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Thanks very much for the informative blog.

Say a strip patient is about 6 months out from FUT surgery and now has buyers regret (please, no reminder about thinking things through first!), and wants to fill in the scar with FUE/beard hair/etc. Is there any advantage to do it at this time or does one need to wait one year. I wonder if scar is more or less vascular when healing. Thanks.

If the donor scar has healed, you don’t need more surgery, and the scar is narrow, then follicular unit extraction (FUE) to the linear scar is possible. FUE does not fill in wide scars well, though. Scalp MicroPigmentation (SMP), on the other hand, may be a better approach. Explore it all.

Hello Doctor

How bad does a scalp wound has to be in order to mean permanent hair loss in the area ? I bleeding or crusting afterwards na indication for bye bye hair ?

Any cut on the skin will produce a scar, and on the scalp no hair will grow on that scar. Even with follicular unit extraction / FUE (advertised as “scarless” surgery by some) will produce a round punctuate scar.

In general, if the injury or wound is significant there will be permanent hair loss. Even a scratch could cause bleeding, but that doesn’t necessarily mean permanent hair loss will result. Only time will tell if your hair will grow back. This time frame is around one year. If you see no hair growth after one year, then it would be safe to bet it is permanent hair loss.

Hello. I had busted my head from a starbucks cappuccino bottle(Please don’t ask how It’s a personal issue..) And I was bleeding harshly from my head so my parents wrapped my head with some bandage really tight and put some healing glue over the scar. In like a week in a half it healed and the glue came off like a scab and I was left with a very smooth scar on the back of my head near the root of my head about the size of a quarter, the top part of your pointer finger(the first line part and up cant explain it good). I know hair isn’t growing back because its been three years.

I want to have the scar removed from my head, the surgery is they cut it out then sew your scalp back together and your left with a lined scar that is barely visible when hair is grown a little. I do NOT want hair transplant please don’t give me information about it. Please explain as much as you can about the “scar removal” surgery I have in mind and also a cost for this.

What I would like to have is have a surgeon cut out the scar since its a little smaller than a quarter and stitch the scalp back together leaving me with just a tiny thin line scar that would be. No wider that the original sizer of the sizer or length. Also since I am african american, I want to cut my hair down low to about a 2 but I can’t cause of this baldspot, my dad is willing to try surgery but not until its reasonable. Remember it is about the size of a quarter which is very small compared to others.

Thank you please help me with my problem. Also the color of the scar is about my skin color maybe even a bit darker, I have black indian hair so a big brown baldspot sticks out. Please fill me in with everything you possibly can.

Scar removal from the scalp sometimes works well… and sometime doesn’t work well. That depends upon:

1. Your healing abilities
2. The location of the scar
3. The direction of the excision scar
4. The surgical technique used

I would have to see your scars to determine what I would do. From what you described here, I am at a loss. You need to see a cosmetic surgeon with experience in scar revision.

Does having an FUE procedure to hairline and mid scalp make it artistically unpleasant to shave your entire head? I like to wear my head closely cropped, but I’m unsure if the punctate scars from FUE are extremely visible when you closely shave your head

There are many variables that produce different scars with follicular unit extraction (FUE). These variables include:

1. The size of the punch used (ranges of punch sizes are from 0.8-1.5mm). The larger the punch used, the bigger the scar.
2. The density of your donor hair dictate the visibility of these scars. Low density donor sites tend to show the punctate scars more than individuals who have high density.

What I am referring to here is shaving your head bald, not clipping it to a #1 length. Shaving the head will almost always show the punctate scars. There’s an extreme photo example shown at this page to give you an idea of scarring from a large FUE session.

I have had 5 hair transplants. All were done by way of the strip method and I am very pleased with the ultimate outcome. However, the linear scar from my 4th surgery is horrible. It is very wide and red. The scars from my prior surgeries and the one subsequent surgery look fine. Because of concerns about elasticity issues, between the 4th and 5th HT I did scalp exercises to improve the donor elasticity which I found on Youtube. My Doctor said that the elasticity between my 4th and 5th surgeries was greatly improved and attributed it to these exercises. With this improvement, I am considering a scar revision with the hopes that the scar from my 4th surgery can turn out like the one from my 5th surgery. Is this realistic?

Lastly, in general would you recommend a plastic surgeon for the scar revision or a hair transplant Doctor? I traveled some distance to have my last hair transplant and don’t plan on making this trip again for a scar revision so I would look for local Doctor to do this procedure.
Thank you for your time

Scar revisions in the hands of an experienced surgeon that deals with hair transplant scar issues on a regular basis is generally better than a plastic surgeon for this type of work. Experience is everything in this process. I don’t know what is realistic to expect, as each case is unique and I haven’t seen you.

If you want to find a doctor in your area, I’d suggest using the physician search at ISHRS.org.

I’m thinking about getting a strip method hair transplant and then just filling in the scar with FUE. Is that an option thats worth pursuing? I don’t want the line scar but I want every graft transplanted. I understand FUE has problems with transection or something.

I get this question quite a bit from patients who have already had the hair transplant strip surgery and then inquire about having a follicular unit extraction (FUE) procedure to follow it up. It makes little sense for the person that already has a strip scar (no matter how wide it is) to have an FUE into the donor harvest. If it’s just about treating the linear scar, better solutions would be a scar revision or Scalp MicroPigmentation (SMP). FUE grafts used in linear scars are generally wasteful and an expensive way to treat the scar with less than ideal results.

My complaints about the way the FUE technique is used are:

1. It’s generally more expensive than a scar revision for those with a troublesome linear scar.
2. The grafts do not come out of the sweet spot in the middle of the donor area (where the grafts are easily taken by a strip).
3. In my opinion, the overall survival of the FUE grafts are not as good as those harvested from a strip in most doctor’s hands (I do not believe that is a problem in our hands).

As the first to publish a paper on FUE (introducing it to the medical community), I can speak with authority on these issues. The ARTAS FUE robot has not really changed the process, except for leveling the playing field for those doctors not skilled in the extraction technique. The FUE technique, as done in most doctor’s hands without the robot, is not as good as the grafts produced by a strip surgery. If there was a formal study, I would expect that each doctor would show variable comparative results when comparing their FUE results with this strip results, making such a comparison between FUE and strip surgery essentially worthless.

This patient had 3 strip procedures, which yielded 7846 total grafts. His donor scar in the back of his head was revised with reasonably good results and a reduction in the width of the scar. You will find before and after photos of his hair transplant and the scar revision below.

Click the photos below to enlarge:

Scar revision (Before on left / After on right):

After (3 procedures totaling 7846 grafts):

Before:

Hi Doctor Rassman,

I have a few questions concerning transplants.

— How big of an issue is scalp laxity? I.e., do you often have patients who still possess donor hair, but who are unable to have FUT a 2nd/3rd/4th time because their scalp has become too tight? Should this be a concern in planning for the future?

— You’ve said that one of the drawbacks of FUE is that it can waste precious donor hair (i.e. some hair doesn’t survive the transplant procedure?) — just how much hair might be “wasted” by going with FUE rather than FUT?

— Why are some readers so concerned about FUT scars? In most of the photos I’ve seen, the scar is a very thin hairless line — not a repulsive, gnarled mass or anything like that. Even if one cropped one’s hair short so that the scar were visible, what’s the big deal?

Thank you so much for taking the time to do this blog.

Scalp laxity become tighter after successive procedure, but this is not usual. The use of scalp exercises solves the problem. It sometimes takes 30 minutes/day for 3 months to adequately address the scalp laxity.

In our original article when we introduced the FUE technique a decade ago, we reported a situation where patients differed with transection rates. We believe that if you assume that the surgeon does FUE perfectly, that some percentage of patients will have unacceptably high transection rates. Although this has become less of a problem as we perfected our FUE skills, it is still present in about 10% of patients. It will be interesting to see if the ARTAS robot can impact these problems in those patients. As Dr. Robert Bernstein (co-author on the original FUE article) just got an ARTAS robot, it will be interesting to see if he experiences the 10% patient problems with transection. FUT should produce less than 5% damage in the hands of a good surgeon.

FUT scars are, as you said, not a problem in 95% of patients on the first procedure. Rarely can you see the scar when the hair is kept long. Even after a second procedure the incidence of scarring is not high either, but if it can be seen, it is only seen if the hair is cut very short or if one lifts the hair to examine it. I would ask, even if the scar is visible, how many times would a person with such a scar that is hidden with longer hair (1 inch in length) gets stopped on the street and asked about it.

Hello, I was in a car accident in 2002. When it happened my scalp was pulled from my head and I am left with a U-shaped scar on the side of my head. The hair around the sar fell out and then grew back. But now my hair is getting thinner an falling out around the scar. It ha been almost 10 years and it is starting to fall out now. I was going to get scar revision to make he scar less noticeable but now that the hair is falling out around the scar I don’t know what to do.

You need a good examination from a doctor that can give you a better assessment of your condition. Maybe you are losing hair around the scar (as part of genetic balding), or a change in your hair thickness has occurred and you are noticing the scar even more. I really couldn’t say, as I haven’t seen the scar.

Scar revisions in general do not completely get rid of scars, but how much improvement depends on where it is and the direction of the scar. Scar revisions in the scalp may reduce the scar by 25 to 50%, but sometimes they can make the scar worse. Speak with your doctor.

I recently had a motorcycle accident about a month and a half ago. unfortunately i was stupid and wasnt wearing a helmet causing a minor injury on my head. i went to the hospital and was told by the doctor that i would need plastic surgery to make sure my wound closed. however throughout the whole process of taking care of paper work and insurance to cover the plastic surgery my wound closed out perfectly fine. even the doctor told me i didnt need the surgery anymore.

however i have a scar about the size of a quarter, a little bigger id say, and i have no hair there. but people say i am gonna grow hair being that everything closed out normal no stitches or anything. i just wanted to clarify that. thanks

I would wait about 6 to 12 months to see if hair will regrow. If not, you can have that scar dealt with, either by having the scar revised or perhaps hair transplanted into the scar. At this point, you’re going to have to wait and see, and if the hair doesn’t return you can meet with your doctor to determine the next step.