Overcoming shame of a hair transplant scar

[gillenator]

Hi Adam,

Please allow me to first say thank you for sharing your story and picture with us. I and probably many others appreciate your transparency because every case adds to the knowledge base of what can be potentially done in the repair arena.

You had your procedure at a very transitional time in the HT industry. I remember it well because I started researching and following the field in 1980 before the internet was even around. I must sound like a dinasour! Anyways, in 1995, there was still alot of open donor work (plugs) being done however the more progressive doctors had already been transitioning into the micro-mini technology. Instead of using punching out plug grafts from the donor, they began to dissect an actual linear strip of scalp tissue and then had surgey techs dissect that strip under magnification. No one was using scopes back then so to dissect the strip into follicular units was near impossible if not impossible altogethor. Too much transection would occur. Micro's were two and three hair grafts, and minnis were four plus hair grafts. Still not very natural appearing on the hairline. I wonder if that's what you had done.

Still in that time period, closing the area after the strip specimen was excised, closure methods were in their infancy and IMHO, did not improve until later into the late 90's and into the turn of the century did improved closure methods like the double-closure technique improve the probability of keeping the scar from stretching so much. Elasticity was not an issue for punch out grafts so quite frankly, HT docotrs did not experience their patients having scar stretch back until they started the strip methods. From my observation, I doubt that you had a double closure method. You must have had a fairly large session because the scar goes ear-to-ear which was somewhat rare back then. I was used to seeing guys with shorter, wider scars from that time period. It was not until after many men ended up with wide scars that the industry realized that elastcity is a major factor regarding potential scar stretchback so many docs began to take the strip thinner and longer. I think one of the main reasons docs took wide strips was because it was easier to dissect into grafts that way. As I said no one used microscopes to dissect back then. It was more cutting tissue, not microsopic dissection like the tops docs use today.

Sorry for my rambling of history. Back to your case. Start researching online the docs with the best reputations for repair work. IMHO, most of them will either want to extract the large grafts in your hairline for two reasons. They are too low situated on your hairline now that you are 34 years old and not getting younger. The second reason is that they are too large of grafts because natural hairlines commence in single hair FU's.

Some may recommend that you begin scalp stretching exercises to extend laxity to do a potential scar revision to make the linear scar much thinner. Then they may want you to come back after complete healing to do a FUE into the scar follow up session. You would be amazed at the end result. I have seen it done many times. Not every case is the same however. What is the implication? You need a reputable doc proven in repair work who is skilled and experienced in both strip AND FUE. It may very well take a combination of methods to bring about the best cosmetic result in your case.

That leads to my last recommendation. Get examined in person once you have narrowed your final selection of repair docs. Scap laxity cannot be tested through pics as you already know. It is difficult to get a gauge on the level of exisitng blood flow/supply in the scar area withoput seeing the area in person. See what I mean? That's why it may be more advantageous to remove dead scar tissue with a scar revision before implanting FUE grafts into the area at a later date. Improving the blood supply to the area can and will improve the chance of graft survival. The more hair that will grow in the scar, the better chance of disguising or camouflaging it.

One of the realities of getting a HT is the fact that we may not be able to buzz our hair extremely short in the future. Our scalps will never be the same as it was before the procedure.

I think you have some good potential to improve the area visually speaking though. Best wishes to you Adam!

Last c

[varonil]

Dear Gillenator,

I really appreciate your thoughtful note, and the historic background info on the development of HT techniques. How I wish I would have waited a while longer.. but I was young and "the sky was falling on me" because of hairloss. Being out on a mining site is reason for my delayed reply.

There's a little more to my story. Slightly after the picture was taken I did go to a Dr. Jones (Oakville, Canada) who said he could reduce my scar by about 75% with FUE implants into it. His opinion was that a scar revision had a significant probability of stretching back out. They said they just happened to have an opening the next day (as opposed to a long wait) so I took it. I had 150 grafts put into the scar; that was October 23rd, 2008. I must say the scar does appear a little smaller to me now, but it certainly hasn't diminished 75%. Dr. Jones said to check in with him in March so I will give it some more time.

From what I can gather Dr. Jones seems to have a good reputation and gets a lot of publicity from talks and articles he gives. I will however research other options for additional procedures.

Do you know if having had FUE implants would complicate me from having a scar revision? I guess one good way to find out and get an opinion from another highly reputable doctor.

[gillenator]

Dear Gillenator,

I really appreciate your thoughtful note, and the historic background info on the development of HT techniques. How I wish I would have waited a while longer.. but I was young and "the sky was falling on me" because of hairloss. Being out on a mining site is reason for my delayed reply.

There's a little more to my story. Slightly after the picture was taken I did go to a Dr. Jones (Oakville, Canada) who said he could reduce my scar by about 75% with FUE implants into it. His opinion was that a scar revision had a significant probability of stretching back out. They said they just happened to have an opening the next day (as opposed to a long wait) so I took it. I had 150 grafts put into the scar; that was October 23rd, 2008. I must say the scar does appear a little smaller to me now, but it certainly hasn't diminished 75%. Dr. Jones said to check in with him in March so I will give it some more time.

From what I can gather Dr. Jones seems to have a good reputation and gets a lot of publicity from talks and articles he gives. I will however research other options for additional procedures.

Do you know if having had FUE implants would complicate me from having a scar revision? I guess one good way to find out and get an opinion from another highly reputable doctor.

You're very welcome. Let's back up for a moment. When the term "reducing" is used, it implies just that. That the scar tissue will be reduced, meaning partially removed. Did Dr. Jones test your elasticity and then determine that you were too tight for a revision?

I just find it highly suspect when he tells you there just happens to be an opening "the next day". If he had done a scar revision, you have to heal first before any grafts are inplanted in what is remaining. In other words, there is no way they can charge you for any grafts when they cannot implant any. Having a scar revison and then FUE grafts added later is a two stage scenario. See what I mean?

Not that I am accusing him of anything, but there's probably not much income in doing just a revision and nothing else.

Having you do scalp stretching exercises for six months or so could have potentially created enough laxity (play in the scalp) to remove some scar tissue. I think that more than anything would have given you the best cosmetic repair result and a much thinner scar to start adding grafts to. I mean you could have started scalp stretching and then let's say in six months, no laxity was gained, then I could see his point much better. But anyone who has dark hair against a light complexion is going to have a much more difficult time camouflaging the scar. IMHO, it is impossible to camoflauge a scar by 70% with that wide of a color contrast. You don't have to be a licensed physician to see that!

But I guess it's easy for a lay person like me to be suspect since I am not a doctor and never performed a scar revision. My opinion however is based on 29 years of clinical observations in this industry. I just feel IMHO that it would have been better to at least see if in fact a scar revision would have worked after trying the stretching exercises.

Also, did he discuss different closing methods with you which can greatly help to prevent scar stretchback before getting you in the next day for FUE?

[Zao]

I would run for the hills if a doctor all of a sudden had an opening for me the next day after a consultation. This smells like desperation to me for some easy cash. I hope things work out for you, but I don't like this doctors tactics. Sounds VERY sleazy to me. Sounds like he took advantage of your desperation.

[Steven Gabel, MD]

Adam

Thank you for posting your situation on the forum, which will hopefully provide you with some options and educate others who are in the same boat as you. There are a multitude of reasons why people develop poor results at the donor area from a patient’s own intrinsic ability to heal to the technique that was used to harvest and close the incision. Unfortunately, some people are just more prone to scar then others.

One question I have for you – do you have any other scars or incision sites on your body that have healed well or not healed well? I ask this because if you were to have a scar revision (which gillenator was referring to in doing the scalp exercises to increase your elasticity and remove the scar) I would like to know if your body tends to form larger then normal scars. If that is the case, you have to be very careful to excising the scar as you may end up in the same spot you are in now. If you do heal well after a cut or prior surgical incision, then reducing the scar as much as possible prior to FUE may be in your best interest. Also, did you have FUE done in the entire scar or just a portion of it? You should monitor the results from the FUE into the scar very closely to see if it grows or not.

Steven Gabel, M.D.
Portland, Oregon
www.gabelcenter.com

[gillenator]

Adam

Thank you for posting your situation on the forum, which will hopefully provide you with some options and educate others who are in the same boat as you. There are a multitude of reasons why people develop poor results at the donor area from a patient’s own intrinsic ability to heal to the technique that was used to harvest and close the incision. Unfortunately, some people are just more prone to scar then others.

One question I have for you – do you have any other scars or incision sites on your body that have healed well or not healed well? I ask this because if you were to have a scar revision (which gillenator was referring to in doing the scalp exercises to increase your elasticity and remove the scar) I would like to know if your body tends to form larger then normal scars. If that is the case, you have to be very careful to excising the scar as you may end up in the same spot you are in now. If you do heal well after a cut or prior surgical incision, then reducing the scar as much as possible prior to FUE may be in your best interest. Also, did you have FUE done in the entire scar or just a portion of it? You should monitor the results from the FUE into the scar very closely to see if it grows or not.

Steven Gabel, M.D.
Portland, Oregon
www.gabelcenter.com

Thank you Dr. Gabel for your input and the additional points that you made regarding how a patient heals from cuts and lacerations. I remember when I used to work inside the clinic and insisting on having that area evaluation included in the patient's medical history.

In fact, as you no doubt are aware of, some darker pigmented patients can have a disposition to healing with raised scars (keyloiding). Not all but enough to want to discuss this with the patient before making any final decisions about moving forward with surgery. It should be covered with every patient IMHO.

Again, we do not have the benefit of seeing his scar in person, but just from viewing the picture he provided, his scar does not appear raised or even discolored. After observing endless linear scars from HTs for nearly three decades, he does not appear to me to have that issue. From my expereince, very few patients have an issue of healing with wide or raised scars relating to how they heal. His looks very clean, just wide.

These are just my observations from a lay person.

[varonil]

Hi Steven,
I'm really sorry I haven't got back to you sooner. I just haven't checked this blog out for awhile, and I guess I thought I would get notifications if I had comments.
I do have stretch marks between my shoulders and biceps from the heavy working out I did in highschool (never used steroids). So perhaps I am prone to scarring. I have got pretty good results from the FUE into the scar and will post those in a few minutes.
Now what I'd like to do is remove my old hairline grafts and repair the cobblestoning and just keep my head shaved close.
I will check this blog more regularly now, but can also be reached at acmc75@gmail.com
Adam

[caresabouthairs]

No one should really know what your scar is from unless they have looked into hair transplant surgery...or have had one.


They sell a scar creme at your local Walgreens for about 20 bucks. It worked for me. I used it on my donor scar when healing...

I had a bad scar on my arm from a tattoo I had removed with a lazer and the creme reduced the pink color very much.


On a lighter note...I worked in an office when I had my transplant done where there was no option of wearing a hat during the recovery.

I told the girls I worked with that I had fell off a peer in the lake and had to get stitches in the back of my head. As far as my frontal hairline...I covered it with my wifes make up and said I had some bad sun burn!!!!

No one knew the better!!!

[gillenator]

No one should really know what your scar is from unless they have looked into hair transplant surgery...or have had one.


They sell a scar creme at your local Walgreens for about 20 bucks. It worked for me. I used it on my donor scar when healing...

I had a bad scar on my arm from a tattoo I had removed with a lazer and the creme reduced the pink color very much.


On a lighter note...I worked in an office when I had my transplant done where there was no option of wearing a hat during the recovery.

I told the girls I worked with that I had fell off a peer in the lake and had to get stitches in the back of my head. As far as my frontal hairline...I covered it with my wifes make up and said I had some bad sun burn!!!!

No one knew the better!!!

Was it Mederma cream that you used for the scars?

[the B spot]

Excellent information Gillenator/Dr. Gabel!!!!

Varonil--- I can appreciate your situation---your story is one that we have heard many, many, unfortunate times. However, there are options--- From the pic you provided, your scar is not overly long, or overly wide and as mid 90's closures go, is not that bad(based on the pic).

However, 150 fue grafts will not make a huge difference in your overall appearance with your head shaved like it is.

It could be the 150 grafts were merely to test the vascularity of your scar tissue and test the potential re-growth of a larger follow-up session----I'm not really sure, so I will just state that I believe 300-350 grafts would provide better camouflage---not to completely eradicate the presence of a scar, but to break it up enough as to render it less of a conversation piece.

Also, if the tissue must be removed, Gillenator is right that a resection can be performed, any grafts removed transplanted to help disguise the old work, and a new scar produced that has a higher likelihood of accepting FUE grafts to disguise it.

Of course, that doesn't help you select the right clinic for you, etc... I would suggest working with Gillenator who is an independent patient advocate and can offer unbiased help--He has helped MANY people in your situation.

Take Care,
Jason