What is the 2-layer closure and why is it used in hair transplant surgery?
Many hair restoration physicians use a 2-layered trichophytic closure. The deep layer of (dissolving) sutures goes under the hair follicles in the fat layer to close the gap and to reduce tension on the surface. After that layer, I test to make sure the edges will come together easily then remove a 1 mm wide and 1 mm deep ledge from an edge of the incision. That trims just the surface of the skin and the tips of the hairs. Finally, I use fine sutures to bring the edges of the skin together without tension. I remove the surface sutures after 7 days so they don’t leave suture marks.
The trimmed hair will later grow back through the narrow scar. For the first 6 months, I suggest that patients keep their hair at least 1 inch long but after that most can hide the scar with hair cut with a #4 clipper (1/2 inch long). Some can go shorter but I can’t promise that up front.
Scoring-blunt dissection is a method I developed to preserve as much hair as possible along the edges of the incision.
Dr. Cam Simmons
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