Scar Grafting with Dr Cole

[gillenator]

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.

It's so nice to hear about your continued progress NEGuy.

Looking forward to your updated pics as well!

[northeastguy]

80 days post op 2nd procedure

Thanks Gill.... very much appreciated.

OK... as promised. these photos where taken today immediately after my hair was cut. the bottom is a 1 guard blends to a 2 guard and the longest area is a 4 guard. Once I'm past the 3 month mark, which is in 10 days, I will experiment with a 3 guard and go from there.
If you zoom in on the close up, you can see the issue with the "horses tail" caused by the multiple strip procedures.





...To say "I'm itching to go with a 1 guard" is the understatement of the century right now.

[John P. Cole, MD]

You are making progress.

Strip surgeons never mention anything other than the scar as the complication of strip harvesting. Strips marry coarse, dark hair to fine lighter hair. They marry one angle of hair growth to another angle of hair growth. They cause follicles below the scar to grow in a more elevated direction similar to a horse's tail.

Sometimes these complications are worse than the scar itself. It looks like you could be home free other than some minor imperfections. I wonder if they will be worth bothering with. I hope you are home free.

[jetfan11]

scar grafting

NE Guy,

Man impressive stuff. I am in similar situation and this is inspiring as corny as it sounds. I have a doosy of a strip scar 5 to 8mm. I met with Cole and his people and they were very gracious to me. Was very appreciative.

Dr. Cole did mention I might want to do a scar revision 1st as its a bit wider than yours but certainly could just go ahead and graft the scar.

I am basically tormented by this decision because I am not crazy about having my scalp cut open again but at the same time I don't want to use up my donor hair for the scar and have it not grow and then I would kick myself for not putting the hair up top.

I mean if I could get my hair to look like yours the nightmare is over Id just shave my head and be bald guy with that amount of coverage on sides and back. Then again Ive some scar grafting fail miserably and that would suck.

My question is how wide is your scar? I believe you said 5mm. Is that correct?

Man if you got that close guard 1 to 4 with 2 scars why couldnt I get there with 1 scar thats 3mm wide in some spots....
Tough decisions!

Let me know what you think.

[John P. Cole, MD]

When a strip scar is 2 to 5 mm wide, a scar revision may or may not be of benefit. The first thing to recognize is that the average strip scar following a single procedure is 2 to 5 mm wide. A physician really has to work hard to get a scar that is wider than 5 mm. In other words, they have to do things during a strip harvest and I have no idea how to perform. It must how they harvest, how they close, or some form of magical recipe because no strip scar should be more than 5 mm in diameter if the harvesting is performed properly and closed properly. You will hear physicians say that a wider scar results when the tissue is closed under too much tension. I don't really know exactly what that means because there is no gauge measuring tension on closure. I think it is more likely that the physician got greedy, extracted too wide of a strip, closed haphazardly, and got the resulting wide scar.

When a strip is initially removed, the width of the scar rarely is improved with a multiple layer closure. When you do a second strip, a two layer closure may help reduce the width of a scar. If you have a wider strip scar, you may try a revision with a two layer closure provided this has not been done before by a qualified strip surgeon. If a qualified strip surgeon has already tried a two layer closure, you are unlikely to benefit from a scar revision.

A good scar revision will result in a strip scar that reduces in width by 50%. There is a risk that the scar can become wider on revision. I hear of this often, but i personally never had it happen. I did have them return to their original width after proper closure initially (2-5mm). In other words, when you've tried everything and done it well, you are unlikely to have further improvement. Strip scars that were not closed with multiple layers initially will generally improve 50% with a two layer closure.

Two layer closures really help on the second harvest. They are of little help with scar width on the initial harvest.

[35YrsAfter]

Thanks Gill.... very much appreciated.

OK... as promised. these photos where taken today immediately after my hair was cut. the bottom is a 1 guard blends to a 2 guard and the longest area is a 4 guard. Once I'm past the 3 month mark, which is in 10 days, I will experiment with a 3 guard and go from there.
If you zoom in on the close up, you can see the issue with the "horses tail" caused by the multiple strip procedures.

...To say "I'm itching to go with a 1 guard" is the understatement of the century right now.

northeastguy:
Looks excellent! A lot more growth to come.

jetfan11:
It was great meeting you at our office. Scar revision can be a tough decision. Your hair on top really looks great BTW. I remember you had concerns about shock loss.

35YrsAfter also posts as CITNews and works at Dr. Cole's office
Cole Hair Transplant - Atlanta
Phone 678-566-1011

[northeastguy]

NE Guy,

Man impressive stuff. I am in similar situation and this is inspiring as corny as it sounds. I have a doosy of a strip scar 5 to 8mm. I met with Cole and his people and they were very gracious to me. Was very appreciative.

Dr. Cole did mention I might want to do a scar revision 1st as its a bit wider than yours but certainly could just go ahead and graft the scar.

I am basically tormented by this decision because I am not crazy about having my scalp cut open again but at the same time I don't want to use up my donor hair for the scar and have it not grow and then I would kick myself for not putting the hair up top.

I mean if I could get my hair to look like yours the nightmare is over Id just shave my head and be bald guy with that amount of coverage on sides and back. Then again Ive some scar grafting fail miserably and that would suck.

My question is how wide is your scar? I believe you said 5mm. Is that correct?

Man if you got that close guard 1 to 4 with 2 scars why couldnt I get there with 1 scar thats 3mm wide in some spots....
Tough decisions!

Let me know what you think.

Hi Jetfan,

Try to look at it a different way. One advantage you have over me was you have one scar. I have 2...... if you want to call it an advantage. my upper scar was 1-2mm on the sides then got as wide as 5-6 mm in the middle. the lower scar was a consistent 5-6 mm from end to end. The reason I decided to not do a revision was the need to address both scars and it would have taken up to 2 years before I could have grafted. factor in my scalp is pretty tight I wasn't sure the results would have improved any. These were my scars just before we got heavily involved in the first procedure...





I was comfortable that I had enough scalp donor to address the scars and the ability to use beard hair should I need additional density. I was no longer interested in addressing the top (although we did soften the hairline). Should cloning come make its way to the industry in the future, I'll address the top and front then. My #1 issue was to fix these scars so I could buzz my hair short and live a normal life. I can pretty much say we achieved that. As far as I'm concerned, the rest is gravy. Will I address the little imperfections? probably, because I had a specific goal and I am still shooting for it.

When I was still considering a revision, there were 3 individuals I liked. Dr Linsey because he is not only a Strip surgeon but also has a plastics background. Dr Wong because of his reputation as a strip surgeon and the limited issues I had read about their donor sites. And lastly Dr Frechet because of his claim of an invisible scar closure technique... this was what he said regarding my situation:

"The trychophitic closure technique( TCT) is very different to the invisible scar technique( IST).
The TCT does not improve significantly scars.
The ICT is very efficient on previously" virgen scalps"
In your case, with previous scars, you need an other approach I have worked on . If you heal normally your scar will be 1.5 mm wide or less after revision.
I can only remove one scar at a time and I would start by your top scar.
After If the result pleases you ,I shall take care of your lower scar.
No one in the US performs this technique.

Best regards

Doctor P Frechet"

You can certainly research all three and others should you decide to go the route of revision. Like Dr Cole said, there's just no guarantee how well the scar will heal. My top scar was closed by a very well known and respected HT surgeon in the industry and it still stretched. Maybe your scalp is loose and might fair better....this is something you have to decide.
Just keep in mind, if you go FUE, your going to need 2 passes. its not a 1 and done deal to make it right. Some do but it often takes 2 passes. I can say this, the healing for FUE is night and day easier then strip. We even did a modified version of the shaveless technique and it allowed me to attend a function little over a month post op with no signs of surgery. I can't speak well enough about Dr Cole. His results speak for themselves.

..... ask any questions you have, I'll answer the best I can. you can also reach me at northeastguy14@gmail.com

[jetfan11]

Dr Cole NE Guy and 35 years

Dr. Cole,

Thanks for the thoughtful response. And thats damn damn good work on NE guy. Very tough decision. If I go the revision route first. How long should I wait from last surgery? I am about 8 months out now.

I have consult with Dr Hasson on 8/23. Figured I would check it out as I am in Seattle. WHat do you think of him for a revision?

35 years,

Top of my head has come a long way. Never quite made it back to where I was before last surgery but its passable. Great def not. But thx you.

NE Guy,

I will check out this Dr Frecht guy. Sounds interesting. THX YOU FOR THE HEADS UP.

The really tempting piece of this whole thing is that I think i am 1000 to 1500 grafts away from a result I would cry tears of joy for. And if I were to go to a rockstar like Cole have him revise the scar pull out a 1000 grafts or so with it I could end up with better scar and enough to fill mid scalp and refine hair line. Done and done. Freedom with hair!!

BUT LAST TIME I HAD A HT 8 MONTHS AGO EVERY DAMN HAIR ON MY HEAD FELL OUT!!!! (WITH PRP AND ACELL) I COULD HAVE SHOCK LOSS AGAIN MAYBE PERMANENT THIS TIME AND END UP WITH SAME CRAPPY SCAR BECAUSE I GOT GREEDY FOR GRAFTS. ESPECIALLY SINCE I HAVENO BALD AREAS JUST AREAS WITH PREVIOUSLY PLACED GRAFTS AND NATIVE HAIR. TEMPTING AS ALL HELL.

We shall see thanks all for responding.

[John P. Cole, MD]

Quite honestly, I have nothing but good things to say about Dr. Hasson. I like Dr. Wong better only because the two of us get along better and he gets great results too. You see Dr. Hasson and I are like oil and water. He loves his strips and I hate them. My view on strips is that you can put all the lipstick you want on a pig and it's still a pig. I don't think Dr. Hasson has much compassion for that perspective. As a strip surgeon, I think he is one of the finest. He is very detailed in his approach. I've seen him work once and I was VERY impressed. Not many impress me. He did.

Dr. Frechet probably popularized the trichophytic closure in 2005. He is a true gentleman. I love him to death, but his graft work is horrible (minis and micros that look like minis). He's a scalp reduction guy and probably the best at it. Unfortunately, that sort of aggressive procedure often leads to big problems in the best of hands, which he's become a master of resolving. If you had a midline scalp reduction scar and needed to resolve the angle issues in your crown as a result, i'd recommend him. He might be great at a scar revision. Actually, he might be spectacular, but what do you do with the hair the revision removes? I would not toss it in the trash and I'd never let him graft it. If he ever stepped up to "follicular unit and single hair grafts", I'd recommend him for scar revisions, but thus far I can't. Stick with Dr. Hasson to revise the scar first. If you had a frechet extender leading to a scalp reduction scar in the crown area, i'd recommend him for a triple flap revision. The name says it all....aggressive procedure that leaves major problems that require a major procedure to resolve those problems provided that all hell does not break loose and you wind up in one hell of a sticky situation.

Look, I think i was really good a revising scars at one time. I just don't do it that much any longer so I just can't recommend myself. You know I see these guys talking about their FUE skills at times and I wince because they do one or two a month or they use a robot. I just can't get behind that because how can you get good at something you do a handful of times each year and we know the robot is not as good as great hands. Now, even though I've closed over 8000 strips, I just can't recommend myself any longer. In comparison, I'm sure I'm better at strip scar revision than the FUE performed by a guy whose done 100 lifetime FUE cases based on the number of strips I've closed, but someone like Dr. Hasson does strip closure every day. I did not do a single one last year. Now, they are easy in my opinion and I was good at them, but it's a no brainer. I'm sure Dr. Hasson would recommend me for a FUE procedure over himself and I can't possibly argue that he is a better choice to revise your scar than I am at this point in my life.

I think your top looks great. Ok, you can be better. Who can't be 10% better. Give it some more time and see it things don't fill in better. I hear you about wanting to be better, but you are pretty close to the top already. I often use the analogy of a jar of marbles. If the jar is empty and you add 50, anyone will look better, but what if you have 800 marbles and we add 50, there is not much change. Don't expect miracles at this point. Anyone with major hair loss would love to have your hair. Ok, beauty is in the eye of the beholder. 850 is better than 800.

The scar. Most are final at 3 months though there is some movement up to 6 months. They continue to heal to 12 months but widening is mostly done at the 3 month mark. Hair on top? Wait a year at the minimum. In a year, the top may look so good that you forget about the scar. I'm Praying for you, brother!

You know what I love about you guys? You want perfection. I'd say that 90% of those who get a hair transplant are ok with mediocre. I'm a perfection guy. I want the patient who sees a single hair out of place. I want the 10% that see every flaw and I love the 3% who would rather die than have a hair out of alignment. That's my kind of patient.


The key to any scar revision, in my opinion, is to minimize the width of excision to the normal margins of the scar and the scar itself. The margin of a typical scar will be about 30 cm from ear to ear. Boy that sounds ugly doesn't it? Yet it is true. Follicular density is reduce on the margins of the scar so you should get a total of about 200 grafts when you take clean margins. Prior to you first strip this margin would have contained about 580 grafts, but stretching the skin to cover the excised surface area reduces follicular density. If there is a huge number of grafts, your physician took a margin much wider than necessary. This may result in a wider scar following revision. The next key is to place a deep suture to avoid stretch back in a scar revision. If done properly, a revision should be at least 50% better to the same. If done improperly, the scar might be wider based on my experience.

Don't expect a scar revision by trichophytic method to totally conceal the scar. It most likely will not, but let me know if it does so I can bring this to the attention of other patients. This is not to say that a scar revision that produces more than 300 grafts will not heal better than the original scar. A properly closed wound that yields more than 300 grafts might heal fine, but it is a risk because it might heal worse. It is far better to stay on the safe side near 200 grafts than to try for 2000 grafts and a scar revision at the same time. The two are incongruous. In other words, if you are looking for 2000 grafts don't expect the optimal scar. If you are comfortable with 200 grafts, look for a better scar. If you don't get it, you know what you have to do at that point. You have to graft it. The other alternative is to graft it right off. It sounds like you are comfortable revising it first so look for 50% better or the same. In good hands and with a conservative approach, it should be 50% better or the same by next year. You should have a good idea of the width by 3 months as most scar widening occurs in the first 3 months. Three months means 90 days plus, not 89 or even one day less. Keep us posted.

[northeastguy]

On Saturday I had reached the 3 month mark on my 2nd procedure. Although early, I was still interested in trying out a 3 guard with a 1 guard above the ears and neck area. My hair grows supper fast so went for it. I took these photo's outside to get the best lighting. Its funny, some angles you can't see much, when looking straight on, you can see the issue of the permanent shock loss I received below each scar from the strips. Even if I still have Dr Cole touch up the scars or any dotting and small density issues with beard hair, I will still have this issue. This is where I think the Trico would be so beneficial until I am all grey. once that happens, the contrast between my scalp and hair won't be so noticeable. One big value of not being permanent, as I grey, won't need it as much.
Then there's the horses tail.....
It's still so very early from the second procedure to evaluate but it gives me time to decide the next step.

[jetfan11]

scar grafting

Dynamite dude. Id say you are really really really close to being perfect. At 3 months Id say at 6 or 8 you'll be damn close to perfect.

[baldesswonder]

Ive heard a lot of good things about cole he seems well known on the net.

[fauxhawk]

Any photo updates (I know it's only been about 2 more months)? I am fascinated by these results and thread as I am contemplating on doing this myself.

[chicago99]

We would all love to see update photos. So far looks great!

[northeastguy]

My next haircut I'll have the stylist take some photo's. I definitely need to do a session with beard hair this winter if I want to safely go to a 1 guard. It's my goal and I want to achieve it. I could leave things alone and be ok with a longer cut but it isn't what I set out to do.
I also need to work on the lower scar in regards to the "horses tail" caused by the strip surgeries and pinkness that remains. I most likely will be using a combination of Kenalog injections and Pulse dye laser treatments.
I'll start with a test pass soon from my neck to determine what type of scaring I may receive from beard grafting then do a large pass in the winter while treating the lower scar.