You are a sound veteran and your help and guidance is always appreciated to many readers and you are defo one of the level headed good guys on the boards.
There are a variety of successful options for repairing scars now days - patience is key though as you well know!
I had FUE into my old Bosley scar (4x strip sessions) with great success in the areas worked on and its been documented online over the years. I have have multiple small FUE sessions into my old Bosley scar. The yield was high and it helped break up the appearance. It allowed me to have some greater flexibility but i wanted more ( dont we all.. ) i didnt want to waste or throw more FUE into my scar or use BHT as i'm not a fan of it, so i recently attempted temporary SMP ( scalp micro pigmentation) into the scar area and in weak areas along the scar and areas of the scar that had continued to stretch and caused me concern on a shorter grade, which so far has really helped. I have documented this also.
FUE and BHT are both good ways to get hair growing in scars again. It is important that patients understand that scars generally only can get diluted down and camouflaged however, not removed. Some do have delusions of grandure initially when it comes to scar repair, i have seen this over the years and these patients reside on somewhat wishful thinking and hope - This often boils down to their desperate and vulnerable state. Often these patients feel they have been violated and often they have - Its all understandable and patients want to attempt to back out the one way tunnel! Its important to stay grounded when entering into scar repair especially, and keep expectations in check at all times and be very patient. Nothing wrong with a positive attitude, but be realistic is all i'm trying to say, otherwise you might well be disappointed.
Scar repair and yield into scars is unpredictable whether via revision, FUE or BHT as you well know Sparky and its impossible to say how successful a revision will be or growth will be into scars until 12-18 months post op minimum. Growth is generally slower in scars and yield generally lower. I tried to explain this recently that in some cases yield can be very low ( generally speaking) as all depends on the individuals scar, blood supply etc. If the scar is small then chances are % yield will be high and the outcome more visually successful. My statement was a general one regarding grafting into scars generally - as its a fact, yield can and is lower into scars than say a virgin scalp. be prepared for every eventuality.
See write up on BHR site. I clinic well known for helping repair scars with FUE and BHT.
To add grafts into the scar can be a good option depending on the size of scar and how well it has healed. It is considered that the yield will be lower when placing in a scar line and it is prudent to place a lower density initially and measure the yield before using too many precious grafts that might not subsequently grow.
Body Hair FUE (BHFUE) uses the same principles of extraction as FUE, but the hair is extracted from various parts of the body and not from the scalp. BHFUE is recommended in cases where there is insufficient scalp donor hair.To add grafts into the scar can be a good option depending on the size of scar and how well it has healed. It is considered that the yield will be lower when placing in a scar line and it is prudent to place a lower density initially and measure the yield before using too many precious grafts that might not subsequently grow.BHFUE is a relatively new form of hair replacement; it is important to appreciate that because of genetic variants, hair characteristics and growth rate, BH will behave differently to scalp hair and the yield can be much slower and lower. BHFUE in certain special instances may be the answer to repair or restore hair but only after an extensive consultation period. A patch test would also be undertaken.
Its important that patients understand yield can be lower into scars so always go with a test patch FIRST , based on the outcome you can then determine the best way to proceed with YOUR scar. ALL scars are unique!
FUE into the scar is a good first port of call if the scar can not be revised. If the scar is wide and long then revision might be the better option as minimising the scars surface area will make it easier to camouflage with fewer alternative session whether via FUE or BHT or even SMP.
My recommendation depending on the individuals goal is FUE into it first then possibly try BHT after that. These are permanent options and realistic options and ones i personally recommend especially FUE. Be realistic and keep expectations in check however. The smaller the scar the easier it will be to repair via FUE /BHT with fewer sessions required for a permanent solution. I mentioned and recommended an individual do FUE initially into his scar recently given his goal and advised this was defo the best way to go initially for HIM given the size of the scar ( very small ) . I mentioned yield can be low in scars and tried to help him understand the general risks however.
I want this guy to know whilst i'm here i actually only ever wanted to educate him and was not trying to down play FUE into scars in anyway shape or form. I'm pro FUE into scar - as i personally like this option better over all other options, including temp SMP. SMP is an option but not permanent. FUE is the way to go initially especially with small scars for a permanent solution. SMP has its place, and a small one at that. Its very early days too for it and hopefully it will become a good option for certain people and also give them hope and realistic options. We are doing our best to provide info on this and time will only help.
Depending on the individual and their goal SMP is now a potential option into scars, however, as i told the same guy previously mentioned, explore more proven methods/ options first and be patient and lets wait to see more scar sessions documented online. Every scar is different and some scars are not even conductive for SMP ( This is why a small test patch is advisable also a minimum of 10 days prior to any large session) as the scar might not be able to carry the ink, the ink can disperse as the scar tissue can not hold it.
Fortunately my scar took it very well and it has completely camouflaged my scar, however its a temp solution, one which will only last a couple of years. The temporary ink SMP has and is becoming more appealing over the permant ink tattooing we have all seen previously as if the temp ink temp doesnt suit or work, it fades over the course of 2 years approx. There is a back out option so to speak.
Scar revision is a viable option for many too, especially with larger scars from poor surgery or previous multiple surgeries if the scalp has laxity. Many cases of scar revisions online too. However there are NO guarantees with scar revision. Every time you cut the skin it will leave a scar. Laxity and physiology play a vital role in scar revision. Research this in great depth and always get examined by a recommend Doc in person to assess all your revision variables. You have more than you think
Be aware that scar repair is a time consuming matter regardless of size and regardless of age of scar. Every patients goal and scars are different and there are options out there for repairing scars, just be aware that there are limitations and impossible to completely reverse the strip scar process. It can be camouflaged and diluted down but it will always be there!
Be REALISTIC and PATIENT despite what a Doctor thinks he can do to improve ones scar the proof is only ever going to be in the pudding despite all best intensions and ability.
Would you agree Sparky ?