More on Scarring – Page 15

October 20, 2008

Scarring Acne and Hair Transplantation – Hair Loss Information – Balding Blog

First off, excellent blog. What a fantastic resource!

I’m in my late 20’s, have never had a HT procedure before, and I’m considering a strip procedure in the near future. I have read that people with scarring in the recipient area might be at risk of experiencing poor growth/yield of transplanted hair into that area. (discussed on another forum somewhat here: hairlosshelp.com )

Though mostly clear today, in the past I have had acne at my hairline and behind it (on the scalp), sometimes in hard cystic form. Some of this acne may have caused some scarring at my hairline and behind it, though it is difficult to notice any visible scarring on my scalp. I do have acne scarring on some areas of my face from cystic acne, and it appears that the cystic acne led to a loss of fat or collagen in some areas, given the depressed look of the scarred areas. I also have some pitted scarring in my temple areas (where the hair is also receding), which is an area where I hope to have hair transplanted.

Could acne scarring from cystic acne affect the growth of transplanted hairs in the recipient area (e.g. hairline, scalp or temple area)? Or, when people talk about the risks of scarring in the recipient area, are they mostly talking about scarring possibly resulting from incisions made during previous HT procedures’ (or even the result of grafts from previous HT procedures being removed or extracted)? I read in a message (found in the thread I linked to above) that scarring in the recipient area could inhibit blood flow and hinder growth of transplanted hair.

Have you ever heard of acne scarring leading to poor transplanted hair growth? Also, if acne scarring could pose a risk to transplanted hair growth, is there anything that one can do before surgery to try to minimize that risk, other than try to prevent any further breakouts?

Thank you for any information!!

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I have not heard of a one to one relationship between acne scarring impacting hair transplantation. If there is any active acne present, it could well have an impact. If you are concerned, you can have your doctor perform a small test transplant into the scar and see what grows. Using a FUE (follicular unit extraction) technique for a quick procedure will take less than 10 minutes. It is not unusual for me to do test transplants on a limited basis in people with scarring alopecias. Wait a full 8 months and then you will know what the risks are. As I can not examine you, I can not really render an opinion at this time.

October 14, 2008

Picked Off Scabs 4 Days After FUE – Hair Loss Information by Dr. William Rassman

I was wondering if after having a FOX procedure if you pick off the scabs from the donor area will this cause more significant scarring. I took off a scab 4 days from my procedure and it looks like it left a dimpled hole. I wonder if this will heal?

It is never a good idea to pick at a wound, as it creates the opportunity for infection. If you have eschar/crusts at the donor site from the FUE procedure (which is usually the case) you can wash them off with a good shampoo and a surgical brush. I don’t know what the dimpled hole is without seeing it, but hopefully it healed up for you.

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September 30, 2008

Repairing a Dent in the Scalp at the Hairline – Balding Blog

I have a severe scar beginning at my ( receding ) hairline. It is a prominent scar, probably 1 1/2″x 1/2 inch. Obviously no hair grows there and I cannot completely cover it. The injury that caused the scar also took a little “tissue,” meaning there is a slight indentation.

My question is this: Is there a procedure where someone could “reconstruct” the damage? Perhaps by taking a mold of the scar, a piece could be made and have hair implanted. And if so, could this “piece” be safely adhered to my head? I am open to suggestion as well. Thanks.

It would be best for me to see what you look like by sending photos of your hairline and the scar (reference this page). Scars at or just behind the hairline are relatively easy to fix with hair transplants. Sometimes the scar can be partly excised as well (though unusual), but without seeing it you have tied my hands. I have repaired many frontal hairline scars.

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September 25, 2008

Brain Surgery Scars, Burr Holes, and Hair Transplants – Hair Loss Information by Dr. William Rassman

Dear Dr. Rassman, I have two burr holes on my temples from an operation when I was a baby. My temples receded to a mature hairline whe I was 25 & the scars are now visible (I’m 32). I don’t suffer from hairloss & seem to have the same hair as my dad who still has a full head of hair at the age of 60 (temples slightly receded). I was considering a HT to get back to my original hairline & cover the scars. I was wondering if the holes in the skull underneath could be a problem during the operation. Is there any danger (I don’t know how deep the needles go)? Thanks!

I have performed hair transplants on many post brain surgery scars and burr holes. Skills in such a situation is critical in placing hair into scars or burr holes to be sure that it does not penetrate into the brain. If the normal hairline will cover it, then this is a wonderful solution to the problem.

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September 12, 2008

Revising a Donor Scar with a Tight Scalp? – Hair Loss Information by Dr. William Rassman

I have hair transplant done 2 years ago about 2000 grafts, however I have a donor scar that runs from ear to ear and wider than 1 cm since the skin got constantly pulled. My head skin is very tight,so i am wondering what can I do to fix this ? I want to cut my hair short in the back. Should I transplant hair from other part back to the donor area or any other solutions?

thanks.

You should start doing scalp exercises (see video) and then try to get a surgeon to perform a scar revision surgery with new techniques that are available today. These do not always work, because your body has a new baseline after you have a surgery. You can also try transplanting hair to the scar using the FUE technique, which will work if a revision of the scar does not work. None of these methods are perfect, but they can minimize the look of the scarring. You need to see a doctor to discuss these options for your specific needs and expectations.

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August 18, 2008

Can My 2 Year Old Son Have Hair Transplanted into Scalp Scars? – Hair Loss Information by Dr. William Rassman

what age is ok to have hair transplant? i have a son who’s 2 years of age and he has two scars on his scalp about 1 centimeter (diameter) each…

thanks..

It might be traumatic to do it now. I would wait until he’s older and if this becomes a social issue, then it is something to consider. I have performed surgery on children, but most don’t care until they approach their teenage years when looks are important to them. I would not suggest this is something you should pursue at this time.

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August 15, 2008

Seborrheic Dermatitis After a Hair Transplant – Hair Loss Information by Dr. William Rassman

Hello Doc. can you please answer this question please. Can a flare up of seborrheic dermatitis during the growth period (3-9 months)following a hair transplant procedure,in the recipeint area(itching,redness,swelling, etc..) lead to poor results of the transplant?? Also if the scar from a strip harvest is still pink and tender 6 months after procedure, will it always be like that or will it eventually toughen and turn all the way white? thx

Seborrheic dermatitis should not impact hair growth from a hair transplant. Scars can be judged by their width, and scars that are greater than 3mm may cause a problem. The pink color is usually gone in less than 6 months, but it can be delayed. The pink color has really more to do with the way your body heals the scar (appearance) than on the actual strength of the healed wound at six months.

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July 17, 2008

Using Couvre to Mask Linear Hair Transplant Scar (with Photos) – Balding Blog

Hello Dr,

First of all,,,a Fantastic/helpful blog. I am 50 years old. I visited 10 different hair transplant surgeons and decided to go with a doctor in Northern California. I think you hit the nail on the head, when you say ‘you have to feel RIGHT about the surgeon’. I did an FUT for 3000 grafts about 1 month ago, and everything has gone great. We just have to wait and see now as to what will be the outcome.

I wanted to contribute ’something’ to your blog,,,so I decided to send photos of my scar before and after application of a masking black lotion (COUVRE). It takes 1-2 minute, it will not come off with water and it is practically invisible from about 12″ away. The photos were taken by my wife. I keep my hair at 1/4″ length (I know I can go to #2 clippers and still mask it good). I send these photos for folks whom are worried about having the surgery and wanting to keep their hair short.

Now to my questions. I am on Propecia (4 months now) and Rogaine. I also have the laser comb, but I am hesitant to use it, fearing it might damage the ‘babe grafts’. What do you recommend to your patients regarding this scenario. I truly believe the comb works, not as much as the hype, but it DOES work (for me anyway). The question is, can it hurt the newly transplanted/asleep grafts

My second question is related to a comment my surgeon made prior to surgery. I asked, what percentage of the grafts are normally expected to survive. The reply was 113-120%!!!! It was explained by my surgeon that they do not believe in ‘dense packing’ of grafts in a CM2 and by inserting no more than 40 grafts (or was it 40 hairs?!), it insures the growth of all grafts + some regeneration of already dormant follicles!!! I found that pretty interesting, what is your opinion on this?!

Thanks again for all your great help on the blog, keep up the great work

Masking/concealing agents like Couvre can work “miracles”, as your photos demonstrate. There are two surgical solutions that also work well:

Follicular unit extraction (FUE) into the wound will put hair into the scar, or
A trichophytic closure could wipe out much of the wound if the laxity is good enough

The telogen count is about 10% of hairs, but as these telogen hairs grow back, others fall out so I would not expect more than 100%. I have read such studies and they are clearly flawed in their methodology. You can’t believe everything you hear or read. Nonetheless, thank you for contributing your photos and allowing me to publish them! The results after the Couvre look great. The photos are below; click to enlarge.

June 30, 2008

Hair Loss InformationAfter 7 Scalp Reductions, Would I Have Donor Grafts Left? – Hair Loss Information – Balding Blog

Dr. Rassman, you won’t believe this. Maybe you will. I have had I guess 7 scalp reductions. Brandy did a lateral with that Y incision, but not a scalp lift, per se. Marzola, Stough, all did a couple of procedures. I saw my scalp under bright lights (the last thing one wants as that is very unforgiving) on a big screen last night and was shocked by the 1 inch by three inch or so bald thin area in the midline. Dr. Hitzig performed two large midline graft sessions around 1999 or 2000, fixing the scar but the density leaves something to be desired. I see you mentioned Dr. Frechet of Frechet extender fame I imagine in a response to a patient. Some sort of triple flap procedure. I have some donor left but can’t get over my lack of crown density despite a large number of grafts. I know Dr. Hitzig always grafted the midline before reducing a scalp. Do grafts just not grow after reductions, especially that many reductions? I could emply better styling but I wish I had followed the late C.P. Chamber’s advice and avoided reductions altogether. He knew what he was talking about. It sounds like there is no practical fix at any price.

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Your case is complex. I have no idea what densities you have or the extent of your scar and wound defect. Most people who’ve had 7 scalp reductions are left with a slot deformity. I would like to see some good pictures of your scalp from the front, top, sides, and back. I am sure that you know that scalp reduction is no longer the standard of care today, because they do not work. I have seen men who had up to 16 scalp reduction surgeries and the last ones never really accomplished anything. I wonder about your 7th procedure and what you were trying to accomplish that the prior 6 have not.

It is best to be examined carefully by an expert and then see what your needs are. Patients should make a list of priorities and then try to work down the list. Patients who have had so many procedures never really get too far down that list, so be realistic.

For more information on scalp reductions, see:

June 5, 2008

I Think My Donor Scar Is too High and Will Show Soon – Hair Loss Information by Dr. William Rassman

I’m concerned that one of my donor scars is too high and that eventually it would show as well as the grafts taken from the area will die. I’ve had three procedures. The first was in 1997. I had 800 micro/mini grafts. Then in 1998, I had another 1000. This time the doctor seemed to place the incision in the donor area high. My third procedure was in 2007. I had 2000 FU’s placed. I think I’m a class 5 or 6 (not completely sure). During my last consultation before my procedure, the doctor told me that the scar from the previous procedure looked high.

It is 2″ above the bump at the base of my skull – about the height of my eyes and the top of my ears. I’m not sure if it was higher before my last procedure. Is it possible that it now appears a little lower given that 2000 FU’s were taken below it? Does this sound too high? Would hair mapping help me to know with greater certainty? If so, where can I go to have my hair mapped?

I appreciate your time in reading and responding to my question. I’ve read several of your blog comments, etc. and I’m considering using your services in the future.

Thanks again

Perhaps your donor scar is higher than normal, but this can be a normal thing as the doctor will make subtle judgment calls during the procedure. It may bother you cosmetically, but there is not much you can do other than to grow your hair long enough to cover the scar. From a long term point of view, if the donor hair was taken too high, it may not be in the area of permanent hair, in which case you risk losing the hair that was transplanted from that area.

You should start off with a good examination and consultation for a second opinion. That will address your concerns above. You must have a worst case scenario managed with a Master Plan for future hair loss, as you are suggesting in your questions. I don’t have a list of every doctor that will map your scalp, but you can find a transplant doctor in your area by using the physician search at ISHRS.org.

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