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Although modern hair transplantation is normally considered a very effective and minimally invasive procedure, one element continually dissuades and disappoints patients: the hair transplant scar. However, through the guidance and skill of a dedicated hair restoration surgeon, hair transplant scars can be efficiently managed. Below, recommended hair transplant surgeon Dr. Parsa Mohebi discusses scars and explains how to manage this obligatory surgical side effect:

How to Manage a Hair Transplant Scar

Hair transplant scars can be a concern for many hair loss sufferers considering a hair restoration procedure.  We continue to see a lot of patients in our office whom require a procedure to revise their old hair transplant donor scar.  Some of these patients come for another procedure to increase the hair density or restore other areas of their scalp which was initially covered. Others may only need a surgery for hair transplant scar revision.

Often times these are patients who received a hair transplant back when the newest technology in hair restoration did not offer adequate solutions for dealing with post-surgical scar appearance. Many of these patients were forced to keep the hair on the back of their head long to conceal the remains of their original procedure.

Hair transplant donor scar revision could be performed through several methods based on the qualities of hair transplant scars such as their location, shape and size.  Patient hair styling preference also plays a big role in choosing the proper surgical procedure.

Although follicular unit extraction (FUE) is an exciting, highly demanded type of hair restoration surgery, not all hair loss sufferers are appropriate candidates. Knowing this, hair transplant patients may wonder what characteristics make an individual a “good” or “bad” FUE candidate?  Below is a response from Coalition hair transplant surgeon Dr. Alan Feller, discussing FUE candidacy and explaining what it takes to be a “good follicular unit extraction patient:”

Years ago when FUE first came out and was incredibly over-hyped there were indeed some clinics that claimed all patients were candidates. Those clinics now no longer make that wildely inaccurate statement publically, or they are now flat out of business. And well they should be.

FUE is a very traumatic procedure on delicate human tissue. Some people’s physiology will allow for it, some will not, but most fall somewhere in the middle. That’s just a fact bourne out of time. Just look at the number FUE results posted over the years compared to follicular unit transplantation (FUT) results and that conclusion is obvious.

There are a number of techniques to decrease FUE graft trauma and increase yield, however none represent the “magic bullet”. 

Some patient’s skin are too mushy, brittle, or hard to allow for safe removal of the grafts. So follicular units themselves are just to splayed or wide to allow for safe removal. That’s the reality of the situation and one the doctor MUST by LAW share with every patient who requests FUE procedures.

I had a hair transplant around 4 months ago. Since the transplant I’ve had an itchy scalp and sometimes it gets very bad where I have to scratch.

I also have some pus filled cysts in random areas of my transplanted scalp. My hairs are growing but a lot of them are starting to fall. Is this normal or what should I do?

Itching is perfectly normal for the first weeks/months after hair transplant surgery as are pimples. While pimples can be very uncomfortable, they are typically seen as a good sign that there is hair growth happening below the skin. However, it’s always best to discuss your concerns with your hair restoration physician. Severe acne or folliculitis may need to be treated with an antibiotic.

At 4 months post-surgery most, if not all, of your transplanted hairs should have shed already. It’s normal for your hair to appear thinner during this time. These hairs will begin to grow back along with the transplanted hair follicles between three and four months post-op.

Some products that may help with itching and irritation of the scalp are, aloe vera gel, moisturizing conditioners and a quality dandruff shampoo like Nizoral.

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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

Follow our community on Twitter

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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

Follow our community on Twitter

Watch hair transplant videos on YouTube

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.