Not A 'Pencil Thin Scar'

[teg_101]

I'm not sure if this thread should be put in under the Veterans section, or left here. Moderators: please move if necessary.

I have undergone two strip procedures from a clinic to repair my frontal zone. While the results have shown some improvement, I will still have to go in for a third procedure to achieve the density that i wish to have. As a result of the two procedures, I have been left with scar that you see in the pic below. It is not quite 'pencil thin' as most clinics tend to guarantee, as was the case with mine. I'm left with a horrible scar which I can only cover up with a #3 guard clipper.

I recall the response from my clinic when i bought up the width of the scar was something along the lines of, "Who cares about the back, its the front that should look good". At this point, I am moving forward and looking into have the scar repaired. In both surgeries, the trichophytic closure method was used with staples.

My question at this point is, would stitches/sutures produce a better scar in my case, or is it simply a case of patient's physiology, where my scar will end up the same way? Also, based on the picture, would is this scar 2+ cm wide? Should I look into other repair methods, FUE etc? A scar such as this is simply not acceptable by any standard in this day and age. Any thoughts/comments.suggestions are appreciated. Thank you.

[Delphi]

That's not a great scar, but I have seen much worse. I'm surprised that your clinic actually guaranteed a pencil thin scar, since that's a tough thing to guarantee.

I know that Hasson and Wong use staples while a lot of the other top clinics use stitches, so I really have no idea if one is better than the other. Since you're having a third surgery, why don't you wait to see how the final scar looks? They should be able to cut that one out and hopefully the next scar will be thinner.

How does the transplant look otherwise?

[teg_101]

Delphi, the scar is about 1.5 years old now, so I don't imagine its going to change much at this point. Yes, as mentioned, I am simply moving forward and looking at other clinics that could produce a refined/improved scar. The results of the surgery have been good, a big improvement from where I started off, but I am looking to have some additional grafts added, as the density is quite uneven in the recipient zone from the first two surgeries. I will upload pics of the results. My only fear at this point is if I were to get cut open again, and have the same end result. Since I am looking into an additional procedure, I am looking into possibly FUE'ing the scar..

[Delphi]

Delphi, the scar is about 1.5 years old now, so I don't imagine its going to change much at this point. Yes, as mentioned, I am simply moving forward and looking at other clinics that could produce a refined/improved scar. The results of the surgery have been good, a big improvement from where I started off, but I am looking to have some additional grafts added, as the density is quite uneven in the recipient zone from the first two surgeries. I will upload pics of the results. My only fear at this point is if I were to get cut open again, and have the same end result. Since I am looking into an additional procedure, I am looking into possibly FUE'ing the scar..

I can understand where you're coming from. FUE might be the way to go from this point forward. I look forward to seeing your pictures.

Have you thought about Dr. Cole?

[teg_101]

I have looked into Dr Cole, amongst a few others clinics. I'm thinking of giving the FUT another try and seeing how the scar turns out in the hands of another surgeon that uses stitches rather than staples. If that route results in the same situation that I'm in, I might look into FUE or SMP, while that is in its early stages, seems to be working out well for some. How successful is Dr Rahal in scar revision? Perhaps some other patients of his could chime in on the topic? Thanks

[sp8rky]

"Who cares about the back, its the front that should look good"

This attitude sucks, this is a terrible and very unethical thing to say!

[topcat]

I think if you ask for advice depending on the forum you are going to be directed towards certain clinics. This is not always in your best interest so I would suggest expanding your research to include other forums while also speaking with patients.

[Delphi]

I have looked into Dr Cole, amongst a few others clinics. I'm thinking of giving the FUT another try and seeing how the scar turns out in the hands of another surgeon that uses stitches rather than staples. If that route results in the same situation that I'm in, I might look into FUE or SMP, while that is in its early stages, seems to be working out well for some. How successful is Dr Rahal in scar revision? Perhaps some other patients of his could chime in on the topic? Thanks

Seems reasonable since you already had 2 FUTs. Rahal is known to be one of the best, but it's hard to say how anyone will heal. You know, I was the biggest SMP sceptic and thought it was absolutely ridiculous to even consider it, but after seeing Spex's temporary SMP result, I think I'm changing my tune.
Good luck with whatever you decide.

[teg_101]

Yeah the SMP route is definitely an option. I've inquired about having this procedure done through HIS hair clinic, based out of London. I don't think they've had any cases where their patients had their donor scars filled, while keeping their hair long, and plus their treatment is permanent from what they say. If I could do it all over again, I would have under gone the FUE method for the entire restoration, although FUT has a higher success rate, so far.

[ejj]

I would consult with Dr Lindsey , he has done lots of scar revisions with documented results , see if your suitable for a revision or not , in my opinion revision is high risk when you have already stretched , option 2 is fue into the scar , keep us informed with what route you take

all the best
ejj

[chrisdav]

Dr Lindsey and Dr Konior are excellent with scarring.

Both are former plastic surgeons.

Definitely consider Hasson&Wong also if you want the scar revised.

Alternatively,you could have fue into the scar,smp or a combination of the three.

[mattj]

FUE into scar as an option is usually best for a patient who isn't also looking for improvement in the balding area. The doctor can extract just what he or she needs to improve the scar. FUE-into-scar can be very successful, but in scar tissue the blood supply can be compromised, reducing the chance that the grafts placed into it will grow.

If you need to increase the density in your frontal zone then an FUT procedure including scar revision might be the best choice. They offer predictable results, are more cost-effective for the patient and Dr Rahal performs them routinely.

[ejj]

with the greatest respect matt , i would have to disagree with you , a further revision is high risk , more so when the patient has already stretched on a second strip , the reason i believe we dont see more of these poor revisions on the forums is due to the Drs offering the revision ` free of charge ` and then silencing the patient with legal disclaimers and ` pay offs` again just my opinion

The second point i would address is i have had excellent growth with fue into my huge scars from my former drs , so much so im back in the chair for the third time week on wednesday , low density grafting to start with and establish blood supply , small procedures , small manual punch , excellent Dr with excellent surgical plan has been hugely beneficial to me

regards

ejj

[mattj]

Hi ejj,

I'm glad you're having success with disguising your scar with FUE. I'm not saying that this approach can't work and I'm not saying that there aren't possible drawbacks to scar revisions. Both are options Dr Rahal makes available. I'm just saying that in my opinion, based on what I've observed, scar revisions are probably a better choice in most situations - especially if the patient requires more grafts in the balding area. In some cases a patient will be at a high risk of the new scar stretching and in some cases the scar just can't be extracted, for whatever reason (such as if it's positioned too high or too low).

You've actually highlighted a drawback of FUE-into-scar in that you're apparently in need of a third procedure to complete the work. It's not uncommon for doctor's to prefer this step-by-step approach to ensure that the grafts are taking. The length of time and in many cases the travel involved for return visits won't be convenient for many patients.

Ultimately the best choice will depend on the individual circumstances of the patient, which is always a combination of what they want and what is best or possible in their case.

[ejj]

Hi Matt

I think ive highlighted the need of the importance of a good surgical plan for the repair of strip scars ,a plan that the patient needs to fully understand,

too many patients are led to believe that they can just have the scar revised and all will be ok , which is often not the case , for successful fue the scar has to be grafted into with ` low density ` to establish blood supply , the growth can be assessed and density increased with a further procedure , such was the extent of my scarring im looking at six repair procedures , obviously others may not need this amount of repair ,however half way through i have huge improvement , i would rather go with a slow , safe , successful ,approach than risk further likely damage

hope this helps

ejj