This question was posed by a hair loss sufferer seeking hair loss help on our hair restoration forum and answered by Dr. Ricardo Mejia of Jupiter, FL who is one of our recommended hair restoration physicians. His professional answer is below.
I will try to summarize my thoughts on the issue of scar stretching for you:
1. Scarring is a risk factor with any surgery even in the hands of a first-rate hair restoration physician and even when we try to minimize the risks, it happens. Yet they can also be the fault of the hair transplant doctor. In some cases hair transplant surgeons have overestimated the elasticity of the scalp and the wound tension was too great after donor closure. There are ways for hair restoration physicians to measure scalp elasticity.
2. Trichophytic closures help minimize the appearance of scars by getting hair to grow through the scar to camouflage it. However, the donor scar can still stretch.
3. Stretch scars are blamed or presumed to be an unknown genetic variation of Ehlers-Danlos syndrome (EDS), but never proven in hair transplantation. True Ehlers-Danlos patients have hypermobile joints and very elastic skin among other things. We generally assume this if we can truly find no other reasons for the wide scar and thus truly inexplicable. However, hair transplant patients have no other signs or symptoms of Ehlers Danlos syndrome (EDS). Assume it is true that 50% of EDS patients can touch their nose with their tongue. This does not mean that if you can do it, you have a 50% chance of having EDS. There is no data to suggest this.
4. There are many ways to minimize the tension on a wound site. Do not make too wide of an incision and remove too wide of of a strip. With larger hair transplant megasessions above 3000 grafts, you have to excise longer and wider strips. Remember its purely mathematical. If a hair restoration patient has an average density of 80 follicular unit grafts per cm2, you need 30 cm2 for 2400 grafts and 50 cm2 for 4500 grafts. For an average excision length ear to ear of 25 cm long, you will need a 1.2 cm width strip for 2400 grafts and 2 cm for 4500 grafts ( assuming a pure rectangle). In general, A 2 cm strip on the same hair transplant patient will have more tension than a 1.2 cm strip.
5. Undermining or loosening the skin after the strip has been removed and internal sutures can help reduce the wound tension. There are different methods to try to minimize theses risks, but that would be a much longer post.
6. If you have a stretched scar that is of concern it may be worth excising only the scar and not trying to combine it with another hair transplant megasession. However, in some cases the stretch reoccurs despite minimal tension.
7. Excision of the donor strip too low ( below the occipital protuberance or the bump or ridge behind your head) has been observed by some to result in higher stretched scars.
8. Every hair transplant clinics has created scars that are great and hardly noticeable and some that are not so great.
9. Looking at previous scars, from knee injuries appendectomies, or others can give me a clue if a patient has prior stretch scars. In my consults I point these out and explain stretch scars are possible. I explain the limitations of hairstyling and coverage and the potential future impact of extracting more donor area.
10. Any time you cut through the skin, a scar of some sort forms. Even with follicular unit extraction (FUE) / follicular isolation technique (FIT), hair grafts without strip excision you can notice the mottled scars in some cases. The risk gets higher as the number of grafts extracted increases.
In the end, hair transplant surgery is a risk and we have ways of minimizing the risks. Hope this helps to answer your questions.
Dr. Ricardo Mejia
Technorati Tags: hair loss, hair loss help, scar stretching, hair restoration, hair transplant doctor, hair transplant surgeon, donor closure, hair restoration physician, Trichophytic closure, donor scar, Ehlers-Danlos syndrome, hair transplantation, hair transplant patient, hair transplant megasession, hair restoration patient, follicular unit grafts, hair transplant clinics, donor area, FUE, follicular isolation technique, FIT, hair grafts, hair transplant surgery