Hair Restoration Blog

Q:

Thanks Dr Mohebi,

for your time and information, really appreciate it. I have seen a neurologist who gave steroid shots and a pain management Dr who gave an occipital nerve block, neither worked. Had Botox injection into the area also. EMG and neck MRI tests didn’t show anything. Is the donor incision sometimes deep enough to damage muscle such as the occipital muscle or trapezius? Deep enough to damage the fascia tissue?

thanks again,

A:

It seems like you have done the proper work up for evaluation of your donor scar complication. If a hair transplant is done by a skilled hair transplant surgeon it should not be that deep to injure the fascia. In most patients it is easy to find the subcutaneous fat, which is our safe zone. Even if the fascia is injured, it should not create such a problem. The area of the strip is generally much higher than the levels of the neck muscles. Injury to the muscle and fascia should not cause any such feeling without involvement of the nerves.

I cannot imagine anything except the nerve damage to be the cause of your current problem. I occasionally have seen patients with some unusual sensation after old surgeries that get better when they get a repeat hair transplant. The reason for the improvement is that the hair transplant surgeon removes the scar and by doing that can release the adhesion of scar of first hair transplant and underlying tissues including the nerves.

Q:

Dear Doctor,

I had a hair transplant at another clinic, X Medical, 8 yrs ago. The donor area was 1 strip 1 inch wide, 4 inch length, going diagonally from the occipital protuberance bone towards the right ear.

When I woke up the day after the procedure, I could tell something was really wrong. The whole back and right side of my head was really tight. It felt like the scalp was being pulled backwards, mostly on the right side. It hasn’t changed to this day and its constant. It’s a crippling feeling and I’ve been having problem with it since then. I understand there could be some tightness from removing the donor area. But this is something different than just tightness or scalp stretching; it’s a whole other type of problem in the tissue under the scalp surface. The clinic said the tightness should go away after awhile but hasn’t given me any possible solutions or possibilities.

I thought I might get some answers by contacting other hair transplant doctors who do these procedures frequently and who know the anatomy of the head. It would be so helpful if you could try to give me an idea of what could have happened or went wrong.

Thank you for your time,

A:

Hi,

This is an unusual condition that I have not seen or heard. The donor skin tightness usually improves in two to three weeks following a hair restoration surgery with strip technique. However the numbness and tingling around the donor incision may continue for a few months due to violation of the very small superficial branches of nerves of the donor area.

Although removing the donor strip may look simple, it should be done meticulously. The best method of removing the strip is to trace the skin on the back superficially while having a good control on the depth of the incision and then remove the right thickness of the scalp skin. We follow this procedure religiously at the Los Angeles hair transplant offices of US Hair Restoration. The incisions should be done within the subcutaneous fat layer, which is the safe zone with minimal chance of injuring the main sensory nerves of that area.

Since you have an unusual sensation on the back of head, you need to be evaluated by a physician for confirming your diagnosis. I have not examined you, but one of your sensory nerves might have been injured during the strip removal. Mild nerve injuries recover within a few months with complete return of the sensation. More serious injuries may leave patient with a numb area or a sense of tingling or tightness for a longer time or permanently. This complication is generally rare, but may be seen in any skin procedure that involves making incisions around the sensory nerves. If this is the right diagnosis and you are experiencing a phantom pain or sensation due to injury of a nerve, a pain specialist might be able to help you with the injections of some medications into the local nerve to block the irritated nerve.

We have discussed different methods to repair hair transplant donor scar in the past. There was an interesting article in Dermatologic Surgery Magazine last months on repairing the wide donor scar using body hair by Dr. Robert Jones from Oakville, Ontario, Canada.

Dr. Jones has reports revising a wide donor scar after previous hair transplant surgery by body hair transplant. He uses chest hair removed by follicular unit extraction method using a 1mm punch device. He has transplanted the grafts directly into the scar area so follicular unit grafts did not have to wait more than a few seconds.

Three months post-op follow up pictures were shown with some hair growth on transplanted donor scar with some reasonable coverage. The growth of the transplanted hair is not completed before 6-8 months after hair transplant and it is expected to see better coverage by the end of that period.

I have had a presentation on revising neurosurgical scars using hair transplant with follicular unit transplantation in the annual meeting of International Society of Hair Restoration Surgery in 2007. In that meeting, I presented four patients who underwent hair transplant surgeries to revise the widened scar of their neurosurgical scars. The results of the hair transplant on those patients were great and the appearances of the scars were completely vanished in all four of them.

Again the current article by Dr. Jones proves that hair restoration could be used effectively for improving the appearance of scalp scars. My personal preference and the method that I use in our Los Angeles hair transplant clinics is to use scalp scar rather than body hair unless patient’s donor area is completely depleted and there is not enough harvestable hair on the donor area. In those cases body hair transplant could be an alternative if patient have good quality body hair for a body hair transplant through FUE (Follicular Unit Extraction).