Scar Grafting with Dr Cole

[Stevie R]

Hey Northeastguy, what was the reason the redness stayed so long in your lower scar? Did anyone say anything about why it stayed red for long? I was just wondering cause the bottom scar of yours stayed red and was smaller than teh top scar and my scar is red and is small, does that have anything to do with it I wonder...Any help? I am sure it will go down eventually but was just curious if you got any info on it...take care.

[John P. Cole, MD]

Strip scars can be white, pink, or red following the healing process. The redness can last indefinitely. We have found that grafting these scars is the only way to eliminate the redness. I honestly don't know why they stay red or pink after they heal. I also don't know why the redness fades when we graft them. Grafting also adds a more normal color to white scars. We know that red implies more blood flow. Scars typically have good blood flow even when they are white, however.

[Stevie R]

Thanks Dr. Cole, I realize that grafting a white scar, reddish or pink scar can be helped by grafting as the color improves alot and varies how well form person to person but was just wondering if size have anything to do with it. My scar is thin and Northeastguys bottom scar is thinner than his top one so I wondered if the thinness of a scar had something to do with it. I am not worried about my redness as I am going for another pass soon and I know it will be red again. I was wondering what knowledge you have on lasers such as fraxel, the palomar laser, and V-Beam to improve redness and overall to blend the scar into a normal skin color? Also what do you know about recell? I ask because it has been my experience that many HT docs are fairly naive on these methods but it seems you may have some experience or knowledge you can share with us?

[John P. Cole, MD]

Pulsed dye lasers are effective for improving red scars. There is no data re their effect on newly transplanted hair follicles but we know there is No effect at all on pigmented terminal hair follicles.

For white scars there are some excimer lasers that with multiply treatments help repigment skin. The problem is maintenance treatments are needed.

Summary
Pulsed dye laser are excellent for red scars. Excimer lasers are somewhat effective and require maintenance for white scars.


Recel is interesting primarily for adding pigment, but unavailable here in the USA at this point. I think sometimes you substitute slightly red for white scars though. I don't think it will be beneficial in red scars, but who knows. I think it is mostly used with skin grafts and dermabrasion. Strip scars are often very deep, but it makes sense to add some normal cells to the scars to make them look better. I think the follicle grafts we add to scars do something similar by adding melanocytes, keratinocytes, elastin, and hair follicles to make the scar look more like a scar.

I have no patients that responded well to lasers. I'm just giving you what is supposed to happen with lasers. That does not mean what is supposed to happens is what happens.

[Stevie R]

Hello again, thanks for the reply, my scar is not exactly red, it is similar to the skin tone but perhaps a little whitish, however after grafting, their is redness around the scar, more so on the bottom. Again, I am not worried and like you say it will go away but I was just wondering why is is red around the scar? Sorry if I didn't make that clear but it is nice to hear your insight on the V Beam and other lasers and so on. But do you understand what I mean by the scar being red around it, and if so is it common? I am 7 months post op and am a bit surprised it is still red as many have told me their redness has gone away long before 7 months, thanks again for sharing your experience and knowledge with us all, it's nice to hear it.

[John P. Cole, MD]

The V Beam is a pulsed dye laser. It can help with color issues. I honestly don't know how it works on strip scars. I just know it can help with pigment problems including redness. I don't personally use lasers.

I'm sorry to have avoided your question. You have redness around a scar. Are you saying the scar was grafted already? Redness around any scar would suggest possible follicullitis. This might sound bad, but it would probably be limited to some ingrown hairs that might easily be removed with forceps or a needle. If the scar were grafted, perhaps the doctor also added grafts in the surrounding area. While this might seem prudent, it probably is not because all it does is increase the density around the scar so that the contrast between scar and the surrounding area is of greater contrast in terms of hair density. I don't recommend grafting around a scar unless there are tiny white marks usually resulting from the insertion of the needle during the suturing process.

A good photo of the problem might be beneficial.

[Stevie R]

Hello Dr Cole, I did do my first pass already 7 months ago and no worries about not responding as I did not word it well. I don't know how to post pics up here but I am not real worried just waned to hear your opinion on it as the redness was dying down but in a year in a half I will do something like the V Beam to fix the redness (I imagine I will have some more after my second pass in 5 months late as well) and then I will do recell after it, or I may just do recell because I am sold that it is the best to improve my case. But honestly my scar is so small in some areas it is hard to tell if it is red just under the scar or on the bottom of the scar...but redness seems to just be in the bottom and yeah I think he did graft below the scar a bit and perhaps above it a bit as well. The reason why this interests me is because the color of my scar is so close to skin, yet with fewer density of course, but not that much fewer in places where my scar is less half or more of 1mm and the hairs put in already have met the density or nearly have, however what gives the area off according to my wife and others I have shared pics with is the redness, at least in the areas where I don't need many more hairs, and my wife and all else agree the redness is just below the scar...Can it be perhaps that what you consider is a red scar is just below the scar and in fact the scar itself is not reddish? I don't mean to call your experience or professionalism out, I am just asking because we may just misunderstand each other. I don't think it is follicullitis and I may have some small dots here and their but not many and honestly it is very hard to see since the lowest I have ever went is a one guard but my wife says I don't have them, yet I may have small train tracks, but that to is hard to see because my scar is smallish and I have not had the opportunity to shave down lower than a 1 guard, if you can't give any other opinion on the subject due to the lack of a picture I fully understand.

[John P. Cole, MD]

No worries. It is hard to understand exactly what is going on with your redness. I apologize for that. Here is a strip scar that is red. Note that some of the redness extends in the upper part above the scar where hair is apparent. Then you see a 8 month result after low density grafting. Maybe the pulse dye laser can reduce redness, but grafting is the only way that I've been able to personally get the red out of these scars.

I think that redness in the lower margin of your scar suggests some sort of irritation. I did have one patient with a hypertrophic scar and an angry redness. I tried to reduce his scar as there was alot of hair growing in the margins of the scar. I thought the hair growing in the scar might be the culprit of the angry look and hypertrophy so i revised the scar. By the way, I did not perform his strip procedure. Grafting alone would have left the raised scar so i thought perhaps it was just bad work and I might be able to make it much better revising it. After the revision, the scar was much better, but it came back still raised and angry red. Thus, I elected not to graft it because I assumed that any surgery to it would just make it more angry. I began a series of steroid injections. I began at 10mg/cc of kenalog and raised this to 20 mg/cc of kenalog over time. After several injections, i was able to get the red out and the scar flat. Some areas responded faster than other areas. It just goes to show that there are many reasons for a pink or red scar. One has to look at the individual scar and treat it on an individual basis. It may be that something else is going on with your scar as most pink or red scars are not angry looking. They are just pink or red.

It sounds like your problem is not terrible. That's a good thing.

[Stevie R]

Yes I was not too worried just liked to hear what you had to say since you were commenting on here. However, my scar was not red before my FUE and it is below the scar mainly where it is red, not on the scar, his scar after more closely resembles my scar even in color as the redness surrounding is not that bad even, but that being said it is the main thing from getting my scar fixed at the moment but I imagine it needs more time for whatever the reasonhich shouldn't matter anyway because I will go for my second pass in 5 months. But my scar is slightly raised on the right, where the redness is more prevalent ,which I don't think is a coincidence because when I shot them up with steriod injections about a year ago it flattened some of the scar out very well and the biggest parts were red so it seems their is some connection, yes? I know it is hard without pics but honestly even if I took pics the scar is so small it is hard to get even with a high resolution camera. The reason I say that the redness is the main problem also is when I use the derma roller and then the scar becomes red it blends in with the redness below the scar and it is nearly impossible to find in the places where the density is near perfect already. I think however, this conversation has to be a kind of stab in the dark for ya as it is hard to know what to say without a pic but I was just interested what you think about my assessment of it. Also do you think some more steroid injections might help the redness and raisedness at the moment? The reason I ask is because when I did the first set they worked so well that I was planning on waiting 3 months and doing another round but was urged not to by a different dermatologist than the first I saw that was away on vacation because she felt the scar my strecth as the skin felt thin she said and it may stretch the scar, of course I was cautious and then about two months later I did my FUE pass without ever consulting the first dermatologist but I have had doubts when she was scarred of it stretching, did her caution make sense to you and do you think I may benefit from another round of steroid injections and if so how many months post op is sufficient, 10, 12 14? Not for this time of course since I will do the next round in 5 months but to keep in mind for next time, unless you think it may benefit my next pass? One thing is for sure those first steroid injections really helped my scar.

[Stevie R]

Any thoughts Dr. Cole? If not I understand your pretty busy and thanks for your input on those last posts, anyone else have any input on my last post? I think I just need to heal and that I am over complicating it though.

[John P. Cole, MD]

Yes, grafting a scar will make it turn red. The redness will generally fade over 3 months. Redness below the scar is difficult to explain. It is one of those things that you'd like to see and you would also like to see the before grafting photos. Hopefully some good ones were taken.

I do not think steroid injections make scars widen; I have never seen them cause a scar to widen. It is ok to inject a 10mg/cc kenalog concentration in the elevated areas again.

[Stevie R]

Actually after looking at it today it seems that both top and bottom are red, just around the edges, perhaps because it is raised? Sorry if I thought it was just the bottom, but it seems less on the top, hard to see due to the hair more easily concealing it. Oh okay, I thought it was odd when she said it would stretch, but I was of course cautious as I know little about these shots of course, I think I will look into getting another shot then, thank you. Just curious and for everyone else here, how long after is the shortest time to get a steroid injection after FUE into a scar? And do you think injections would benefit me for my next FUE pass in 5 months in any way?

[northeastguy]

[QUOTE=35YrsAfter;132544]Repair work can often take more work than expected. How is your lower scar? Does it feel less elevated?

Sorry for the late reply. Seems I missed quite a discussion. The lower scar is doing well. it is still raised in some areas but doing much better than it did after the first pass. I think the kenolog injections certainly helped. We will be able to do another pass with the steroid when I deal with the horses tail. all in all it less raised and not as red. Should start seeing growth in about a month now....

[northeastguy]

Coming up on 3 months on the 18th so looking forward to cutting down to a 3 guard. Going to try to get some good photos. This is when I wish i was a little closer to Dr Coles office. Its hard to beat those quality images for comparision.
Definately getting growth because I get the occational pimple effect along the scars.

[35YrsAfter]

Coming up on 3 months on the 18th so looking forward to cutting down to a 3 guard. Going to try to get some good photos. This is when I wish i was a little closer to Dr Coles office. Its hard to beat those quality images for comparision.
Definately getting growth because I get the occational pimple effect along the scars.

Looking forward to seeing your progress.