Strip scars in asian patients (brown skin individuals)

[Folly]

Hi Guys,

For those who didn't know, abnormal healing of the skin occurs frequently in individuals with brown/black skin, comapred to those with white skin. When skin is injured, it may heal with one of several types of scars: normal (level with the surrounding skin), atrophic (depressed), hypertrophic (slightly raised), and keloidal (large and raised). Keloid scarring occurs much more frequencetly in people with darker skin. Not to mention people with brown skin are also more prone to hyperpigmentation after injury (produce too much pigment).

Does anyone have any information on strip scars in brown skinned people ? I have medium brown indian skin and a very lax scalp, but i'm still worried about the scar due to the reasons mentioned above. Thanks.

[fitness-man]

i liked these...comparisons.

http://www.baldtruthtalk.com/showthread.php?t=7057&highlight=strip

http://www.baldtruthtalk.com/showthread.php?t=7058&highlight=strip

[Folly]

Very interesting, thanks for the links fitnesse-man. As Dr. Charles mentions, darker skin people are more at risk of hypertrophic scarring. How much more of a risk ? I think this is something only a HT surgeon can give a valid opinion on, based on experieces with darker skin individuals. Something i'll be asking at my consultations over the next few months. I'll let you guys know what i found out.

[Folly]

Update for any brown skinned brothers out there. I spoke to Dr. Hasson at a London consultation about this issue last month. He said he has come across keloid scarring twice in his entire time performing HT surgery. Both times were with brown skin patients, but he has treated hundreds and hundreds of brown/black skin patients (can't remember if he said thousands), so it is still extremely unlikely. I think the patient will know if he/she has a history of keloid scarring, in which case they should talk to their HT surgeon about it pre-op. Otherwise, i gathered from Dr. Hasson that it's not something to worry about.

Not sure how they deal with keloid scarring in a strip scar if it does happen. It's just a raised scar, so maybe they just 'trim' it. I'm assuming the scar tissue underneath will be the same as a normal scar, so FUE'ing into the scar once it's trimmed should produce the same yield. Maybe keloid scarring isn't that big a deal ?

I'll be seeing Dr. Feller next month, so i'll pick his brains on this issue too and update this thread.

Thanks.

[UKresponder]

Hi there,

Don't worry about the stats that are associated with hyperpigmentation with dark skinned people. It's really about the skill of the surgeon producing a nice lnear clean scar also the more grafts you go for naturally the wider the scar will be and hence nore tension will be present on the tissue where it hs been taken from.

I have ahs two strips form Dr feller and they have both healed beautifully in fact the 2nd time round was even better than the first.

here are some pics

Dr Feller will give you a great scar he goes long and thin = less teniosna dn a thinner scar

best
Uk R

[Folly]

Thanks UK responder. Yeah, i've seen a few of Dr. Feller's tricho scars and they look very good indeed. I saw a couple of Dr. Hasson's closures recently too in person (Jotronic and another H&W patient) and i couldn't believe how undetectable they were. I was totally stunned at the comparison of my head to Jotronics. He seems to have less scarring than me and i've only had 1,250 grafts via FUE. White dots on brown skin looks terrible by the way !! I had lots of them. The extra contrast of the white dots on brown skin really accentuates the overall scarring effect. I definitely don't think i could shave down to a 1 guard without those white dots showing through.

Your scar looks great mate and good luck with the growth. You know where the staples ener the scalp, above and below the scar.....Do the hairs there get damaged by the staple entry point ? Just wondering.

Thanks.

[Jeffrey Epstein, MD]

While what you describe is overall true, there is an extremely low risk of any keloid or even other scarring with a donor strip incision. What I occasionally see is some darkening of the scar in some patients. What you have described as your skin, most likely you'd be in the top one-third in terms of donor site scar appearance.

[Folly]

Thanks for the input Dr. Epstein.

[gillenator]

Folly,

Are you then Asian as your thread implies? If so, I am also Asian (half) and had 4 strip procedures without any issues with my donor scar. Even after 4 strips, I still have a very long thin linear scar!

And yes my 4th strip had the triclosure method done.

[Spex]

Folly, You have good donor , your strip scar will be hard to find

[Folly]

Hey Gillenator....hope you're well bro

Are you then Asian as your thread implies?

Yeah, i'm of Indian descent. Medium brown skin.

If so, I am also Asian (half) and had 4 strip procedures without any issues with my donor scar. Even after 4 strips, I still have a very long thin linear scar!

Wow. Did your scalp laxticity come back to normal every time and if so, how many grafts did you have ?

Folly, You have good donor , your strip scar will be hard to find

Cheers Spex. I'll definitely be going for strip after Dr. Feller told me my hairs are too fine for FUE. Probably explains the poor results i've had from my previous FUE surgery.

So that's 3 HT docs (Dr. Feller, Dr. Hasson & Dr. Epstein) who have said there is nothing to worry about with strip scars in those with darker skin colours.Thanks to everyone for their comments.

I live in London, where it's very sunny currently. I was outside for about 45 minutes and had a mirror next to me. I took a look at my hairline and couldn't believe what i noticed. I had lots and lots of hypo pigmentation marks on my hairline, where the incisions had been made for my transplanted hairs. I didn't realise the incision sites also cause hypo. I thought it was just the FUE punch marks in the donor area. If i wear my hair up, it's actually quite obvious and noticeable (maybe only during the summer, but maybe not).

This isn't something i've read about before....but then again, almost all the information regarding hair transplants is relevant to caucasian males, so i'm not that surprised.

That's something else darker skinned people should be aware of (hypo in the hairline)

[gillenator]

Folly,

I probably have seen more hypo-pigmented and "raised" scar cases over the past 30 years because patients needing repair tend to contact me and I have no doubt seen more photos than any other individual(s). Most HT surgeons do not see that volume of pics of repair cases. Not boasting by any means, just stating the facts.

Anyways, your asian decent (Eastern/South Asian) is not prone to raised scarring that I have noticed. The keloiding from my observations is more prevalent with those of African American decent or middle Eastern decent. Still even amoung those groups, it is not common. Those cases mostly involved the more darker pigmented individuals.

Yet I have observed very fair complected caucasians heal with a wider or raised scar and have seen lingering redness in very fair skinned individuals.

If you are a good healer, then there is a much more higher probability that you will not end up with a raised scar from a strip excision. It's more of the hypo-pigmented spots you have noticed at the recipient sites where the former grafts were placed that's IMHO more of an issue for you.

I would recommned that you discuss the use of custom-sized micro blades to create your future recipient sites verses using hypodermic needles in creating your recipient sites, espcially at the hairline where the impact of visibility is high and more profound. Hopefully you won't have any more recipient "dots" on your hairline.

Many asians of Indian decent have profoundly dense donor. It sounds from your own words that your hair caliber is more thin however.

I had 6900 grafts total, and my last procedure of roughly 2400 grafts was done by strip as well. My laxity was a bit tight however the surgeon closed me with staples. We both wanted that extra assurance of a thin linear scar which was accomplished.

Thanks for asking and best wishes to you my good friend!

[Folly]

Folly,
I would recommned that you discuss the use of custom-sized micro blades to create your future recipient sites verses using hypodermic needles in creating your recipient sites, espcially at the hairline where the impact of visibility is high and more profound. Hopefully you won't have any more recipient "dots" on your hairline.

Great info. I'll mention this at my next consult.

Thanks for your help once again Gillenator. If we ever cross paths in a bar, drinks are on me bro !!

[gillenator]

You are welcome Folly, anytime brother!