This hair loss question was answered by Dr. Damkerng Pathomvanich of Bangkok, Thailand, who is a member of the Coalition of Independent Hair Restoration Physicians. See his professional answer below.
Just over two weeks ago I had a hair transplant with Dr. Pathomvanich in Bangkok. I’m a VI on the Norwood Scale and I got 3700 grafts. The procedure went well. I had little pain or swelling and my scar is healing well.
My question is; if the first hair restoration surgery had few to no complications, can I expect that of a second procedure? My surgeon tells me he creates a second scar. Experience has taught him to leave the first one alone. Is this a normal/standard procedure? I am definitely going ahead in a year’s time with a second hair transplant. That was always the plan. I’m just trying to be as well educated as possible beforehand.
There’s no doubt that one scar is the best for multiple hair transplants. However, subsequent sessions make the single scar wider depending on the width of the strip that is excised. A 1cm width strip will leave a minimal or invisible scar on average, whereas a wider strip will leave a bigger scar. The outcome of a single scar after two follicular unit transplant (FUT) procedures usually results in a donor scar that is wider than the original since the total width is doubled, more or less.
Excising the scar from the first hair transplant is not easy since the hair follicles within the scar are not aligned in the same direction as normal hair follicles since they are embedded in scar tissue. Even with trichophytic closure, the hair follicles within the scar are in danger of transection. Careful dissection is very important to avoid damage to these follicles even though I use my open technique with the aid of skin hooks. I still have a hard time in some cases to try to dissect the follicles that are within the scar to avoid transection, since the hair direction of the follicle is distorted due to fibrosis. If we excise the strip and the scar is included at the center it would be much easier, in the same manner as if we avoided dissecting inside the scar. However, slivering a strip inside the scar is more difficult. When you encounter the scar, there is the potential for follicular transection.
In my opinion, if the scar is invisible, why bother to incise the same scar causing more potential for follicular transection. If we make a second scar, we do not encounter the old scar and there will be less potential for transection. If the patient needs further sessions, the two scars can be incorporated into one.
If the scar from the first hair transplant session is a little bit wider, I will use a single scar by excising the first scar and incorporating the scar inside the strip to prevent an even wider scar when it heals.
I always discuss with my patients prior to surgery whether they would want a single scar or two scars. Whether to do one or two-scar strip is still a debate. However, the majority of hair restoration surgeons as well as patients will select a single scar, if possible. The majority of my patients still have a single scar after subsequent sessions.
Dr. Damkerng Pathomvanich
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