the WTF Scar!

[redhusky]

Here is a pic of my scar recieved from removing non-cancerous birth mark in 1995 (age 23), I made mistake of shaving down to #1 and there it is in all of its glory. Ive tried Toppix, sprays etc, but all they do is enhance the hair around the scar and it begins to take on the characteristcs of a vagina (not a good look). Can hide when hair is longer but still want to fix. Any suggestions (Fue, Tri-Closure??)Or do I have to have to wear my hair like Joe Dirt the rest of my life? HELP!..Thanks RH

[NoName72]

An FUE can fix this i think. You have a lot of donnor hair available and you won't need a lot of them to cover this, so i'm assuming it won't be super expensive.

[mattj]

Was the birthmark removed by cutting away the skin? FUE can be successful in adding grafts to cover a scar, but it largely depends on the type of scar tissue present. Some scar tissue is thick and not very well supplied with blood vessels which can lead to poor growth.

Was the birthmark visible through your hair?

[redhusky]

it had a long name

birthmark is the term I loosley use, It was called nevus sebaceous of johansson. It was a patch of hairloss that developed in the 90s, I guess if I didnt remove it can become cancer. Anyway they hacked away, Dermotolgists say it is cosmetic now. The biopsys didnt reflect a lack of bloodflow.

[Spex]

You could FUE into it - however if laxity is good you could have a competent doc revise the scar making it much smaller and then FUE into it increasing the chances of a better end result.
FUE'ing into scars is always a little unpredictable so therefore minimising the surface area you need to cover would be beneficial.

Where are you based as if anywhere near Washington DC look into Dr Lindsey as he will be a great guy to consult with to gain an accurate opinion on how best proceed given his vast experience with facial plastic surgery and scar repairs.

Hope this helps
Spex

[gillenator]

redhusky,

You may first want to consider treating the area with Acell which has been demonstrating awesome results with scar repair.

Possibly this can improve the appearance with or without additional scar revision surgery.

There is a huge thread within this section of the forum which you may want to read first.

Wish you the best in getting this scar improved.

[Spex]

The acell results i have seen in person are far from awesome.

[gillenator]

The acell results i have seen in person are far from awesome.

That's a very general statement Spex so please give us the basis for your comment. Are you saying that Dr. Feller is using Acell? How long and how many patients has he treated with Acell?

Please tell us then exactly how many patients you have examined "in person" who haved used Acell, and considering you are in the UK right? Where did you examine these patients? Which doctors you are referring to, and how the Acell was employed by them. How many used the powder form, how many were by fluid injection, and exactly what you meant by "far from awesome".

Which clinics in the UK or Europe are using Acell? Just wondering where and what you are basing your opinion on.

[Spex]

Gill,

It is only my opinion based on the 2 patients i have met in person who were highly disappointed with acell as had left them an expanse of bald flesh opposed to scar tissue. One of these patients was a veteran repair patient and due to his unsatisfactory result had been in contact with several others privately regarding their acell results too whom were also unsatisfied as acell had far from met their expectations supposedly.

Maybe acell is great when used correctly, time will tell i suppose.
Dr Feller doesnt use it and has no plans to either. I do not know what method the acell was used and do not know which docs are using it or their methods.

Best
Spex

[boricotico]

With all due respect I don't see a reason you should do anything man. Yours it's just a scar as any scar in the body like one on any leg or arm. Well that's of course just my point of view but I don't think you look bad with that scar a difference when you are losing hair where you can see spots here and there but yours for me it's just fine.

I'd live happily with that scar.

[redhusky]

thanks

thanks for nice words, its just one of those things u become obsessed about. I know I might take some flack for coming to a bald forum (like showing up for a testicular cancer support group and there's nothing wrong with me, ala "fight club") but we are here because how we perceive ourselves and how we deal with it. some people bald and take it fine, some bald and its leads them depressed and mental, what does the one guy have that the other one doesn't? u got me! I think this whole thing runs deeper than we imagine! sorry to go all Dr Phil on you.

[redhusky]

disclaimer

The last post was made on ambien,

[Jerry Cooley, MD]

Gill,

It is only my opinion based on the 2 patients i have met in person who were highly disappointed with acell as had left them an expanse of bald flesh opposed to scar tissue. One of these patients was a veteran repair patient and due to his unsatisfactory result had been in contact with several others privately regarding their acell results too whom were also unsatisfied as acell had far from met their expectations supposedly.

Maybe acell is great when used correctly, time will tell i suppose.
Dr Feller doesnt use it and has no plans to either. I do not know what method the acell was used and do not know which docs are using it or their methods.

Best
Spex

Both Spex and Gillenator are right...ACell use can be associated with results that are either awesome or disappointing, and everything in between. One of the mistakes I made early in my work with ACell was assuming that because I saw awesome results in donor excisions with no tension, that it would cause awesome results in all excisions. When there is tension, all that ACell will do is reduces dense scar tissue. The skin will be soft and natural feeling but it will be hairless and white so it may look the same from a distance. It will however be much more receptive to grafts.

The vertical scar in this case is not too surprising and would be about what I would expect from an excision of a nevus sebaceus. Usually, I would excise this first to reduce the scar tissue and then graft what is left. For the past 9 months, we've been using an enzyme called hyaluronidase, injected into the skin around what is being excised. This softens the skin and significantly reduces closing tension. I would use ACell for the above mentioned benefits and also use a permanent buried subcutaneous stitch to ward off stretching post op. The trichophytic doesn't work in a vertical incision because the hair is not shingling over itself. Doing the excision like this first will reduce the number of grafts needed, and would result in excellent improvement in my opinion.

best regards

Dr Cooley

[gillenator]

Gill,

It is only my opinion based on the 2 patients i have met in person who were highly disappointed with acell as had left them an expanse of bald flesh opposed to scar tissue. One of these patients was a veteran repair patient and due to his unsatisfactory result had been in contact with several others privately regarding their acell results too whom were also unsatisfied as acell had far from met their expectations supposedly.

Maybe acell is great when used correctly, time will tell i suppose.
Dr Feller doesnt use it and has no plans to either. I do not know what method the acell was used and do not know which docs are using it or their methods.

Best
Spex

That's why I asked for further clarification from you. I can hardly understand why you would make such a profound statement and judgement based on only two examples! And then we have no idea exactly how the Acell was applied in the cases you did see in person.

The delivery of Acell is being applied with enhancing compounds that Drs. Cooley, Hitzig, and Cole continue to explain. Dr. Cole went into elaborate explanations of the potential complications of the efficacy of Acell when delivered in powder form only.

I have seen some promising and not so promising results in scar repair using Acell. And as you said, time will tell. We need more cases tried as it is more refined in delivery and application including the use of enzymes.

I am still in the observation stage with no final conclusions. I do believe in the right hands with continued research and applications, Acell will benefit patients.

[Alan Bauman, MD]

Scar Coverage using FUE

@redhusky,
I can certainly appreciate your desire to try to camouflage or improve the appearance of a scar. We see a number of patients from across the U.S. and elsewhere with similar concerns. Vertical scars are the most difficult to improve. I would not recommend excision and trichophytic closure as this may distort the surrounding hair and still leave a substantial defect.

However, the FUE hair transplant approach is well suited to address this kind of scar. In my practice, we have had an excellent track record of success with scar camouflage using this technique to repair old linear strip scars, other surgical scars (craniotomy/plastic surgery) as well as traumatic scars from injuries.

With appropriate technique, there seem to be no issue with growth of FUE grafts into the scar tissue in our hands. I've also developed a process which uses a careful combination of recipient sites that harvests out some of the 'abnormal' scar tissue and replaces it with normal skin, in addition to traditional implantation of the grafts into small sites. The careful use of this combination technique cannot be overstated--if done incorrectly this can cause skin necrosis (not a good thing).

The NeoGraft tool with the suction activated is particularly good at one of the types of RECIPIENT site-creation for the removal of abnormal tissue. Be aware that this approach may take more than one procedure to achieve the results you seek, depending on the size and shape of the scar as well as other factors like hairstyle, color/curl/thickness of your hair.

The use of ECMs, like ACell (micronized) and Humatrix with wound-healing adjuncts like hyperbaric oxygen, LLLT, PRP at physiologic concentrations, etc. help with the regeneration of normal looking tissue and camouflage, although I've yet to see any 'autocloning' to date.

This detailed, combination approach helps improve skin tone while at the same time adding hair, providing better coverage than just the addition of hair alone. Micropigmentation (tattoo) of the scalp should be done with caution, as the black ink often has a tendency to fade to blue.

A young patient (Chris) of ours with a birth defect was a pro-bono case we did recently. His enthusiasm about the results caught the attention of the local news. You can see his video here:


6-month photos of Chris show some nice improvement:

http://www.flickr.com/photos/alanbauman/5792851979/in/set-72157623107285006/lightbox/

He no longer wears a huge amount of Toppik to school/camp every day.

Another patient who had FUE scar-repair on a crainiotomy scar left from the treatment of a childhood injury is seen here immediately post-op and one year later:

http://www.flickr.com/photos/alanbauman/375843853/

http://www.flickr.com/photos/alanbauman/4050495714/

Good improvement seen with the single FUE transplant session could be further improved with additional FUE if desired.

We perform these kinds of repair procedures and others at no charge to patients at least once a month. The Operation Restore Pro-Bono program of the ISHRS may be able to help you reduce or eliminate the cost of the procedure in addition to the cost of travel, etc. For more information on how to qualify for this program, feel free to contact me privately or my office directly.