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Hi Doc,

I have a question about FUT scar. I have heard so much about scar repair and removal, so I was just wondering why don’t people just get an FUT from a good surgeon and eventually (Once they feel they need no more surgeries and have effectively treated their hairloss via surgery) get the scar removed?? instead of having the many dots of FUE?

Basically my question is it is possible to get the scar removed or made invisible completely (by putting fue grafts in it or some other technique like SMP) for the majority of people??….so that they can shave their head if they wanted later without indication of surgery ..??

There is no such thing as scar-less surgery, no matter how skillful a doctor may be. Even FUE surgery can leave significant scarring that look like thousands of whitish dots. The key point is any cut on the skin will leave a mark and each person heals differently.

In other words, it is not solely about the surgeon or a technique used. It is just as equally the individual patient’s body and the way it heals/scars.

i have a question about pubic hair transplants. i would like to use this hair because i have limited donor and very thin body hair. i was told the only way to remove this was by incision. i do not want a scar in this area. i would take hair from this area in a heartbeat if fue’s could be done. are fue’s possible in this area? thanks for taking my question

I have done pubic hair to scalp transplants before — a couple of them were with FUE, and most with a small strip. Scarring should not be a big problem, depending on the amount of grafts that are removed. All surgery produces some kind of scarring, though, even if it is minimal or barely detectable. The quality and character of your pubic hair might not be what you want to appear on your scalp, but that is up to you.

If you are looking to give the appearance of thicker hair, there is an alternative with Scalp Micropigmentation. Take a look at some photos of SMP in use with thinning hair and see if this applies to your problem.

Dear Doctor Rassman,

First of all, thank you for your blog, it’s a huge source of information. I had a hair transplant over 20 years ago. It has not given me the result I was (naively) looking for. This is why I want to shave my head with a no guards clippers. Then I am looking to fill my scar with SMP to hide it. I took photos today as part of the consultation but I noticed I have small squares of reddened skin above and below the scar. Do you have an idea what this could be and would you have any advice to maybe soften it? You have my permission to use my photo.

Thanks and all the best

And thank you for allowing us to publish your photo here. Click to enlarge:

We routinely perform Scalp Micropigmentation (SMP) at our office on a daily basis for the type of scars you have. In fact, most scars we see are worse than the one you show. I’m not sure why you’d still see any redness around the scar if you had your surgery two decades ago, though. A topical hydrocortisone might reduce the redness, but you should talk to your dermatologist about this.

If you would like more information on having SMP done, you can call our office at (310) 553-9113 or (800) NEW-HAIR for a consultation with a doctor. And for those interested in seeing a before/after example of SMP done over a strip scar, here’s one such patient:

Does the crown stretch when closing a FUT scar?

Hi there - First off I would just like to thank you for providing this excellent resource. I just have two short questions related to FUT scars:

1) Firstly, I know you have answered this in the past with hairlines, however since the crown is within inches of the incision site above the prominent bone, does it slightly move/stretch downwards towards the incision site once the scar is closed?. For example… I have some thinning in my crown but im lucky in the fact that it doesnt dip low at the back so its not very visible unless looking from above my head. If I had a strip procedure would this thinning crown be more visible from the back because the skin has been pulled down to close the strip wound?

2) Secondly, I believe avoiding strenuous exercise is recommended for about a month after the procedure to avoid scar widening, but is general head tilting and looking downwards in the weeks after surgery ok in terms of putting stress on the scar?

I would be most grateful for any response you have for the above questions. Kind regards.

Strip scars placed in the true donor area in the back of the head should not impact the location or the size of the crown area. Strip surgery takes up laxity that is there at the time of the surgery. Bending your head should also not impact the crown area.

I have never been sure why we tell the patients not to lift heavy weights. If there is a pull from the muscles, it comes from the trapezius muscle, which inserts below the scar at the base of the skull. I still tell the patients not to lift heavy objects, but I am not certain there is any value to the advice.

Hi,
I have had 2 successful transplants, the last being about 28 months ago. My scar is still a light pink colour. My scars usually take a long time to fade, so I think this is probably normal for me. Is it possible to use lasers get the scar to fade as I would like to get SMP into the scar. Or alternatively, can you get SMP and then reduce the scar redness with lasers, or would this likely cause the SMP dots to fade too?

Thanks!

If you let your hair grow out to a reasonable length, the pink color of the scar will be covered. That’s the easiest solution, really. Was your scar pink for a long while after your first hair transplant?

You may just have to wait it out. You can try topical hydrocortisone (a small dab spread over the scar) for up to to 7 consecutive days, then pull back for two weeks and try it again. This might work to lessen the pinkness.

I had 3 FUSS transplants over a decade. It left a wide scar. I had a scar revision. It resulted in a liner revision line. However after the scar revision, 5 years later, I have bouts where the scalp area is really itchy. It ceases in a day and then restful for awhile

1. What causes this?
2. What can one do?

thanks for the tip and your powerful website!

You can try an over the counter hydrocortisone treatment in small doses 3 times a week or once a day, whichever relives the itching. I can’t say a scar revision and scalp itch are related — at least, it’s not something I’ve heard of before. If it continues, I would see a dermatologist.

As an aside, we are no longer doing scar revisions, but rather offer Scalp Micropigmentation (SMP) as the treatment of choice for scars. Most people who have scar revisions still have significant scarring, and SMP literally wipes out the appearance of the scar.

The pluggy hair transplants of the 1980s and 90s, and even the strip surgeries in the years following that, caused considerable scarring in some percentage of patients. Few of them complained unless their donor area was depleted from multiple surgeries so that long hair would not cover it. Even today, scars from follicular unit extraction (FUE) are causing problems for some patients who have had donor area depletion. I’ve seen a few men for consultations recently that have shown a see-through appearance at the back of their heads, asking us what they could do to help make this less noticeable, and prompting me to write this post.

The best solution for unmanageable scars was introduced by us in 2010 — Scalp MicroPigmentation (SMP) — and it can be effectively used to camouflage scars so that they can be made undetectable. Scars are more of a problem when patients have multiple surgeries, each surgery adding to the amount of scarring.

In the past, we have recommended scar revisions with variable success. Usually the scar would be reduced following the revision, but the biggest problem we found with this solution is in the patients who get poor scarring after strip surgery, get it because that is the way they heal. So when trying to repair it, we found limited value with occasional good results, but always leaving some level of detectable scar. There are people like me (three strip surgeries and no detectable scar) who heal very well, but there are some that aren’t as lucky. Treating these scars with SMP seems to always work regardless of the patients tendency to scar.

We’ve posted some outstanding results in the treatment of scars of all types and this is usually what happens to all patients, not the select few shown on this website.

Dr.Rassman/Dr.Pak,
Is it possible for an FUT patient:-

- to have several small (5cms) donor-strip scars rather than the normal one large scar, and would such scars heal better if they followed Langer’s lines?
- to have donor-strip scars incorporated into existing scars (in permanent zone)?
- to have, using your experience and artistry, donor-strip scars with the appearance of naturally-occurring scars: the normal scars that most people receive from the everyday knocks and bumps of an active childhood/adulthood (falling out of trees, falling off bikes, sport injuries, fisticuffs, etc.).

I appreciate that all surgery inevitably leaves scarring and even with the standard of your work some compromise is necessary. But, perhaps like many men, I’m uncomfortable with the thought of having scars that are so obviously due to hair transplant surgery - even though such scars can be covered by wearing longer hair and/or camouflaged by SMP. However, if the scars could be disguised as accident-related scars much of the anxiety of having FUT surgery would be removed and, within reason, any amount of scars would be acceptable.

Thank you.

Multiple small scars were offered in the past, all placed horizontally in Langer’s lines (the lines in the skin where collagen fibers are naturally oriented). Some were significantly less detectable; however, they may not be very efficient if a lot of hair is needed (as in the Norwood class 6 or 7 patients) and multiple small scars often have some hair loss associated with them.

I frankly do not know of any doctors offering this approach. If for any reason, you are a person that widens scars, this approach would leave your head full of scars.

I had three strip surgeries all in the same place for my balding crown, but only one scar remains that is so small, few can see it. In my situation, having only one scar was the right decision and I did not need Scalp MicroPigmentation (SMP), as I did not need to hide what was already hidden.

Hi,
Are there any ways to speed up the process of the strip scar turning white? I have had mine for just over 2 years and although it is slowly fading it is still a light pink colour. Does vitamin E or steroid cream help as I have heard people mention these.

Thanks!

I would ask your doctor first for an examination and a diagnosis for the correct treatment plan. Sometimes, just giving it time may be the best treatment. It generally takes over a year for a scar to settle, but if it has been over 2 years, I would consult with a doctor. Most of the time the redness is very difficult to treat.

Some doctors may recommend over-the-counter steroid creams, but the redness is sometimes due to superficial blood vessels, in which case a cream would likely not be effective. Be careful, as this type of medication can be absorbed by the body with prolonged use.

I (Dr. Rassman) have had a total of 2200 grafts in three strip surgeries over the past 20 years, the last one being 6 months ago. If you were to look at my single linear scar, most people (even with a comb in their hand looking for it) can’t locate it. My strip scar is certainly far less significant than the mottled scars from follicular unit extraction (FUE) in this patient below. To be fair, if the patient had let his hair grow slightly longer, the scars would be less visible.

This is not my FUE patient, but I was told that he had 2500 grafts extracted in one session four years ago (and saw extremely poor growth). FUE scars like these are very common, and as most people get FUE procedures because they want the option of cutting their hair very short without a linear scar, many of them can’t do so when these dot scars are so detectable. Click the photo to enlarge:

I grant that some patients will have visible scarring from a traditional strip procedure, but now with Scalp Micropigmentation (SMP) the linear scars can be made undetectable. The same treatment can make these ugly FUE scars undetectable.

My point for this post is that scarring occurs with all types of surgery. Scarring should not be the motivator for the choice of FUE over strip surgery. Considering the cost differential between strip and FUE surgery, this is just part of the calculation each person must do in making the decision between strip and FUE surgeries.