Trichophytic closure explained. Dr. Lindsey McLean VA

Its been a few years since I put up something on trichophytic closure. Trichophytic essentially means hair preserving. This technique was developed by facial plastic surgeons to get better scars for browlifts. In that surgery, hairless forehead skin is excised, and sewn to the hairline. Some bright guy realized that if you bevel the cut so that the scar is back a few hairs from the hairline itself...and the hair roots are left on the deep edge of the posterior surface...that hairs will grow out through the forehead skin hiding the scar. Wow. It works really quite well and I've done maybe 90 browlifts using this technique over the past 20 years.

Well...some bright hair doctor figured out that if you bevel the edges of a strip excision AND you close the wound so that the tension is taking off of the skin edges, that USUALLY, but not always, the scar won't widen and hairs will grow out through the scarline. It works too. I'd guess that I've closed maybe 1500 scalps like this and as I've bluntly posted many, many times before...each and every year, out of about 130 strip scars...I get 8 PERFECT scars, 120 really quite good scars, and 4 crappy scars three or four mm wide. Every year....I just don't know who is getting the 4 crappy ones and I'm very up front with guys about that possibility.

So here are pics showing the technique. They are out of a facial surgery book so the drawing shows hair from the forehead growing in front of the scarline on the skin...same principle in the donor region except both sides have hair.

Note in the example case pictures that the scar is reddish at the 6 week scar check AND there is usually a little shock loss but the scar is not wide, and one of the results is at 5 months, the other at 10 months and the last at 12 months when we excised it for a second case. And in all 3 cases, the scar is easily concealed and has hair growing right out of the scar itself.

Dr. Lindsey McLean VA