Dr. Lindsey excision of 50 cent sized congenital bald spot on 10 year old boy, McLean

[Dr. Lindsey]

This little boy was referred by a dermatologist a couple of years ago for a 50 cent piece size bald spot. Mom and I talked about options including excision of the area, FUE into the area, or a combination of both. They returned this summer as other kids have started making this little boy self-conscious about the spot. Given how dense his surrounding hair is, I frankly thought that just FUE-ing the area would not be dense enough particularly with a short haircut. So we agreed to excise the area and next summer we’ll re-assess and see if any additional work needs to be done.
I told them that I’d expect that we’ll decrease his bald spot 50% or more with this procedure, but from the looks of the picture, I’d say we likely got 90%....assuming it doesn’t stretch back much.
Note the size of the bald spot before excision. Then I excised about ¾ of it so that I knew that I could get the area closed with minimal tension. Once it felt like it would close well, I then excised another sliver of it.
On the white surgical drape, you’ll see the size of the original specimen (where the pink color is) and how quickly the lesion contracted down to a much smaller size. This is because people lose collagen-the springy connective tissue that holds your skin tight-at 1%/year of age. So he’s only lost 10% of his collagen and his skin contracts quickly. If you did this on a 70 year old, the specimen would barely shrink.
Then a deep layer closure taking all of the tension off the skin edges was done, and then skin sutures were placed. He went swimming the next day and sutures were removed at day 9. I’ve recommended vitamin E applied twice daily and expect to do a scar check in a month. If it doesn’t stretch…we may be done, but I think we’ll likely need a small FUE case next summer.
The little boy was easy to work with and was a real trooper. Hopefully his mom will come on and describe their experience.

Dr. Lindsey McLean VA

[Follicle Death Row]

Nice job Dr. Lindsey. Looks way better. Well done.

[Dr. Lindsey]

The real test will be in 6 months after any shock loss and stretching of the scar has declared itself.

Thanks

Dr. Lindsey McLean VA

[Dr. Lindsey]

Its been 5 weeks. Mom sent in these pics. Looks like we're making progress. First the redness is normal...particularly in a child. It will take what seems like forever for that redness to fade and the younger the longer it takes. Next he has a little shock loss on the edges even though I didn't use cautery. That should come back by next summer. ( I did the same cut on my son to take off a dime sized mole and it took 8 months to start growing back ) Lastly, it doesn't look like the scar is stretching.

I'd have like to have seen him in the office but the patient had a math test and that took priority. Hopefully one day soon school will be a holiday day and they can stop by.

Dr. Lindsey McLean VA