Can scars be cured with FUEs?
I do not like your use of the word ‘cured’. FUE (Follicular Unit Extractions) can be used to fill in scars found in the scalp, eyebrow or beard. The more that are placed and the closer they match the surrounding hair, the more they will cover a scar. Scars do have a different vasculature than normal skin, so at times we must reduce the densities of scars to get the best growth.
Do linear donor scars stretch (widen) over time?
You are asking about hair transplant scars from the rim of permanent hair that is found around the back and sides of your head. This area (donor area) is generally not prone to stretching if the incisions are made in the horizontal plain (side to side). The scalp has some degree of redundancy so that there is ‘extra’ scalp which you can easily slide up and down on the back of your head. This makes the scalp loose in most people so when some of it is removed, there should be enough excess scalp to close without tension on the wound. When there is minimal tension on the wound, it usually will close without stretching in people with normal healing tissues. If either the scalp is tight, or the body’s tissues are not strong, then these wounds may stretch. The more surgeries you have, the more the potential to develop stretched scalp scars.
Are doctors still using the plugs that I see on the street, in the malls and at airports all of the time?
Not as a rule. The old plugs that gave this industry a bad name in the 1970-80s have largely been replaced with small grafts that are called follicular units. But there are some doctors that use ‘combination grafting’ which is a mixture of larger small grafts and naturally occurring follicular units. Only the follicular units are undetectable in bright light or close inspection.
Dr. Rassman,
This is a bit of a tangent. I had 3 surgeries with you folks between 97 and 2000, and I continue to be pleased with the results. It appears it will be quite some time before I need more work done. When I researched different groups, you folks stood head and shoulders above the rest in terms of professionalism and especially how much research you had done. It was clear you were at least as interested in advancing the art as being successful from the business end.
Thus I am interested in your opinion on scar revision. I have two 6-7 inch scars – one on my elbow from nerve transposition surgery, another one that is horseshoe shaped above my armpit from reattaching a torn pec from a snowboarding mishap. Both scars spread kind of badly, such that at spots they are about as thick as my index finger. Apparently both those spots tend to be high tension, which causes the spreading. Both incisions were sutured with plain stitches or staples, not any interior stitches.
I’ve been doing web research on and off for several years, but I haven’t been able to convince myself that there is any group or technique that has a good chance of making a big improvement. What are your thoughts about the state of the art of scar revision? Perhaps this is a new area of study to apply your innovation. 🙂
When a person has stretched scars on many parts of their body, I often think of diseases that produce this problem. You should first be sure that you do not have any of these diseases such as Ehlers-Danlos Syndrome which is a connective tissue disorder. You are correct that some scars that come from wounds which are located in areas where the skin is stressed, can stretch in any person, even those without a connective tissue disorder. Plastic surgeons are often good at dealing with changing the way forces are applied to these stretched areas. One common procedure for managing scars is a process called a Z-plasty, where a linear scar is change to a Z type scar so that the forces do not oppose each other to stretch the scar. In the scalp, there are other factors far too complex for me to cover in a blog response here.
Hi Dr. Rassman, I have had several procedures done at your San Jose NHI office over the past five or so years. The transplants are very nice and natural. However, the donor scar stretched quite badly from side to side, about 1/2 in in thickness at it’s widest behind each ear. I wear my hair cropped quite short because as my hair grows longer it does not look very good. It looks best and healthiest short. Dr. Jones performed a scar revision about 18 months ago and it reduced the scar to a fine line and it looked great for a while. However the scar has stretched back, and is even wider than before. The scar is now getting noticed fairly regularly, regardless of whether I leave my hair short or let it grow longer. If it’s possible I would still like to have more transplants as I’ve lost some of my natural hair in the past few years, but I really do not want to make this scar problem worse. And of course I really want to have the donor scar reversed and stay that way. The doctor of course was completely helpful and offered to re-revise the scar if needed, but I wanted to get your opinion. I read in your newsletter that you have new procedures that are better for the scar. I’m hoping you can help. It’s quite embarassing to have to answer the question “how did you get that strange scar?” but worse, just wondering whether people are noticing. I just want to solve the problem, and for it not to “come back” again.
Thanks for your help.
There are no guarantees, of course. There are two causes of donor wound scars: one from your body tissue type/healing properties, and the other from surgical techniques as they interact with your healing and body tissues. You may have a collagen defect, but another attempt at scar revision is worth a try and if we were involved, we generally do these revisions at no charge for our patients. If that fails again (even with the new techniques), there are two other ways to fix scars. Each of these have a high degree of success, but they are expensive – the first is FUE and the second balloon stretching of the scalp. We subsidize the FUE repair of wound scars that were a result of a previous NHI surgery. We can talk about these alternatives and which would work best for you, once I have had a chance to examine you.
Dr. Rassman:
I too have some scarring in the front forelock area. I have never had a prior procedure and ample non-scarred donor areas. Can hair grow in the front forelock scarred area? If so, are you ever in the NYC or NJ office?
Hair transplants can grow in scar. It is, in fact, a good way to hide a scar. I use hair transplants to hide neurosurgery scars, accident scars and plastic surgery scars from face lifts and brow lifts.
I no longer go to the east coast to perform surgery. Dr. Robert Bernstein is a great surgeon and I would advise seeing him for a consultation. I would have no hesitation for him to do surgery on any of my family. His phone number is 201-585-1115 and has offices in New York City and Fort Lee, New Jersey.
I would like to shave my head, but have a donor scar about 1/4 ” in width….. We communicated in the past about 2 choices:
1) Scar Revision, Not sure about this one, since, it seems my scar will just stretch again…the scar reaches the lateral side of my head, about the top of the auricle apex.
2) FUE into scar….This seems like the best shot…but will I really be able to shave my head…I would think you would still see a scar even if their is hair growing through it….and can hair grow into scar tissue?Thanks for answering my concerns
Yes, hair can grow nicely in scars. The question then becomes, “Where will the donor hair come from?” If the scar is very wide, then the ability to produce donor hair (even with FUE) may be difficult. Some of the worst scars I have seen are very wide. In those patients with a collagen defect, the tendency for the scars to return is very high.
There are two causes of scars. The first is your body’s ability to heal. Some people with the same surgery that you had, developed no scars. The second cause may be technique-related and there are a number of techniques that work well in those patients with wide scars. These techniques include a) limited fascial repairs, b) balloon and expander use. Provided that there is no defect in the healing ability of the patient and the presence of non-stretchable collagen (no Ehlers-Danlos Syndrome) then there is a probable solution to your problem. As you appear to be in the Los Angeles area, I would be happy to meet with you to discuss your options.
With regard to shaving your head, even under the best of end results, some scar will remain, albiet small, so I would not recommend the shaving option.
I have a bad elevated, thick scar from my hair transplant incision. I was told by my doctor that this is a keloid scar. Can you explain this to me and what it means if I ever have another surgery?
In medicine, we always talk about the differential diagnosis of a particular problem or disease. Scars come in many flavors and we are focusing upon healing wounds with this question. Some scars stretch, some get red for a short period of time, some hold their redness for weeks (even months), others get elevated and some form tumor type growths which grow from them – the keloid scar. Many people, even some doctors use the term keloid scars when they are not really understanding what a keloid is. The keloid has become famous from photos in the annals of National Geographic, showing people creating these grape like tumors by cutting into the ears and applying a chemical irritant which produces the keloids. When keloids are found naturally in wounds, they are most often found in the darker skinned races. Doctors have been polled reflecting the cumulative experience of tens of thousands of patients, and keloids are almost unheard of when we talk about scalp scars. When a keloid exists, it is a proliferative process in which the scar significantly exceeds the boundaries of the original wound and is significantly elevated and often globular. Hypertrophic scars can be elevated or simply a thick scar. Burn scars can also be hypertrophic, but rarely keloidal. The trunk and shoulders develop widened and hypertrophic scars quite commonly after mole removal, and this would not be a contraindication for elective surgery. I have done scalp surgery on people who are known keloid formers, but I have never seen one appear in the scalp from which the donor area is harvested.
As a former patient of NHI, I remember that it was desired/required to keep the hair length longer in the donor area in order to “cover” the post surgury scar/shaved area. Do the new procedures (scar minization) used for the donor area make this no longer necessary?
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. With new techniques recently developed over the past year or two, the risk of scarring in first time surgery patients has been reduced. We have notified all of our patients from over the years to contact us if they had scars that were noticeable or bothersome. New techniques can reduce these scars and there are a series of options now available to treat problematic scars. As you can see from my publishing your question in my blog, my goal has always been to focus my efforts on good patient follow-up and communication. I want 100% of my patients to be satisfied and I will work towards that end. Please contact me and make an appointment.
I have terrible scars on my head from a burn I got when I was a child. I had many, many surgeries with balloons placed in my head to stretch the scalp and the scars (which are significantly better) are still there. Prior to the last three surgeries, I had a scar that ran from ear to ear which was about 1/3rd inch wide. The cosmetic surgeons tried to remove the scar but it kept coming back. Is there something that you can do for me with Hair Transplants?
Yes, hair transplants work very well for the scars you are talking about. Depending upon your hair color and the density we need to get in the scars, we can usually fill scars in nicely in one or two surgical sessions. In some patients we can not push the density so more than one session may be required. Still, after just a single session, you should see a benefit of the surgery.
