Scar revision; "nuggets"
Posted 03-29-2012 at 03:48 PM by Sara Wasserbauer, MD
I just had a patient ask me about two big scars at the back of his head. Both were from old strip surgeries and in both cases the surgeons were trying to maximize the number of grafts. He has black hair and light skin so the contrast really makes the 8 (top) and 5 (bottom) inches in length visible. The width is about 4-5mm for each.
So should this guy do a strip scar revision or try FUE into the scar? The answer depends on the individual. A revision might put him right back in the same position. Since he has fair skin and dark hair, the contrast is working against him as is the relatively low density of his hair (which is probably why they took a lot via the strip in the first place). Strip scar revision success depends in large part on elasticity. If you have a very elastic scalp, the likelihood of stretch-back is high. Look up the Mayer-Pauls elasticity scale online to see how to measure this. In this kind of case one would want to measure it at several locations; lower scar, upper scar, and in-between the scars at least.
FUE is also a good option but without examining the individual and seeing how the blood return is in those scars it is difficult to predict. I usually prick with a needle and count how long it takes to bleed as a measure of blood supply across the scar (i.e in several places), and this can help give you a more accurate idea of the chance of success. If a patient decides to go through with FUE into the scars, you can usually get good outcomes and many patients plan on doing it twice - once for filling in initially and possible a second time for density if needed.
Nevertheless, there can be slight issues with directionality for two reasons 1) the hair on top of the scar and the hair below might already be heading in slightly different directions so you have to bridge that gap and 2) hair growing out of a scar can sometimes vary direction all by itself. Realizing that these issue can occur helps you to decide how to proceed and having realistic expectations is half the battle. Also, hair placed into scar takes much longer to grow (I tell people at least 18 months) and depending on the blood supply, can have lower growth rates overall. This is why it is a good idea to choose surgeons with experience doing these.
Remember that most hair surgeons are going to be trying their best for their patients and that this is a tricky surgery. Good results CAN BE ACHIEVED though so there is hope! Good Luck everyone and I hope that helps!
So should this guy do a strip scar revision or try FUE into the scar? The answer depends on the individual. A revision might put him right back in the same position. Since he has fair skin and dark hair, the contrast is working against him as is the relatively low density of his hair (which is probably why they took a lot via the strip in the first place). Strip scar revision success depends in large part on elasticity. If you have a very elastic scalp, the likelihood of stretch-back is high. Look up the Mayer-Pauls elasticity scale online to see how to measure this. In this kind of case one would want to measure it at several locations; lower scar, upper scar, and in-between the scars at least.
FUE is also a good option but without examining the individual and seeing how the blood return is in those scars it is difficult to predict. I usually prick with a needle and count how long it takes to bleed as a measure of blood supply across the scar (i.e in several places), and this can help give you a more accurate idea of the chance of success. If a patient decides to go through with FUE into the scars, you can usually get good outcomes and many patients plan on doing it twice - once for filling in initially and possible a second time for density if needed.
Nevertheless, there can be slight issues with directionality for two reasons 1) the hair on top of the scar and the hair below might already be heading in slightly different directions so you have to bridge that gap and 2) hair growing out of a scar can sometimes vary direction all by itself. Realizing that these issue can occur helps you to decide how to proceed and having realistic expectations is half the battle. Also, hair placed into scar takes much longer to grow (I tell people at least 18 months) and depending on the blood supply, can have lower growth rates overall. This is why it is a good idea to choose surgeons with experience doing these.
Remember that most hair surgeons are going to be trying their best for their patients and that this is a tricky surgery. Good results CAN BE ACHIEVED though so there is hope! Good Luck everyone and I hope that helps!
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