Category: More on Scarring

Sir,

I’ve always wondered why photos of hair transplant procedures never include a section of the donor area (elapsed over healing period)? I considered the transplant option years ago but I became very uneasy about scarring at the donor area. I have not seen one photo regarding this part of the procedure at any of the more reputable transplant provider sites. Why? Thank you for your insight.

It’s true that we do not routinely take scar photos, but we have posted photos of scars in the past:

• Result from Trichophytic Incision
• Typical Donor Wound Scar

Typically, donor scar will vary in each individual. It can be fine as a pencil-line or thick like the width of your picky finger (rare). Most scars are about 2 to 3mm in width. If you ever had a cut that needed stitches, you can use that as a baseline comparison. Some people are bad healers, some doctors use scar-minimizing closure techniques… so there are factors that can make scarring more or less severe.

(female) I’d had a bald spot since birth, possibly a birthmark and possibly a scar from my extraction. At 20 I had an stapled excision. Now I’m curious, Is hair meant to grow in the area where the staples were, or will there always be a bald line? Is there anything I can do to improve my chances?

The general concept you should understand is that if you have a scar where hair previously existed, regrowth in that area more than likely won’t occur on its own (though it can depend on how the closure method was done). However, transplanting hair into the scar should see growth just as it would if we put it on the frontal hairline area or on the tip of your nose. I’ve performed hair transplants procedures into scarred areas from head trauma, but I’m not sure how big of a bald spot you’re talking about and whether it’d even be worth having a transplant to fix it.

Dr. Rassman,

Thank you for your informative blog. I wanted to ask two questions. I had a hair transplant recently with a well-recommended surgeon. Two things concern me. First, the scar feels awfully high. It’s right above the ridge at the back of the skull. Second, one side has grown in much faster than the other. The surgeon said asymmetrical growth was normal, but I’m not sure.

Thanks for your feedback.

The location of the incision should be within 1/2 cm above the notch on the back of the skull in the midline and then if it needs to be longer, taken to about 1 inch above the ears. The permanent fringe area is seen in the Norwood class 7 patient (see diagram) and measures 2 1/2 inches high. If the surgeon takes the strip above this 2 1/2 inch point in the midline, it would not reflect the permanent hair.

As for the asymmetrical growth, I don’t know how long it has been since your transplant, but give it some time and it should even out.

This is a follow-up to a post last week, Transplanting Hair Into a Cleft Lip Scar:

Hi Dr. Rassman, this is a continuation from the cleft lip question. I forgot to add, the failed surgery was due to laser surgery. It became a hypertrophic scar after the laser surgery. So not sure if hair transplant is possible for that??

thanks for answer the question though

For a specific case, I’d need to make an examination to see what could be possible. Generally, transplanted hair grafts in real hypertrophic scars (keloids) often do not grow as well.

Paid advertisements (not an endorsement):

Hello Dr

I was just wondering about donor scars. How high up is the donor area on the back of the scalp? Also in your opinion how long does the remaining hair usually need to grow to get a good cover-up over the scar? I prefer to wear my hair short but i was just curious to know what the norm is for most patients that go through the HT surgery.
Thanks

The donor area starts at the base of the skull (feel the prominent bone on the bottom of the skull) and go up a distance of 2.5-3 inches high. That is the donor area (see Norwood 7 art at right).

Scars from strip surgery vary in width. On average about 95% of patients will have a less than a 3mm high scar after one procedure and less than a 6mm high scar after the second procedure. Scarring varies and I see many patients who keep a very small scar (under 3 mm) for as many as 3 procedures. Likewise, some patients will stretch their scars more than others, and the scar could be 1cm high in the rare case. The wider the scar, the longer the hair has to be to cover it. Generally, the width of the scar (height) will require almost twice the hair length to cover it well, but that depends upon the hair thickness and the color / contrast between hair and skin color. On occasion, there is no significant visible scar in strip surgery and this is even more common when a trichophytic closure is used to close the donor area. In these patients, the scalp hair length can be 2-3mm long without showing anything. Having the FUE technique used will change the visible scar risk radically.