Category: More on Scarring

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Hair Loss InformationClarify Scarring Opinion – Hair Loss Information – Balding Blog

In an answer to a previous post, you wrote:
“Only about 5% of former patient developed noticeable scarring. Most of these scars are the result of the healing properties of the patient, although some are technique dependent.”

But another top hair restoration practice, Hasson & Wong, asserts a different view:
“The single most important factors in donor scarring is the ability of the surgeon to excise the strip and close the wound from the donor site correctly. The ability of the individual to “heal well” is much less important except for a very small percentage of individuals who either heal with keloid formation or have an abnormality of collagen formation.” (from their website)

My questions are, how can two leading medical groups in the field hold such seemingly polar-opposite opinions? And, do you base your assertion on anecdotal observations, or have formal studies been published on this topic?

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Much of what I say about scars is based upon: (1) anecdotal observations that I am constantly researching on my patients, and (2) direct measurements on patients whose scars I have measured before and after repairs.

I do not agree with you that our two statement are polar. I always assume that doctors are all competent and the techniques are all consistent between doctors. I know that is not always true, but I generally like to believe that doctors try their best to do their best. When it comes to wound closure, it is not rocket science. I am a surgeon by training, so I am more qualified to make that statement then others who did not invest the years of training and experience that I have. With that said, both of us are in agreement. I suspect that Drs. Hassan and Wong are not making the same assumption on the uniformity of techniques in the first place.

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Hair Loss InformationRemoving a Hair Transplant – Hair Loss Information – Balding Blog

hi, i’ve had two hair transplant procedures in the past. over the last couple of years i have just been shaving my head. i feel very uncomfortable going anywhere without a hat because of my scars. i would just like to be able to shave my head without the scars being so obvious. they are mostly right at my front hairline. can i go to a physician to have the transplants removed? and if they are removed will my scalp where the transpants are taken out heal so those little puncture holes are not as noticible? or could a procedure such a dermabrasion or laser help to smooth out the area? thank you

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Without seeing you it would be difficult to make an assessment. Please send photos to the email address on the Contact page.

Generally, it is difficult to put you back in time to the days before you had your hair transplanted. With that said, we can reverse it in many ways, and sometimes it might be brought back to the “before” status. I like to tell my patients that I have good news and bad news about hair transplants: they are permanent, so get it done right the first time. If you are amongst the unfortunate that did not time your procedure correctly with current technology, then the good news is that there is a great deal of experience now in removing or hiding the ugly plugs of the older types of hair transplants.

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Hair Loss InformationTransplanting Hair Into Burned Tissue – Hair Loss Information – Balding Blog

Dear Dr.
I am a recovered burn patient from childhood with forehead scars that extend to my left temple area. I was able to grow my hair to cover it as a young man until my late 30’s. My hair started to thin and I now wear a hair system to cover and blend the non hair scarred area. Are hair transplants now being able to be transplanted into scarred areas that are cosemetically acceptable. I have been told that bloodflow below my scarred areas is still good. Thank you for your response.

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If your skin is what we call a full thickness, hair may be able to grow from it. If it is covered with a split thickness of skin and scar, it may not support hair growth. There are things that can be done today to bring your hair-baring skin here and may include a variety of surgeries like flaps, and balloon-stretching the normal scalp and rearranging it to cover the bare area. Some of the results are remarkable. I would be happy to give you an opinion and as you’ve indicated that you are in Southern California, I would suggest that you make an appointment with me and maybe together, we can address your problem. Please call my office at 800-NEW-HAIR to set up a free consultation.

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After Care for Scar Revision – Hair Loss Information – Balding Blog

Everything seems very promising at this stage, two weeks after a scar revision procedure. I am wondering whether there is anything proactive that I can do to help minimize the presence of the new scar. (Besides avoiding exercise involving unexpected head-turning.) Such as:
– applying onion-based anti-scarring ointment; or
– not applying onion-based anti-scarring ointment;
– or using or not using some other topical thing.

Thanks for everything!

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I think that patience is a virtue and if the surgery was done well, that should suffice. Applications of any topical ointment may be pointless at this time. If hypertrophic scarring should occur, then you may need to take a look at it as it forms. Stretching of the scar will take time, as stretching usually starts to become evident at about 6 weeks. Keep in touch with your doctor if anything worries you.

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Mederma – Hair Loss Information – Balding Blog

I just had a transplant (3000 units) what is now about 3 months ago for my frontal hairline and is seems to all be coming in very quickly so no problems there. I have very fair skin and have been using “Mederma” for the donor scar on the BACK which is helping fade it considerably. However in the recipient area on the FRONT of my scalp is still discolored with a notable textural change and color (reddish) from the operation (again, I have very fair skin). Sure – my goal here is both new hair (which eventually will cover much of it) but also not to have a discolored or red scalp underneath. so my question is: would using mederma to help fade the redness in the FRONT interfere with the new hair growth?
please let me know asap

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Those people with fair skin sometimes get unusual redness. This is often initially caused by histamine release at the wound level that is causing increased and persistent redness. It is best treated with topical steroids, like Hydrocortisone cream (limit use for 3-4 days so that you do not absorb massive amounts of it in your system). Please note that if you are a professional sports person, the steroids will show up in a blood test.

In searching the internet, I found the following statement: “Mederma is a gel that contains an onion extract which is thought to be the active moiety. It can be used on all types of scars including: surgical, burns, stretch marks, acne, and old or existing scars. It should be applied 3-4 times daily for 2-6 months depending on the type of scar. The data available are conflicting as to the effectiveness of Mederma in reducing the size and quality of the ultimate scar. The question still remains whether the act of massage or the onion extract contained in Mederma will decrease the appearance of unsightly scars.”

That being said, I have no personal experience with Mederma.

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Scalp Reduction Slot Deformity – Hair Loss Information – Balding Blog

I had scalp reductions many years ago, about 7 such surgeries. I have this long narrow straight defect in my head that looks crazy from the back. Many people think that I had brain surgery and ask me about my brain operation. Can this be fixed?

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Thousands of men have had the bald spots of the scalp removed in a procedure called a scalp reduction. There was a naïve view by many doctors that bald areas could simply be excised surgically. When this was attempted, the surgeon might be able to remove about 1 inch per procedure and therefore some patients would have many procedures done to tackle extensive balding of the ‘Top and Crown’ that might be as much as 7 inches wide. What the patient found out, however, was that after 7 surgical procedures, they might have only reduced the bald area by 3 inches or so. The match did not add up.

That meant that the bald areas came back by stretching (“stretch-back” was the term used), and the patient was subjected to a never ending battle to remove all of the bald spot. Rarely was this ever successful for any large bald spot, but what was successful was the appearance of a slot in the back of the excision area which joined the two sides of hair that normally was on the side of the head, growing towards the ears. It was like a aprt in the middle of the head with a bald slot in the center of this slot that often measured 1/2 inch wide or so. This abnormal hair direction moved to the top of the head accentuating the slot deformity that appeared.

There have been many attempts to get this fixed, but only one surgery really works well. It is a triple flap procedure where scalp is moved around on the two sides of the slot. The hair direction is changed. The scalp reductions themselves are well exemplified in this article by Dr. Patrick Frechet, where the slot deformity as well as Dr. Frechet’s newer methods to remove the bald areas are shown.

You might want to go to France and consider having him do the surgery, as he is one of the few doctors world-wide that can achieve consistent results from this surgery with minimal risk of scalp necrosis (a common problem in inexperienced hands).

For more information, please see:

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Using FUE to Fill In Old Donor Scar – Hair Loss Information by Dr. William Rassman

Some 5-6 weeks ago, i had my first FUT procedure for about 1600 grafts that were harvested by removing a donor strip from the back of my head, but this time its not because my hair is thinning but to increase the facial hair density. I must say that i’m now very concerned since i begun seeing those infinitely many cases who had bad experciences with the donor scar visibility(detectibility) even at this early stage of my procedure. I would like to know the validity that successful FUE could be used to conceal the donor scar so that i can wear my hair short assuming that my scar is (2-3)mm wide and not raised plus that am a good candidate for FUE. Thanks

One of the particularly good uses for Follicular Unit Extraction (FUE) is to address the donor wounds of the traditional strip harvesting methods used in standard hair transplantation. The frequency of significant scarring (a width equal or greater than 2-3 mm) is about 5% in the first procedure and 10% in the second. FUE works well to fill in these scars if you are in the unfortunate few that get significant scarring.

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Dermatix – Hair Loss Information – Balding Blog

Had a FUT procedure (not with you) and since i noticed the big deal about the donor scar i started worrying which made me try to avoid any strenuous activities. I bought some scar reduction product called DERMATIX which claimed to smooth raised surfaces and reduce redness associated with scarring. Ever heard about it? its also mentioned that it musn’t be used until the wound is completely healed,so how long does i take donor scar to be healed?

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Dermatix is a transparent, self-drying silicone gel with claimed advantages over other silicone formulations that are used by some people to smooth or soften scars and as a result, reduce itching. It is reported to be FDA approved in the US and Europe (it has a CE mark). It appears to be recommended for the prevention of hypertrophic and keloid scars, possibly in their treatment as well. Hypertrophic and keloid scars are your body’s reaction to wound healing, so I would be doubtful that it would prevent these scars, but frankly I am a skeptic, so take what I say here with a perverbial ‘grain of salt’. Some people use sheets of silicone to try to soften such scars when they occur, and that might work.

For most hair transplant donor scars, it is usually not hypertrophic or keloid scars, but rather widened scars, and here I would really doubt that Dermatix would prevent the widening of the donor scars. It is the widened donor scars that cause much of the internet comments about scars, not the hypertrophic or keloid problem. From your question, it sounds like you are more concerned about prevention. In that case, the best solution for a future surgery is to have a good surgeon use a ‘fascial’ closure to minimize the donor scar for traditional strip harvesting (second surgeries do run a higher risk of scarring of 5-10%), or consider having a Follicular Unit Extraction (FUE) procedure, where the surgery does not produce a linear scar (see our FUE page for details).

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Subsidize Wound Scar Repair? – Hair Loss Information by Dr. William Rassman

In a previous post you said:

“We subsidize the FUE repair of wound scars that were a result of a previous NHI surgery.”

What are the details of this, ie how much do you subsidize? Thanks.

I take the view that we are a full service medical practice. Because significant scarring is relatively uncommon, we will absorb the costs for scars that come about from our surgeries. If a scar came about from an NHI surgery, we will repair it at no charge to the patient with a modified scar revision surgery we recently developed. The results of this surgery has been very good in most situations.

On a few patients, the scars may reflect the person’s healing abilities, in which case a scar revision may not work. In those situations, for those who do not respond to this surgery to their satisfaction, we will perform an FUE at a cost of $2000 per surgery and put in whatever number of grafts that are available provided that this surgery can be done safely and effectively. Some patients may not qualify because they may not make good candidates for FUE surgery.

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Hair Loss InformationRecipient Area Scarring – Hair Loss Information – Balding Blog

I had two hair transplant procedures performed on me. The first was in 96 and the second in 98. I was only 21 at the time of my first procedure. I recieved a total of about 900 graphs between both sessions. I am very unhappy with the results. I’d like to know if my transplant can be reversed. What could be done about scarring in the recipient area? Any info would be greatly appreciated.

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You may be able to have the grafts removed with FUE. This may remove the grafts, but the skin may still not be normal and it would shows scars. Alternatively, you can fix it and complete the process if the hair supply is good. You first need to be examined by a first rate doctor. For more info, please see the following links: