I have a very wide scar from a previous hair transplant, well over 7mm in places. It’s only ear to ear so I understand that grafts might only be available at the sides of my head since remaining donor is probably nonexistent in the back. I am also wondering if a qualified hair restoration surgeon could just take grafts from above my scar and close it up without removing the old scar. I keep my hair long enough to cover it anyway. To me, this is preferable than losing grafts that I need in the hairline.
The decision to revise an old hair transplant scar or to take a new strip depends on many factors. I prefer to revise scars whenever possible because it usually allows improvement in both recipient and donor areas. Particularly for younger patients or patients who could face donor hair limitations, I usually recommend revising the scar and getting fewer grafts in this session so that there will be less donor scarring and more hair available in the future. There are times when it does make sense to remove a new strip, away from the old scar. Usually slow and steady wins the race but decisions must be made on a patient-by-patient basis.
A new narrow scar created too close to an old scar can create the appearance of a wider scarred area. The old scar can tether the skin and cause the new scar to be wider. Usually 1 cm is a safe distance away from the old scar but the hair between the 2 scars becomes unavailable for future hair transplants because it is needed to hide the lower old scar.
Successful scar revision surgery depends on the location of the old scar, the width of the scar, the patient’s scalp laxity, the patient’s own healing characteristics, and the surgical technique. A mobile area, a very wide scar, or a very tight scalp may make it so that there is not a good chance for successful one-time scar revision. Sometimes serial revisions may work or sometimes it is best to abandon the old scar and take donor hair from elsewhere.
Fortunately, with the advancements in donor closure techniques in the last 5 years, fewer hair replacement patients in the future should have to deal with wider scars but it is important that we do our best to help patients who already have wider scars from past procedures.
Cam Simmons MD ABHRS