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I went in for my second HT yesterday. When I asked the Doctor if my first scar was normal he said, “it was very thin” but, the stitches left marks and it looks like a zipper? (You know, the thin line marks you see on top and bottom of the main horizontal scar line). He said that’s very rare. Is it? and if so, is there a way to eliminate that if I had another HT in 6 months or so with your group of Doctors?

The zipper effect means that your doctor placed the suture far from the edge. That will produce the zipper effect. There is no practical solution other than if you have another transplant and remove the “zipper” along with the hair you need for the transplant. There are techniques that avoid the zipper effect, which most doctors use today.

If you’d like to come to us it can probably be eliminated, but I’d have to see you first before promising surgical solutions. If you opt to go elsewhere, you’ll obviously want to be sure that your surgeon does not do the same thing again next time.

I had a graft procedure 7 days ago. I hit my head and caused a small cut about the size of a pencil eraser where I had transplants. Will I lose the grafts in the area?

It would be unlikely to lose grafts 1 weeks post surgery, however, if the skin separated that distance and healed on its own, it will develop a scar in the area. I am sure you have seen many men with these small scars in their heads that came from such injuries.

Hello. When I was in 7th grade I contracted an abscess on the back of my scalp resulting in inflammation and pus and as it healed it left a bald spot. I thought it was from the dirty wrestling mats but never knew exactly where i contracted it. I am 29 today and hair still does not grow in that spot. What are some remedies or things i could do to grow hair back in this spot.

It would depend on the size of the spot to see if it could be excised. A hair transplant would solve that problem. I highly doubt medication would help you in a case like this.

At 4 weeks post op i have significant shock loss on the donor area primarily just behind each ear where the loss is. Not so bad in middle but still some. Is it normal for more loss behind the ears and will it grow back?? Is that area more prone to shock loss than the middle of the back of the head.

Thanks

Sometimes the donor area can experience hair loss from the stress and/or tension from the surgery. Unlike the shock loss in the recipient area, the hair loss in the donor area should grow back in a few months to a year. I would follow up with your surgeon and have him/her further evaluate it.

This patient came in last week, a few years after having 709 grafts taken from a very depleted donor area. Half of the grafts contained just one hair. Getting those 709 grafts was a challenge, as his scalp was tight and the donor area heavily scarred. Because of the anticipated poor yield, I elected to spread the grafts over an inch from the plugs (forward) creating a loosely built thin hairline. When he allows his hair to stand up rather than pull it back as shown here, the results are even more spectacular. This patient gave up his wig and is thrilled with his result. We will try to do another procedure with up to 700 grafts in the recipient area to thicken it, but that will be even more of a challenge because the scarring is very bad and the density of the donor area is very low and he knows it.

Many of what I will call the “normal transplant patients” we perform surgery on today who have not had the old type of plugs, may look at pictures like those shown here and get very frightened. I understand the fear that gets invoked by these patients, but some of my most satisfied patients are those who walked around for years and found that people never looked into their eyes, only to their hairline. This man is an example of a patient where just a small change had a major impact on his life, allowing him freedom from a wig he despised to cover a pluggy look he hated.

Click the photos below to enlarge.

Before:

After:

Well I am black male and currently shave bald. I want to continue to shave bald. I am thinking of FUE to give me some hair in a thinning area. I have few questions: What does the donor area look like when you shave bald after FUE, does it show scarring? I mean razor bald like MJ. Is it worth doing?

I’m confused as to why you’d want a hair transplant only to shave your head bald. All wounds to the scalp will cause some scarring. With FUE, the scars are tiny dots, instead of a straight line scar like that of the strip transplant and they may have a white color to it that would show up after healing an FUE donor area. With dark skin, that might be a problem and one way to tell that is to have a test FUE session done of just 2-4 grafts and assess the healing at 3 months. These tiny scars allow you to keep your hair very short without noticeable scarring if the whitish scar does not appear, but that being said, completely shaving your head may make these scars visible. Again, a test is worth a try.

Dr. Rassman I want to first thank you for maintaining such a top notch site. I have a question for you regarding transplanting hair into scarred tissue. I recently (4 months ago) had hair transplanted into a 1 and 1/2 inch long scar running front to back. I am seeing very little growth…if any. What seems to be present are a few graft which never fell out and have continued to grow. I am aware that growth in scar tissue may take a little longer than if it was to be transplanted into virgin scalp, however, to put my mind at ease I was wondering in your expert opinion, what is a reasonable timeline to expect growth in the scar? Thank you very much in advance for your reply.

It’s only been 4 months, so seeing a little growth is completely normal. I tell all patients to wait for a full 8 months before judging the hair transplant results. You just have to be patient.

First off, excellent blog. What a fantastic resource!

I’m in my late 20’s, have never had a HT procedure before, and I’m considering a strip procedure in the near future. I have read that people with scarring in the recipient area might be at risk of experiencing poor growth/yield of transplanted hair into that area. (discussed on another forum somewhat here: hairlosshelp.com )

Though mostly clear today, in the past I have had acne at my hairline and behind it (on the scalp), sometimes in hard cystic form. Some of this acne may have caused some scarring at my hairline and behind it, though it is difficult to notice any visible scarring on my scalp. I do have acne scarring on some areas of my face from cystic acne, and it appears that the cystic acne led to a loss of fat or collagen in some areas, given the depressed look of the scarred areas. I also have some pitted scarring in my temple areas (where the hair is also receding), which is an area where I hope to have hair transplanted.

Could acne scarring from cystic acne affect the growth of transplanted hairs in the recipient area (e.g. hairline, scalp or temple area)? Or, when people talk about the risks of scarring in the recipient area, are they mostly talking about scarring possibly resulting from incisions made during previous HT procedures’ (or even the result of grafts from previous HT procedures being removed or extracted)? I read in a message (found in the thread I linked to above) that scarring in the recipient area could inhibit blood flow and hinder growth of transplanted hair.

Have you ever heard of acne scarring leading to poor transplanted hair growth? Also, if acne scarring could pose a risk to transplanted hair growth, is there anything that one can do before surgery to try to minimize that risk, other than try to prevent any further breakouts?

Thank you for any information!!

I have not heard of a one to one relationship between acne scarring impacting hair transplantation. If there is any active acne present, it could well have an impact. If you are concerned, you can have your doctor perform a small test transplant into the scar and see what grows. Using a FUE (follicular unit extraction) technique for a quick procedure will take less than 10 minutes. It is not unusual for me to do test transplants on a limited basis in people with scarring alopecias. Wait a full 8 months and then you will know what the risks are. As I can not examine you, I can not really render an opinion at this time.

I was wondering if after having a FOX procedure if you pick off the scabs from the donor area will this cause more significant scarring. I took off a scab 4 days from my procedure and it looks like it left a dimpled hole. I wonder if this will heal?

It is never a good idea to pick at a wound, as it creates the opportunity for infection. If you have eschar/crusts at the donor site from the FUE procedure (which is usually the case) you can wash them off with a good shampoo and a surgical brush. I don’t know what the dimpled hole is without seeing it, but hopefully it healed up for you.

I have a severe scar beginning at my ( receding ) hairline. It is a prominent scar, probably 1 1/2″x 1/2 inch. Obviously no hair grows there and I cannot completely cover it. The injury that caused the scar also took a little “tissue,” meaning there is a slight indentation.

My question is this: Is there a procedure where someone could “reconstruct” the damage? Perhaps by taking a mold of the scar, a piece could be made and have hair implanted. And if so, could this “piece” be safely adhered to my head? I am open to suggestion as well. Thanks.

It would be best for me to see what you look like by sending photos of your hairline and the scar (reference this page). Scars at or just behind the hairline are relatively easy to fix with hair transplants. Sometimes the scar can be partly excised as well (though unusual), but without seeing it you have tied my hands. I have repaired many frontal hairline scars.