Hair Restoration Blog

Donor Scar left behind from a previous Hair Transplant Procedure

Q:

Hi,

I had an FUT procedure done a little more than 5 months ago which left a scar in the donor area at the lower left-rear of my scalp.  The FUT was meant to bring out and define my front hairline.  Can your FUE procedure cover this up as I always prefer to wear my hair short (almost military fade short)?

Also, I was wondering if it\’s possible to increase the density of my new hairline with FUE as the hairs appear to be positioned farther away than my natural hair which makes it look as if I\’m thinning at the front.  I live in San Diego, CA and am interested in your Orange County facility.
Please help.

Thanks,

A:

FUE (follicular unit extraction) can easily be used to bring more hair into the donor scar area to improve the visibility of the donor area.  However, there are other techniques that could be used to help with this condition.  First, you need to be seen by a hair transplant surgeon and be examined for the donor scar type that you have and the quality of your hair in front. In addition, you hair characteristics need to be determined as well.

Many people who need more hair in larger areas can have another strip surgery to respond to that need while removing the old scar and closing it with either one or two sided trichophytic closure. This option can minimize the appearance of the hair transplant donor scar while giving you an adequate number of hair to cover the front or balding areas.  It is also more affordable.  I have seen wonders with this technique.

People who have a stretched scar from their previous hair restoration surgeries can benefit from Botox injection around the scar of surgery after their repeat surgery.  There are reports of improvement in the size of the scar with the Botox in some patients.

If your scar is still visible after doing all those techniques, you can use an FUE transplant to fill the scar in with follicular unit grafts and improve it even further.  You have to understand that none of these techniques eliminate the scar, but they can improve its appearance significantly.

Q:

Hi Dr. Mohebi,

What do you think about this topical scar gel called Kelo-cote for my hair transplant donor scar?

A:
Kelo-cote® is one of the many topical products that is used along with other methods of wound closure or by itself to improve the alignment of the wound in the early stages of wound healing.  Advanced Bio-Technologies, Inc. has developed this wound product, which can maintain the benefits of silicone gel sheets while eliminating the limitations associated with their use.

Kelo-cote® is a topical silicone gel that is used for the management of scars and for the prevention of abnormal scars in the form of hypertrophic scars and keloids. Kelo-cote® is claimed to be beneficial for a variety of scars resulting from trauma, surgery and burns.

Kelo-cote® gel dries to a waterproof sheet that is gas permeable and acts like an extra layer of skin. This wound care product can help to soften and flatten the scar of skin wounds.  Although Kelo-cote has been anecdotally reported to be useful for the donor scar from hair transplant surgery, there is little significant data to prove that claim.  I personally believe that the maturation and stretching of the scalp wound takes a long time after wound closure and post operative care using this type of wound products may not significantly impact the final appearance of the donor scar.

I just gave a lecture on a new application for Laxometer in mega and giga session hair transplants in the annual ISHRS (International Society of Hair Restoration Surgery) meeting in Amsterdam, Netherlands.  As we presented the Laxometer in the prior hair restoration scientific meetings, Laxometer can make us capable of increasing the precision of strip removal method of follicular unit hair transplants while minimizing the risk of donor scar complications.

This year, I presented a new application for Laxometer for its use in patients who have limited laxity of the scalp due to prior hair restoration surgeries or for those who require a maximum number of grafts in one session (3000+, 4000+, 5000+ and so forth).  I performed a research in US Hair Restoration last year in which we removed the strip in sequences for hair transplant surgeries using Laxometer before and after removal of each section of the strip.  This method has increased the safety of the strip removal while decreasing the risk of donor wound complications.

The result that was presented in the ISHRS meeting indicated the effectiveness of Laxometer at increasing the number of grafts in a strip hair transplant while minimizing the donor complications of a hair restoration surgery.  Based on our findings, we now use Laxometer in our California hair transplant offices on a regular basis and obtain positive results consistently.

Q:

I read on the website that scar revisions are case by case in terms of pricing. On an average how much do you charge? I had a hair transplant done in Newport Beach a couple of years ago, and I’d like to revise the scar to a hopefully smaller one. One side is fairly good, about 2-3 mm, the other side is more like 6mm. Is it better to do only half and not touch the good side so to speak? How long would the wait before such a procedure. I’m looking into doing it in May.
Please get back to me,
I’d appreciate it.
Thank you,

A:

Hair transplant scar revision could be done in part or the entire scar and it might require many different techniques:

1.    Simple excision and closure of the scar may reduce scar width.

2.    People who tend to stretch their scars can be treated by injection of BOTOX around the scar after wound closure to prevent future stretching.  Some people require tricophytic closure which allows hair to grow into the scar.
3.    Ultimate elimination of the scar visibility may require an FUE (Follicular Unit Extraction) to fill the scar of a strip hair transplant with hair.

Wound healing and scar maturation is a timely phenomenon.  Most scars continue to evolve for six months from the time of wound closure.  The process of scar maturation may even continue after that but it will be at a much slower pace.  In most cases I generally don’t want to touch scars before 6 months in our California office of US Hair Restoration.

Q:
We have an additional question about the FUT-strip procedure.  My son has explained that he does NOT envision ever shaving his head completely bald.  Instead, what he envisions, someday, is to go with a classic crew (or, “buzz”) cut.

With the scar that is left in the donar area using the FUT-strip procedure, if he were to get such a crew-cut (”buzz cut”) using either a #1 comb clipper-attachment (1/8 inch length of remaining hair) or a # 2 comb clipper-attachment (1/4 inch length of remaining hair) or #3 comb clipper-attachment (3/8 inch length of remaining hair), would the scar show through and be apparent with that close of a cut?  Or, do you think that the hair would be long enough to sufficiently cover or mask the resulting scar?

Putting the question another way, how long do you think the hair would have to be after the crew-cut to cover (or mask) effectively the scar:  1/8 inch; 1/4 inch; 3/8 inch; or, even longer (a #4 comb clipper attachment leaves the hair at 1/2 inch length)?

Thank you again for your continued time and support.

A:

If you are looking for no linear scar the answer is only through FUE or Follicular Unit Extraction technique.  We try our best to minimize the scar of the donor area, but the size of the donor scar may vary in different patients.  In some patients it is very difficult to detect the scar while on the others scar may stretch and become more visible.  By performing tricophytic closure we can bring more hair to the scar which can help to minimize the detectability of the scar.  However, it may not completely eliminate the visibility of the scar especially if you want to shave your head or do 1/4 inch hair crew cut.

There are other methods to minimize the visibility of the scar even further, but it requires other procedures. Today I am repairing a linear scar of a previous strip hair transplant by transplanting hair into the donor scar on the back.  Implanting hair may completely eliminate the scar visibility in many patients and we have previously studied and published the effect of hair transplant on neurosurgical scars.

Q:

Hi, I have a few thousand grafts already and I am interested in getting more as well as trying to revise my scar. My donor area is still quite dense.

A:

Scar revision could be done through several different methods depends upon the location, size and orientation of the scalp scars. The scalp scars that are not aligned with the Resting Skin Tension Lines (RSTLs) generally do not respond well to the revision through simple excision of the scars. For these scars hair follicular unit transplantation is a better solution. Filling the scalp scar with follicular unit transplant can be a successful method for the scars that do not respond to the regular excision. We have treated the scars that have been previously operated with multiple simple excisions by other plastic surgeons with no significant improvement in the final size and appearance of the scar. For more on scalp scar management with hair transplantation, you can read on one of my presentations in the fifteenth annual meeting of the international society of hair restoration surgery (ISHRS) which was titled: Hair Transplant and Neurosurgical Scars. You can also check our website at www.ushairrestoration.com to get more information on the modern hair restoration procedures and possible options for repair of old surgeries or scar revision procedures. You can also browse the Hair Restoration blog at www.ushairrestoration.com/blog to familiarize yourself with the available hair transplantation methods and techniques for revision of the hair transplant scar.