More on Scarring – Page 22

January 23, 2007

Transplanting Into Big Scar — Poor Blood Supply Problem? – Hair Loss Information by Dr. William Rassman

I am 30 y/o.I just want to know if hair transplant is still effective for me since i want to have my scar on the scalp be covered again with hair.I had an accident 20 years ago which left a big scar on my scalp.Would hair transplant be still effective?i know there is already poor blood supply on a scarred tissue which made me think that hair wont grow anymore on the scar after hair transplant.

I can’t answer your question without knowing more. Many large scalp scars are best treated with scalp expanders and the results can be very impressive. As you used the word ‘big’ scar, am I correct to assume that the scar is larger than a baseball? You can send photos (please reference this post) and I’ll be able to tell you more.

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December 28, 2006

Hair Loss InformationGrafting Skin from Elsewhere to the Transplant Scar – Hair Loss Information – Balding Blog

Dr. Rassman- I have no background in medicine, so I apologize if this might be a stupid question. I have a thin transplant scar on the back of my head and would like to shave my head. Would it be possible to do a scar revision that would involve taking skin and tissue from say my upper back and grafting it to the HT donor scar? Would that then leave minimal scarring? I know they do similiar type of work for burn patients.

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You are semi-correct in stating that burn patients get skin grafting. However the burn patients still end up with a scar that is quite visible. To clarify, ALL scars and ALL cuts will be visible and unavoidable. Once you have scar on your scalp (as you have a linear strip surgery scar) it is impossible to hide if you shave your head. The best approach is to minimize the scar as much as possible with a scar revision (if indicated). Also you can consider FUE/FOX into the scar. FUE/FOX scars are scattered dots which are less than 1mm and are in random distribution, thus it does not stand out as a linear scar. Keep in mind if you SHAVE your head you will still have a scar.

December 21, 2006

Hair Loss InformationContraindications of Strip Surgery? – Hair Loss Information – Balding Blog

Dear Dr. Rassman,

What are some possible contraindications in a strip surgery?

Also, is there any difference in the end cosmetic quality between FUE and strip? For example, would there be any difference in transplanted densities between the two?

Finally, if I were to get an FUE procedure done, would I most likely be able to shave my head later without noticeable “dot scarring”. I read on another forum that FUE creates a “confluence of scarring” where the tiny dot scars seem to merge into one another to create a big scar. Can you possibly clarify this?

Thanks

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See the recent post, Is an FUE Procedure a Less Successful Hair Transplant?, which shows that if the quality of the extracted grafts are good, the end result will be the same for FUE or traditional strip surgery. Many FUE grafts are less than ideal, so there might be a difference if the extracted grafts are not perfect. ‘Dot’ scars may or may not be visible with a shaved scalp (razor shave). If your healing is good and the punch size is very small (0.9mm or less), the ‘dots’ may not be visible unless you look very closely. A short hair clipping (1/4 inch length) will not generally show ‘dots’.

December 18, 2006

Wide Scar After Transplant – Hair Loss Information – Balding Blog

I had a hair transplant using the strip procedure 18 months ago. The scar in the donor area is 5mm to 7mm wide. Unfortunately I can’t cut my hair shorter than grade 4.5. Can you please tell me what would be the best option to reduce the scar. I am also thinking of having about 1000 grafts transplanted in the previous transplant area to gain more density and cover up the thin patches. Do you suggest the 1000 grafts should be taken while removing the existing scar together in order to achieve a smaller scare? Please guide me with the best options.

Thank You

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The answer depends upon many variables, such as:

donor density
scalp laxity
the surgical dynamics and wound tension at the time of the last surgery
the techniques to be employed at the proposed surgery
the skill of the surgeon

Your goals should be reasonable and you should go with the opinion of your surgeon if you trust him/her. The scarring may or may not be the fault of the surgeon. It could be the way your body heals. Many times I would do both a scar revision and an additional transplant all included in one step. Special care would be given to minimize risks of recurrence. See:

December 7, 2006

FUE Scarring, Healing, and Other Questions – Hair Loss Information – Balding Blog

will FUE transplanted grafts grow in donor strip scar tissue?

Do you recommend GraftCyte for healing of graft recipient sites?

If a person wanted to have as much hair as possible and not care about having any hair at all on the back and sides of thier head, simulating a rock musician look or marine type cut. Can one successfully FUE that entire area artistically and move it all to the top?

would the tiny dot scars left by the FUE punch eventually be able to tan or blend as not to be too noticeable in person?

And finally if one is nearly totally bald on top – say a 5 vertex – how many grafts will give a thick head of hair on top, not the 50% theory but rather full density, 8000 10,000 or more?

thank you

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I will answer your diverse questions in the order you wrote them:

Yes, and it is a good method of revising scars of the scalp and can also be used for bad scars in donor area.
Yes, GraftCyte contains copper peptide with a mild cleansing effect and we recommend using it for post operative patients who have a tendency to hold on to the red color after the surgery. It may enhance the healing of the recipient and donor area (claimed by the manufacturer) and it may be helpful to control scabbing and crusting of incisions.
This is not practical and I doubt that any doctor would do this. We generally FOX-test most of our patients and the result dictates whether the patient would be a good candidate for FUE procedure or not. We do not recommend FUE for the patients with negative FOX (having high transaction rate).
The scar of FUE is usually not noticeable, but it is there and does not contain pigment cells (as a rule) so the hairless spot will be noticed by discriminating eyes if the scalp is shaved.
As a general rule, you need 3000+ grafts (about 6000 hairs if you are Caucasian with average density), to cover an area of the size of an adult hand with a reasonable density. For more density, for those with dark hair and light skin, or very fine straight hair, a redo procedure may become necessary.

November 7, 2006

I Scalped Myself! – Hair Loss Information by Dr. William Rassman

In the summer of 05 I scalped myself by running my head into a porch. The flap was sewn back on and I experienced hair loss a month later. The majority of the hair grew back, however on the left side the scar was still quite prominent. This past summer (july of 06) I had scar revision surgery. The doctor used a gentle type of cauterization and staples. A month after surgery hair around the scar fell out. Some is growing back, however currently the bald area is worse than it was before surgery. My question is how long until I know whether the hair will grow back or not? And is there anything I can do to help it grow back? I’m a female and almost 23 years old. Thanks.

Hair usually does not grow back on a scar or on the edges of a scar – especially after cauterization. The best way to deal with your scar is to minimize it as much as possible (as you have done). Wait out a full 6 months to see the final result and then you may need a follow up with a small hair transplant along the scar, or possibly another revision of the scar. Scar repairs of the scalp are a real art, so I hope that the doctor who did it had considerable experience with scalp scars. Between the doctor’s experience and good surgery, you should have a good idea on what the results are after 6 months or so. We routinely do these type of procedures at NHI with great results. You may consider sending pictures and I would be happy to look at them for a better assessment.

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November 3, 2006

Hair Loss Information2 Months Post-Operative Trichophytic Closure (with Photos) – Hair Loss Information – Balding Blog

I thought it would be nice to share a 2 month post surgical donor wound (still a bit light pink) with hair growing out of the wound from a trichophytic closure. By the 4th months, this wound will become virtually invisible.

For more information about the trichophytic closure technique, see Techniques to Minimize Donor Area Scarring.

Click the photos to enlarge.

Trichophytic

October 30, 2006

Trigrowthic Suturing Technique – Hair Loss Information by Dr. William Rassman

Dear Dr. Rassman,

I’ve asked you this question before but had not received an answer. I recently read about a so-called new “trigrowthic” suturing technique that promises to leave no visible scarring post strip op. Have you looked into this procedure before and is it to be believed? Thanks.

“What’s in a name? That which we call a rose
By any other word would smell as sweet.”

-From Romeo and Juliet (II, ii, 1-2)

The use of trichophytic closures have been around for years — in fact, that closure has been used in plastic surgery for more than two decades. The hair industry adopted it recently as a standard of wound closure. You could change its name and correctly say that you invented that name, but it would be improper to say that you invented the procedure. The doctors you have referenced here are recycling techniques under a new, original name and as such, if they are claiming inventiveness, then they might be deemed dishonest.

There is NO such technique that can provide results with no visible scarring. ALL cuts on the skin will leave a scar and the scarring is unique to individual patients. Some patients have minimal scarring, while others have more scarring — it is dependent on their genetic makeup, which no one can tell with just a physical examination. Some of our patients heal well and have very minimal scarring that is hard to detect with a regular hair style, but even these patients will have a visible scar if they shave their head bald.

We routinely use a trichophytic closure which I assume is similar to what you have read. For more information about the trichophytic closure, please see:

October 4, 2006

Hair Loss InformationScars from FUE – Hair Loss Information – Balding Blog

I may have heredity loss or loss as the result of medication. I just wanted to confirm that the Fox procedure does leave tiny scars at the donor area (where the hair is taken from)? Also, does the fox procedure also leave tiny scars where the hair is implanted. Please review and let me know of your thoughts.
Thanks in advance

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1 Year After FUE – Parted

1 Year After FUE – Shaved

At the point where the follicular units are removed, there may be small punctate scars, but not at the recipient site, as the skin is trimmed once the grafts are outside the body. The skin disc that was removed in the FUE from the above photo were created by a 1mm punch, today the punch size measures 0.9mm. Trimming of the excised FUE grafts are critical to minimizing the transplantation of skin for the recipient area, which is clearly not the objective. When these FUE grafts are trimmed, the skin disc is reduced to 0.1-0.2mm in size, thereby minimizing scars at the recipient site.

For more on FUE / FOX Procedure, please see:

September 27, 2006

Hair Loss InformationCan Trichophytic Closure Technique Remove My Scar? – Hair Loss Information – Balding Blog

As you can see in the picture I have had 2 HT strip scar procedures. I always liked to cut my hair short with a 1# guard but after 2nd HT scar (top one) I cut hair with 2 guard and it’s still visible. Right now I don’t know if I should get another HT but I do want repair work.

If I go and get the Trichophytic Closure Technique can my old scars be removed? How can this be possible?

How about body hair transplants into my old HT scars?

Will I ever be able to cut hair close again with a 1# guard?

Thank you

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No.

All cuts will produce a scar.

The worst doctor with the worst technique can operate on one patient and have a great result with minimal scarring. Likewise, the best doctor with the best technique (using Trichophytic closure, etc) can operate on another patient and have a poor result with wide scarring. In other words, everybody heals differently and some people are more prone to scarring.

Generally a Trichophytic closure technique will benefit 1mm of the scar margin. So if you have a 5mm width scar, a Trichophytic closure technique will make it look more like a 4mm scar. It is obvious that the wider the scar is, the less benefit will be obtained by the Trichophytic closure.

At NHI, we offer free scar revision to our former patients. Sometimes we are able to achieve an improvement, but as stated earlier, there will always be a scar.

Body hair transplants are not considered a standard of care in my opinion and are still controversial because of their long dormant stage and growth cycles.