Category: More on Scarring

I have hypertrophic scars from numerous cutaneous surgeries, and even under modest tension my scars tend to spread quit a bit. None of them have an adequate cosmetic result in my mind for a hair bearing region. As a result, harvesting grafts with a strip is something I am not considering. Given my propensity for making ugly scars, am I likely to have abnormally visible scarring from follicular unit extraction at the harvest or transplant site, or are these so small that hypertrophy and spreading are of little concern?

Nobody wants a bad scar, but for hair transplant surgery (or any surgery on the scalp), the scar should always be hidden under the hair if you keep it at a normal length (more than 2 inches). Even a bad scar can still be hidden after a haircut with a #3 clipper most of the time. I also realize many men would like to cut their hair very short in the back where the scar may be visible, and that’s when follicular unit extraction (FUE) may be a better option. However, if you have a tendency to have hypertrophic scars, then even the FUE may leave you with hundreds of noticeable dots.

As with everything in life, you need to have some perspective on what you are doing and what you are willing to give up. Nothing is perfect. There is no such thing as scar-less surgery. There are men who choose to have hair in the front and top, but sacrificing the gain with a scar in the back of their head. There are men who do not want any scars on the back of the head (linear or otherwise), and for them surgery is simply not an option. There has to be some give and take that you have to be comfortable with.

Think about cosmetic surgery on women: Women who want larger breasts will sacrifice their gain in cup size with a scar under the breast, around the areola, in the armpit, or in their belly button. Women who want a face lift will sacrifice a youthful face for a scar along the back of their ear and behind their front hairline.

Remember, keeping your hair very short after a hair transplant will not give you the best cosmetic results no matter how many grafts you transplant. A very short hair style will look much thinner than a longer hair style, which covers more of your head. This is because the surgeon is working with a limited number of grafts to cover a big area.

This analogy on the subject of FUE really hit home:

…Your donor is like a grid of marbles. FUT is basically a line through the middle (strip) which is closed up leaving the grid uniform and balanced but when using FUE, you are removing marbles at random from all over. It is much harder to keep the grid “balanced” with FUE…

So Doctor…..when a patient elects the FUE procedure to restore their hair, is there considerably less total donor hair available?

I have heard only half as much as with FUT. Say it ain’t so!

“It ain’t so!”

I suppose your donor area can look patchy with little white dot scars if you have 3000+ FUE grafts extracted. This occurs when your original density was average or less than average. People with high density hair often will not show the white scars (dots) at all. Even with 1000 FUE grafts, you will notice these patchy white dot scars if you shaved your scalp, but in general, even with 3000+ FUE grafts, the scars and the less hair volume will be hard to notice (depending how close you cut your hair).

Remember — not all FUE or FUT (strip surgery) is the same, and not all patients are the same with healing. I have seen awful FUE scars and great FUT scars and vice-versa. Each and every patient needs to talk with their doctor and understand the unique advantages and disadvantages along with the risks and benefits of the surgery. This may sound like generic advice, but many patients who seek out FUE choose to go ahead with a FUT procedure after understanding the limitations of FUE and FUT.

With regard to your main question about which procedure will get you more hair (strip vs FUE), I think that the answer is probably strip surgery. Many doctors now doing FUE surgery actually get the hair outside of the fringe area, which means that the hair is not permanent. Some doctors (who think about $$$ above all else) will push the FUE harvest area to meet the projections given. The donor area has about 20,000 hairs in it and if an FUE procedure harvested 1/3rd of the available supply (assuming average density of the hair in a Caucasian male), that would be about 6,500 hairs or 3,200 grafts on average. All of the higher number we are reading about reflects, most probably, non-donor (non-permanent) hair.