Hair Restoration Blog

Q:

We discussed the possibility to close the scar, which I think is a good idea, but again, I had already achieved camouflage with longer hair. While it may only be a 2-hour operation, I admit being very weary of such an operation because my skin is already so tight. I understand that the skin exercises you recommended should help a great deal, but for whatever reasons I am not comfortable with such an operation, especially considering that I would like to cover the whole head with some hair anyway. Perhaps you will convince me on the scar revision, or maybe you will advise me to pursue the FUE plan which would cover the rest of my head. Assuming I have an “average” density in the donor area, how many grafts do you think you could extract from it? How good or bad would be the mini-scars scattered all over the back of the head? I am assuming the surrounding hair will camouflage them?

A:

If you don’t want to pursue scar revision, the only option will be an FUE transplant into the scar from neighboring areas.  I recommend for you to wait until we see you in your follow up visit with a little longer hair before continuing. You also need to schedule for the FOX test to determine your eligibility for a Follicular Unit Extraction procedure.  The answer to your questions about how many grafts could be harvested in one session of your FUE procedure will be answered the day we do FOX test and confirm your eligibility.

You need to contact US Hair Restoration to schedule the FOX test as soon as you are able.  FOX test’s are done quite easily and assisted by numbing a very small area on the back of your scalp. The small scars of the FUE are going to be scattered throughout a larger area.  That can minimize the visibility of those pinpoint scars.  If you keep your hair not too short it is generally not possible to see them at all, but with a shaved head the tiny scars might be detectable from a close view.

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.

Q:

Scar of face lift surgery

I believe I am a casualty of a brow lift gone wrong.  Three and half years after my brow lift surgery, I am seeing extreme hair loss on the top of my head, with itching burning and a crawling sensation at the affected area.

If this conclusion is correct will any treatment stop the hair loss? Will hair transplantation work?
Thank you

A:

Recession of hairline in a male patterned after a face lift surgery

The condition you are describing may be the beginning of cicatricial alopecia or hair loss secondary to a face or brow lift surgery.  You need to be seen by a good hair restoration surgeon or dermatologist for a close evaluation.  Brow Lift or face lift surgeries require incisions in the scalp that result in scarring and hair loss at the point of incision and around it on the temporal or frontal areas.  This hair loss condition could be seen as a complication of the face lift procedure with unknown mechanism.

Although a rare side effect of the face lift surgery, as a hair transplant surgeon with particular experience and interest in scalp scar revisions, I see many patients with hair loss after face lift procedures in our California hair transplant offices.  Your condition has two components; 1. the scar of incision in the hairy part of scalp; 2. the loss of hair on the temples and frontal areas.   Both these problems can be easily treated with transplanting hair into the scar and on the hair loss areas of the scalp.  If the procedure is done through follicular unit transplantation the result should be quite natural.

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.

Many hair transplant patients are concerned with the scar of cosmetic surgeries including hair transplants. Several techniques have been suggested to minimize the scar such as corticosteroid injections, irradiation, ultrasound, silicone applications into and around the forming scar. However, the effects of most these methods were far from satisfactory. Botox is a new method that could be used to minimize the size of both facial and scalp scars. The use of Botox for reduction of facial scars from surgeries was first suggested by plastic surgeons who were trying to reduce postoperative effect of facial muscles on stretching and widening of scars.

In many patients with ugly scars of the face, Botox or botulinum toxin was used successfully to induce temporary paralysis of the muscles during revision surgery. Botox with the same mechanism can help minimizing tension on the healing wound edges until collagen could mature and scar if completely and firmly formed.

The use of Botox has been suggested for the treatment of stretched scars on the face by many plastic surgeons now. Hair transplant surgeons also use Botox for treatment of the hair transplant widened scars of the donor area that do not show improvement with a simple scar revision procedure. There are reports of successful decrease in the final size of the scars with injection of Botox into the muscles surrounding the maturing scar. We at the Los Angeles hair transplant offices of US Hair Restoration don’t offer Botox to every patient who is having a hair transplant surgery through strip technique, but it certainly could be used for the patients who suffered from widened scars of prior surgeries and did not respond to the other methods of scar revision.

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.