Category: More on Scarring

From 1998 to 2004 I had about ten transplant surgeries done,and each time I had between 200 – 300 grafts done. After having read your blog the last few months, I now wish I would have had fewer surgeries, and more grafts done at those times. For the most part I am pleased with the results that were achieved, but I would like to have one more transplant surgery to hit those last few problem areas. Is there any way for me to tell if there is any donor area still available? My scars have appeared to have healed well. Since the last surgery I have moved 1500 miles from where my doctor is located, so if I am to have any additional work done I will need to locate a new doctor. I would appreciate your thoughts, and I really enjoy this forum you provide. Thank you.

Your situation requires an in-person examination to learn the opportunities and risks for more hair transplant surgery. The distribution of the scars and the width of the scars will probably dictate what can be done in one more surgery. I have an airfare reimbursement program offered to those traveling from out-of-town (see NHI Travel Program). I would be happy to talk with you over the phone to define your problem and goals.

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Dear Dr.Rassman,
I have been reading your blog for quite sometime and have a high regard for your opinions.
I’m considering a transplant and I have a question regarding the scar closure methods different doctors use. I have read they could use staples, sutures and dissolvable sutures. Could you please discuss the pros and cons of the three different methods. In your surgeries which would you prefer and why.

Thanks a lot for your time in advance.

I would have to write a textbook on the logic that distinguishes why one may be better than the others. Essentially, I use them all in different circumstances. I do prefer staples much of the time, because it is fast for the surgery and the staples allow blood to go between them, which in theory gives more blood supply to the skin edge. Sutures have a tendency to constrict the skin along the skin edge when they are use in a baseball type of way.

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When the strip harvest method is used, a linear scar is produced, but what if the doctor uses a trichophytic closure, would the scar be “virtually undetectable”? Would I be able to buzz-cut my hair without the scar being noticeable?

And also, does the number of hairs that grow through the scar vary by the person? And for my last question, if I felt the back of my head for the scar, would I feel it even if I couldn’t see it? (Would there be a bump where the incision was made)?

Good judgments in determining the size of the donor area is the best determinant of the size of a donor scar. When the incision is too tight due to the piece of excised scalp being too large, then the enemy is tension. The use of special closure techniques minimize the scars and the tension, but a bad judgment at the time of surgery can not be offset with a repair process.

The readers interested in the subject of scars, may conclude that special techniques can make the scar disappear. Many surgeons would like you to think that their wonderful skills guarantee that the scars on their patients are either non-existent or non-detectable. I believe that the only surgeons who have never seen scars from strip harvesting are those surgeons who have never done the surgery. If any surgeons give you this line, then that surgeon is not honest, for scars (much of the time) have little to do with the surgeon and much to do with the patient’s healing capabilities, when proper techniques are used.

The use of trichophytic incisions do not offset bad judgments or poor surgery, but when used, they can close the gap in a 2-3 mm scar that usually accompanies a donor wound. The scar will still be present even if it is covered by hair, and yes, you may be able to feel it.