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Hi,

First of all I want to thank you for this informative blog. I have searched this wonderful blog and have found numerous postings relating scars and hair transplant. Here’s my case: I have what “they” call a coronal scar that runs from ear to ear. What I want is to completely cover the scar through a FUE procedure, but I want my scalp to be like how it first was, normal. My research has been conclusive and I first want to have a scar revision surgery to reduce the width of the scar, once that is done i want to follow some type of scar treatment to make the scar less obvious in color (seems like the scar gets pink/red after a scar revision surgery). Afterward get the FUE procedure and go from there. Is there any treatments that you would suggest?

I want the scar to be inconspicuous to the point to be able to cut the hair in the military/short hair style, because ultimatley i want to join the military as an officer.

Best Regards

Your plan is good, but it may not be realistic to have the scar completely hidden. Even if the hair in the scar is brought up to near normal density (which may take a few FUE procedures), there is often a color difference in the remaining scar, though of course it will be hidden with FUE grafts.

As you are local to my Los Angeles office, please arrange to see me so that I can ascertain a plan that matches yours. Any preparatory treatments can be assessed and recommended when you see me. You can call 800-NEW-HAIR (or 310-553-9113) to schedule a free consultation with myself or Dr Pak.

Hey Dr. Rassman,

Appreciate all you do on the blog as well as answering my questions in the past. I had a less than desirable result from a HT procedure to say the least. Make a long story short, if I ever need to get one again, which I will since I have small gaps on my head still, I will be visiting your office before.

The grafts that did grow, which was on the low side, are coming in at all different angles and growing in different directions than both the other grafts and of my current hair. When I mentioned this to my doctor and the dissatisfaction of my results, he mentioned that it might be possible to change the angle of the grafts with a new tool? Is this possible to your knowledge? If not, is there anything I can do or this is just the way my grafts will grow forever? Also, do you ever have any open houses in the New York area?

Thanks so much.

It is unfortunate that your grafts were placed at poor angles and your results are questionable. Your story of a bad procedure result illustrates the fact that hair transplant is for LIFE and you should do your research of the doctors and see their work first hand before going ahead with the surgery.

There is no tool or technique that will change the direction of your hair. I suppose you can individually excise them one by one and try to re-implant them, but that could potentially cause more damage, trauma, scarring, and failure to grow. Plus why would you place more trust and risk a poor outcome from the same doctor who already put the hairs in the wrong angle? You are a brave man!

I don’t have offices on the east coast any more, but Dr. Bernstein does have open houses in his NY office.

Dr. Rassman,

Do you think that 100% elimination of donor scars will be possible in the future? Technology is always improving and it seems like scars could be emliminated. Are there any other possibilities other than Juvista and Acell that are being researched? Thank you for all the helpful information.

Scarring happens as a result of all surgeries. There is no such thing as 100% elimination of a scar and treatments like Juvista and Acell will not dispose of scars entirely. The key to dealing with scars is to keep them very, very small. In the case of a donor scar, it can be as small as 1mm wide naturally in good healers, or reduced to that level on occasion. For bad healers, there really is no solution. By “bad healers” I mean those people who stretch their scars after the wound has healed.

Techniques such as the trichophytic closure repair of a wound in the donor area works well in many, but not all patients. For more info on the trichophytic closure technique, see here and here.

As a young man 25 years ago, he had a hair transplant with the old fashion plugs. After seeing what it looked like (it was partly hidden with some hair at the time), he came to the conclusion that he made a mistake and immediately went to using a wig. Between his wig and a baseball cap, he had hidden his secret. About a year ago, he realized that maybe he could undo his plugs and after a year doing internet research, he came to my office to ask me an important question I’ve heard quite a few times before — “Can you just remove these plugs and make me bald so I can shave my head?”

Remember, this is NOT the standard of care today. Click the photo to enlarge.

To see the deformity, he lifted up his wig, which was tightly held to the scalp with tape. Although he is a Norwood Class 5A pattern with high density in the donor area, he never really wants to do hair transplants again, and just wants to be a normal bald man. This is a common finding in people who lived with the horror of the plug deformities of the old transplant work. Unfortunately, this type of problem is what so many people believe is today’s standard of care. Nothing could be farther from the truth as today’s hair transplants can not be told apart from a normal natural head of hair in a non-balding patient.

We agreed that I would remove each plug one-by-one and sew him up, making him a normal bald man. Removing these plugs may leave some minimal scarring. He wants me to transplant the hair extracted from these plugs and put them into the place they came from, to hide two obvious small neck scars. This should easily be done in one surgical session.

Snippet from the article:

THE HIGH Court has awarded €70,000 damages to a sales and marketing manager over a botched hair transplant which left him disfigured.

Mr Justice John Quirke made the award to Niall Clancy (32), Scholarstown Park, Rathfarnham, Dublin, over the procedure which was carried out in the UK on January 12th, 2004.

The award included €30,000 general damages plus €40,000 for medical expenses to repair the damage.

Mr Justice Quirke also said Dr Maurice Collins, the surgeon who treated Mr Clancy after the transplant, had given him “very poor advice” not to have reconstructive surgery until after the court case was completed.

Read the full article at Irish Times - Man wins €70,000 damages over botched hair transplant

The online currency converter tells me that’s over $99,000 (USD)! I’ve not seen the botched work, but when the doctor told the patient to not have the repair work done until after the case was settled (which took years), it just added to the money the patient was awarded in damages. It is unfortunate that the transplant was so disfiguring, but without seeing photos I’ll have to rely on this article and the court’s decision for my source of case information.

Always remember to do your research on the clinic and physician before getting yourself into a permanent procedure like this. Perhaps this disfiguring hair transplant could’ve been avoided. See:

1. Selecting a Hair Transplant Doctor
2. How to Avoid Dishonest Hair Transplant Doctors
3. Why Should You Visit Us?

Dear Dr,
I’m a man 38 years year old, writing from italy. I had an HT 2 years ago with about 2000 graft implanted FUT. I take 1 mg Propecia for 2 years.

This is my problem:
I have very small pimples (less than 1mm) on each graft implanted there are very visible i.e. under the sun light.they don’t hurt me and seems like the hair is pulling up the skin. I don’t have any of them on non tranplanted hair… I searched on this site but almost all of the discussions I found are on bumps or normal pimples or pitting or scars. the most valid explanation I found is that it is due to the graft that was implanted too deep in the scalp.If it is true, what can I do for improve the situation? Dermabrasion or laser? may I start trying some remedy for folliculitis or is completely useless?pls give me some good hope on what I can do,I’m really desperate. the doctor who make me the surgery (in Mumbay while I was in a long trip for job…)after the first telcon, don’t reply to my calls or mails…however I don’t trust him anymore! I contacted another Dr who said that the only solution maybe is to make another transplant to hide the thin pimples, but I leave this as the last solution and I won’t make another bad transplant. pls tell me if there is something I can do for making less visible these pimples.Thanks in advance. sorry for my bad english. Best Regards

If what you’re describing is a cobblestone appearance (and not actual pimples), then please see this post. Without seeing you, it would be impossible for me to tell you what the problem is caused from.

Dermabrasion to the scalp causes visible scarring and only benefits the doctor’s pocket, not the patients who receive it. There are two types of lasers that can impact hair:

1. Low level light laser therapy (also known as LLLT), which I feel does not work at all
2. Higher powered lasers for hair removal, which do not work 100% on killing the hair

Neither offers much benefit to your situation. If you have bumps, some hair killed with the high powered lasers will just make what remains more visible and the laser itself can cause depigmentation (whitish areas) of the lasered skin. I would need to see you, but it is not an easy trip from Italy to my office in Los Angeles.

can anything be done with plug scars from transplants in 93? scars in the back of my head. i mean im desperate for short hair but i know the scars will notice. i dont have time for make up and that might make more paranoid than i already am…

Scars in the donor area vary by person, surgeon, and the amount of transplanted hair you had. Some of them can be repaired or reduced, but I would have to see you to make such a determination.

This patient received 250 grafts just a few years ago (not from me, obviously). He knew things were going wrong when the doctor put wooden toothpicks (which could leave behind splinters) into the recipient sites which were made on his head. He overheard the staff chuckling at how he looked. He told me that before selecting his original doctor, he researched the field over the internet and had a few doctor consultations. He selected the original doctor because he was promised a great result and he believed that promise. As the hair started to grow, he became very self conscious and progressively depressed. Going out into social situations made him uncomfortable, even just going out of his house (something he rarely did once the grafts started to grow).

Cosmetic surgery of any type reflects people and their innermost feelings about themselves. I wonder if doctors understand how substandard cosmetic surgery like this can impact a person’s life. This nice young man’s life was in ruins and his fear of going to still another doctor who could possibly do even more harm, did not drive him to learn how to correct the problem until very recently when he ran into us on the internet. First, we spoke over the phone and then he set up a surgery with me and flew in. When I saw him this week, he was frightened with flashbacks of his original horrific experience

Just to be sure everyone is clear — the photos that are shown below are of this man’s substandard work and an example of what a doctor could do if he/she does not use state of the art hair transplantation technology. The term “hair plugs” is still incorrectly used for the modern technology we invented, but the lingering images (reinforced by patients such as this) are hard to abandon. Looking at the results that were once commonplace, one can clearly see that referring to this old technique as “plugs” is not out of line. Fortunately, I took steps to correct the appearance of these plugs by coring some of them out and transplanting more hair to fill in the entire frontal area. All of the plugs that were removed were cut into follicular units, and then re-transplanted into the scalp. I expect that he’ll be much, much better off after this first procedure with me of 2600 grafts grows in, which was done this week.

Here are the photos of his pluggy look referenced here (click to enlarge):

I saw two patients recently that are worthy of discussion here…

Patient #1:
He had a typical result from the hair transplant surgeries of the 70s, 80s and early 90s. He had hair transplant plugs in the early 90s which gave him a doll-like hairline in the frontal area. I have worked with him over a 10 year period with four surgeries to remove and thin out the 3 inch wide plugs, redistributing the hair from the plugs to other adjacent areas in an attempt to make them less detectable. He is about 80% closer to his goal over what he had when he first came to see me and now wears a crew cut, but he is still frustrated over the remaining plugs which still bother him when he looks into the mirror every morning. I will continue to work with him, thinning out more plugs until he is satisfied that he looks normal. He shared what it has been like over the past many years, as too much of his life focus revolved around his head and his freaky pluggy look. Fortunately he and I put together a Master Plan 10 years ago to get him back to a normal appearance, and even now, after a decade of my working on him, the process will continue.

Patient #2:
This man has a far worse story. This young man (in his 30s) has had hair transplant work by many doctors over 10 years. Unlike patient #1, he never had a Master Plan and always sought out the best doctor who promised him a quick fix and he believed what the doctors told him. In the midst of the process, he even had a brow lift to raise a hairline that was too low, leaving him scarred in the hairline area. A series of transplants to fix the hair loss from the brow lift in the frontal area failed, compounding the problem further. The donor strips that were taken in the back of his head were all taken in different areas of the scalp and they all stretched and widened substantially. It seemed that the doctors just kept on removing donor hair from different areas to avoid the wide scars previous doctors created.

This man paid tens of thousands of dollars and each successive surgery seemed to leave him worse off. The recent transplants apparently did not work and he asked me if there was something wrong with his skin and recipient areas. I asked him if he called the doctors who did the failed procedures and he said he did call them over and over again, but they never returned his calls. Now he is massively scarred in the back of his head with at least three wide scars each measuring over 1/2+ inch in width. He received body hair transplants into the scar, but the difference was marginal. Each “fix” addressed one problem in isolation of the other problems, resulting (at times) with him being left worse off in the total scheme of things. I don’t know what he will do, but I suggested that he consider working with just one doctor, and building a Master Plan to deal with his problems. One option might be balloon expansion of his scalp to remove the scars in the back of his head by stretching the normal scalp in the crown of his head. The use of balloons to stretch the scalp will take at least 8 weeks of constant inflation of the balloon. If he wanted us to do it in California, he would either have to move to California for the period that the balloon expansion was being done or find a local doctor willing to do the incremental expansion of the balloon in his home town. We have done similar patients with outstanding results, but the commitment of time is substantial. What I gave him was a Master Plan to get him back to a manageable state. Anything short of such a radical approach will just victimized him again and again by some of the doctors who see $$$ in each successive procedure that they can offer him. Too much of his life is being centered around his scalp and the various poor choices he made.

Conclusion:
I often end with the statement: “Let the Buyer Beware,” which is so appropriate in this situation. Doctors are not immune to being scummy. I unfortunately see horror stories like this almost every week, and I post these as a way to educate you (the consumer) so that you can make informed decisions and avoid being taken advantage of.

How do I end a post like this positively? Well, today’s hair transplants in the hands of good and honest doctors are spectacular. At last night’s Open House event in our LA office, Steve Hartman (CBS Sports announcer and radio show host) who is himself a hair transplant patient, told me that not only was his procedure undetectable, but that he and many of the patients who were there looked like they never lost a hair on their head. Those horror stories I wrote about above rarely happen today. There are rotten applies in every barrel, but there are many really great doctors also in that barrel. You just have to do your research before you jump.

I have a small, linear non-transplant scar above my ear. It has healed pretty well, and is looking more and more like normal skin each day. I’ve been thinking about transplanting hair into the scar by an east-coast doctor, about 100 grafts is my guess. If this were to be done with FUE, is there a huge risk that the scars produced from such a small FUE procedure will be worse than my linear scar? I want to be able to wear a buzz cut (somewhere around #2) as I believer my hair is thinning and short hair is a better look. Should I be very worried about moving just 100 grafts from the back of my head into this scar to minimize it?

Follicular unit extraction (FUE) is a good way to fill in a scar, but not all FUE is the same. Different doctors use different techniques and instruments. As long as the FUE instrument is less than 1mm (ideally 0.8 of 0.9mm diameter), you should be OK.

I am flattered you would ask me, but I would ask this question to your doctor since you need to trust the surgeon that will be performing the procedure on you!