairline area, the last step of the procedure involves the removal of the excess, hair-bearing tissue from this region. In various cases, this results in a total removal of the sideburn hair and an unnatural appearance of the hairline (which can be caused by scarring or a distortion of hairline shape or height).

Fortunately, although this side effect often discourages post-operative facelift patients, the damage can be reversed and reconstructed with modern hair transplant surgery.

This below question was asked by a member of our Hair Loss Social Community and Discussion Forums and answered by Janna, the lead medical technician for Coalition hair restoration surgeons Dr. Ron Shapiro and Dr. Paul Shapiro.

I’m undergoing a hair transplant procedure in the near future, and I’m wondering if I should get a haircut before surgery? Is it best to “shave” my head? How short should it be cut?

Blake – aka Future_HT_Doc

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

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Technorati Tags: Hair Loss, hair restoration, Dr. Ron Shapiro, Dr. Paul Shapiro, hair transplant, haircut, follicular unit transplantation, FUT

This question comes from a member of our Hair Loss Social Community and Discussion Forums: 

I recently underwent follicular unit transplantation (FUT) and I’m worried about post-operative scar stretching. I’m curious, could Botox injections help prevent the potential hair transplant scar stretching?

In my opinion, this wouldn’t work. Botox is a purified form of Botulinum toxin, which is a well studied muscle paralytic. Botox, when used for cosmetic purposes in the face, “relaxes” facial muscles and decreases the wrinkled, furrowed, aged appearance associated with excessive muscle contraction.

During follicular unit transplanation (FUT) the depth of the “strip” removed from the donor region goes to the dermis and (likely) slightly into the deeper subcutaneous fatty tissue, but stays superficial to any muscle tissue (which in that region of the scalp is likely to only be the occipital region of the occipitofrontalis muscle).

Because scar tissue forms from the more superficial layers and not the muscle tissue, providing an agent that would decrease potential contraction from the muscle, but not necessarily the overlying tissues, really would not prevent excessive stretching. Furthermore, injecting botox into muscles in the back of the scalp would result in unwanted muscle paralysis with no cosmetic or anti-spastic benefit to the patient.
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Blake – aka Future_HT_Doc

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

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This question, asked by a member of our Hair Loss Social Community and Discussion Forums, was answered by Coalition hair transplant surgeon Dr. Glenn Charles:

I am over a year post-op from a disastrous facelift by a ‘top’ UK surgeon who surgically removed my sideburns without my consent and elevated my hairline above my ears. It’s difficult to find anyone with significant experience of female sideburn reconstruction. There are just a few pics on the Internet and it’s the same few pics constantly circulating.

Some hair restoration surgeons appear to have fantastic results with female sideburn reconstruction using follicular unit transplantation (FUT) but I am a bad candidate for strip surgery as I already have a .8 x 7cm bald strip on my head courtesy the facelift surgeon where he pulled too tight and the scar stretched. My hair fell out and I now have this bald strip. Coupled with the loss of sideburns, I have lost a lot of volume and my hair was thin and fine to begin with so I cannot risk a stretched scar from strip.

I recently had revision surgery to try and minimize the elevated hairline (flap rotation and temple redraping) and to excise the bald strip but this, unfortunately, failed. The bald strip simply stretched again resulting in yet more hair loss and the rotation had no impact on the elevated hairline. My only option now is limited to follicular unit extraction (FUE) and I really need to get it right as the emotional and financial impact continues to devastate me.

This question comes from a member of our Hair Loss Social Community and Discussion Forums:

I began investigating hair transplant surgery and the possibility of shaving the back and sides of my head to a “zero” (very close cut) after the operation. I’m wondering, will an ultra-refined follicular unit transplantation (FUT) scar be visible at this hair length? If so, is follicular unit extraction (FUE) a better option?

At a “zero,” even the best, most “pencil thin” follicular unit transplantation (FUT) scar will be visible.

However, keep in mind that while scarring is very, very minimal with follicular unit extraction (FUE), I wouldn’t be surprised if you could see some scarring in the donor region with a “zero buzz” post-follicular unit extraction as well.

Obviously the type and overall visibility of the scarring will be different, but at this point in time, both these techniques are surgical procedures and will leave “some” type of scarring.

However, if you are an acceptable candidate and do plan on wearing your hair very short, FUE may be a better option. Consulting with a talented hair transplant surgeon will help evaluate your FUE eligibility.
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Blake  – aka Future_HT_Doc

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

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Technorati Tags: Hair Loss, hair transplant surgery, follicular unit transplantation, FUT, hair length, follicular unit extraction, FUE, hair transplant surgeon

This question comes from a member of our Hair Loss Social Community and Discussion Forums: 

I recently underwent hair transplant surgery and the physician recommended I complete several laser treatment (Low Level Laser Therapy or LLLT) sessions after the procedure. Is this necessary? Will it help with post-operative growth and healing?

Laser treatment (sometimes known as Low Lever Laser Therapy or LLLT) is a pretty controversial topic in the hair restoration community. Some believe it is a valid therapy for stimulating follicular growth and aiding in post-operative healing, while others think it is simply ineffective and not recommended.

Frankly, I’ve seen some pretty convincing evidence that LLLT is not an effective hair restoration treatment. Furthermore, I have not been presented with conclusive or persuasive counter-evidence refuting these findings.

Regardless of whether or not you believe LLLT is effective, one thing is certain: our network hosts thousands of hair transplant cases from patients who have undergone surgery without adjunct laser therapy and still manage to achieve excellent results. For me, this is the most convincing proof that surgical hair restoration can stand alone as a restorative therapy without LLLT. Personally, I’d feel comfortable moving forward with this information.

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Blake – aka Future_HT_Doc

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

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This hair loss question was answered by  Dr. Scott Alexander of Phoenix, Arizona who is a member of the Coalition of Independent Hair Restoration Physicians.  His professional answer is below.

Any current studies on lifting weights after hair transplant surgery? The answers are all over the place on the forum. I’m guessing light lifting and cardio after suture removal and high intensity training after 3-4 months as long as I don’t feel any stretch. When are most weight lifters able to safely train heavy free weights including shrugs and abdominal exercises without stretching the scar? I’ve read as long as 6-12 months. My last procedure was about 8 years ago and the doctor allowed me to train after suture removal. I didn’t have any issues from what I remember. I’m guessing hair restoration procedures have improved since then.

I don’t know of any studies regarding hair transplants and heavy weigh lifting. I can only speak from past experience in my practice. I allow my hair transplant patients to resume normal activities along with exercise and weight training 7 days post op. If they are in competition or doing extreme weight lifting I suggest they wait until 14 days post op.

There is no stretch in the scalp with lifting weights. You get a lot more stretch from looking down and putting your chin to your chest. If you do that and it feels tight, then avoid those positions. Otherwise go for it and lift as much as you want.