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This insightful article was written by  Dr. Pathuri Madhu  of Hyderabad, India  who is one of our recommended hair restoration physicians.

Regarding hair transplant scars, I would like to add some scientific insights in this context.

The width and thickness of the hair restoration surgical scar depends on the following factors:

1. Nature of the patient’s scalp.
2. The physician’s surgical technique.
3. The surgeon’s skill.

The nature of scalp (skin) varies from person to person. No two patient’s skin will be identical in every parameter. In 50-70% of the skin’s nature, irrespective of the surgical technique used  and skill of the surgeon, the wound heals very well leaving a negligible scar. But some skin textures are too lax or too tight.   Thus, some unpredictable skin conditions will definitely produce a visible scar regardless of the surgeon and whatever  technique is incorporated. This accounts to 5-10%. If the scalp is very thin and very lax, it tends to produce a wider scar. Scalps of African type / Black scalps produce thicker scars even leading to keloids. Some scalps can be very tight and become difficult to approximate. They also appear wider after healing.

All these wider and thicker scars account for less than 10% of cases. More than 90% of the patients will be happy with minimal evidence of scarring. That is the reason why even the earlier versions of hair transplantation  gave beautiful scars without adapting the trichophytic closure  or any other state of the art techniques.

Regarding hair replacement surgical technique, the latest technique called the trichophytic closure has definitely minimized the width of the scar satisfying more than 90% of the patients.   Because of this technique you can even expect some hair growth through the scar.

A surgeon’s skill also plays a role in defining the hair transplant scar.   Skill can be evident and appreciated better by another hair restoration surgeon by simply watching the surgery performed live or even from immediate post-op pictures. Mainly, the performing surgeon should not take bites so tight as to compromise the vascularity in that region.

All these above mentioned things are mostly related to the Indian skin types. Sometimes it even holds true for other white races also.

Note: a hair transplant scar takes at least  one year to completely mature and only then should it be  analyzed and evaluated. Moreover, a photograph may show surrounding postsurgical telogen effluvium or shock loss in the first few months giving an appearance of a wider scar.

Most of the time,  a session of 2000 follicular unit grafts provides a smaller scar when compared to a session of 4000 on the same patient  because of additional tension on the wound due to a wider donor excision.   A second hair replacement procedure always produces a wider scar than the first one.

Dr. Pathuri Madhi

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Bill Seemiller
Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum
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