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How can someone figure if their donor region has been depleted? Is it evident by the appearance and volume of the donor region; would someone who has a depleted donor region have somewhat of a see through look in that area? I have had two FUHT both around the same size, 1350 grafts each, totaling 2700 grafts. Both of the strips were about six inches long and 5/8 of an inch wide and were remove from the exact same region of my scalp, second strip removed from the previous scar. My doctor says he could easily get another strip totaling 1300 grafts if not more from on top of my now existing scar. I’m a little skeptical of this. Although my donor area still appears just as thick as it ever was, that seems like a lot of grafts from just that small region. I would have totaled 4000 grafts and barely even touched either of the sides of my donor region, having just used the back region. Is this plausible? Side note my donor density is slightly above average

Usually 2700 grafts will not deplete the donor area. You need to have expertise in examining a donor area to make that assessment. If you do not trust your doctor’s opinion, get a second opinion. The depleted donor area usually has a see-through appearance, especially when the hair is lifted up.

This patient came into the office with a widened scar from a hair transplant we did over a year ago. The photo at the lower left is following his second transplant procedure (the first was with another doctor). The widened scar risk increases with each additional procedure. Only the central 2 1/2 inch portion of the wound stretched 1cm (as seen here), while the two 1/2 inch wounds on either side didn’t stretch. Donor scarring is a real risk of strip harvesting for FUT but usually the scar is under 3mm in width. After the second surgery, the scar may widen as in this man.

We suggested scalp micropigmentation (SMP) for camouflaging the scar and these photos below were taken 10 minutes after his SMP session was done. This is a typical scar treatment for SMP. Sometimes a second treatment is needed. Click the photos to enlarge.

BEFORE SMP (on left); IMMEDIATELY AFTER SMP (on right):

About a month ago, I sustained two lacerations to the scalp on the back of my head. They were closed with seven staples. The area was not shaved at the emergency room. The largest of these lacerations is about 20 mm long and 1 mm wide. However, the resulting bald area exceeds the wound width by approximately 5 mm (making the width of the bald area 6 mm). I know no hair will grow again within the wound parameters. So I ask you:

1.) Is the prognosis good for full hair regrowth outside the wound?
2.) How many weeks (or months) must pass before I could justifiably believe there would be no more significant hair regrowth?
3.) What are the potential surgical corrective measures (e.g. cutting open the scar and running hair from one hair bearing edge up through the scar tissue)?

Hair loss with laceration repairs is common around the wound. The size of the bald area will vary depending upon the direction of the wound. The scars will be less significant in the normal Langer lines direction (see here).

The regrowth will usually occur within the first 4 months or so and any hair that has not grown in 6 months may probably reflect some permanent hair loss. Scars from scalp lacerations that form are not easily amenable to excision, as they tend to recur (I am assuming that the scars were properly closed and that there were no unusual circumstances present at the time of the closure, such as dirt in the wound).

I have hypertrophic scars from numerous cutaneous surgeries, and even under modest tension my scars tend to spread quit a bit. None of them have an adequate cosmetic result in my mind for a hair bearing region. As a result, harvesting grafts with a strip is something I am not considering. Given my propensity for making ugly scars, am I likely to have abnormally visible scarring from follicular unit extraction at the harvest or transplant site, or are these so small that hypertrophy and spreading are of little concern?

Nobody wants a bad scar, but for hair transplant surgery (or any surgery on the scalp), the scar should always be hidden under the hair if you keep it at a normal length (more than 2 inches). Even a bad scar can still be hidden after a haircut with a #3 clipper most of the time. I also realize many men would like to cut their hair very short in the back where the scar may be visible, and that’s when follicular unit extraction (FUE) may be a better option. However, if you have a tendency to have hypertrophic scars, then even the FUE may leave you with hundreds of noticeable dots.

As with everything in life, you need to have some perspective on what you are doing and what you are willing to give up. Nothing is perfect. There is no such thing as scar-less surgery. There are men who choose to have hair in the front and top, but sacrificing the gain with a scar in the back of their head. There are men who do not want any scars on the back of the head (linear or otherwise), and for them surgery is simply not an option. There has to be some give and take that you have to be comfortable with.

Think about cosmetic surgery on women: Women who want larger breasts will sacrifice their gain in cup size with a scar under the breast, around the areola, in the armpit, or in their belly button. Women who want a face lift will sacrifice a youthful face for a scar along the back of their ear and behind their front hairline.

Remember, keeping your hair very short after a hair transplant will not give you the best cosmetic results no matter how many grafts you transplant. A very short hair style will look much thinner than a longer hair style, which covers more of your head. This is because the surgeon is working with a limited number of grafts to cover a big area.

Regarding your new SMP procedure I am very interested. I have been thinking about it for years and actually still have a good amount of hair and have had a hair transplant, which was not a great experience. I feel like the SMP can fill in the areas that are thinner than other, also covering up the linear scars? what is your opinion on that? Also, since I live in NY, what is the likelihood that your friend Dr. Bernstein will be offering this service? Thanks for all your help and keep up the good work!

Scalp micro-pigmentation (SMP) has had great success in camouflaging scars on the scalp (see here).

At this time, we are the only physicians offering SMP in the United States. We have a travel reimbursement program for those who wish to fly out to Los Angeles for a day to have the treatment.

Dr. Bernstein is not presently offering this service.

This analogy on the subject of FUE really hit home:

…Your donor is like a grid of marbles. FUT is basically a line through the middle (strip) which is closed up leaving the grid uniform and balanced but when using FUE, you are removing marbles at random from all over. It is much harder to keep the grid “balanced” with FUE…

So Doctor…..when a patient elects the FUE procedure to restore their hair, is there considerably less total donor hair available?

I have heard only half as much as with FUT. Say it ain’t so!

“It ain’t so!”

I suppose your donor area can look patchy with little white dot scars if you have 3000+ FUE grafts extracted. This occurs when your original density was average or less than average. People with high density hair often will not show the white scars (dots) at all. Even with 1000 FUE grafts, you will notice these patchy white dot scars if you shaved your scalp, but in general, even with 3000+ FUE grafts, the scars and the less hair volume will be hard to notice (depending how close you cut your hair).

Remember — not all FUE or FUT (strip surgery) is the same, and not all patients are the same with healing. I have seen awful FUE scars and great FUT scars and vice-versa. Each and every patient needs to talk with their doctor and understand the unique advantages and disadvantages along with the risks and benefits of the surgery. This may sound like generic advice, but many patients who seek out FUE choose to go ahead with a FUT procedure after understanding the limitations of FUE and FUT.

With regard to your main question about which procedure will get you more hair (strip vs FUE), I think that the answer is probably strip surgery. Many doctors now doing FUE surgery actually get the hair outside of the fringe area, which means that the hair is not permanent. Some doctors (who think about $$$ above all else) will push the FUE harvest area to meet the projections given. The donor area has about 20,000 hairs in it and if an FUE procedure harvested 1/3rd of the available supply (assuming average density of the hair in a Caucasian male), that would be about 6,500 hairs or 3,200 grafts on average. All of the higher number we are reading about reflects, most probably, non-donor (non-permanent) hair.

i did a hair transplant surgery,and my surgeon said he used trychophytic closure, but the scar is about 4months old now and its turning into keloid strip. please i want to know if i successfull use the silicone get to heal the keloid, will hair grow out from the scar ever again ?

Keloid formation has nothing to do with a good surgeon or a trichophytic closure. Certain people are just more prone to getting keloids no matter what. It is a genetic predisposition. You can try using the over the counter ointments to diminish keloids, but I do not think it will work well on the scalp because of the hair that is in the way. Sometimes doctors inject steroids to “flatten” out the keloid and this is particularly valuable if the keloid is detected early.

Most people really do not have keloids when they report them, but rather hypertrophic scars (which are usually elevated scars). True keloids look like grapes growing from the wound.

This is a typical patient with a series of scars, some from a hair transplant (the large smiley scar). This man elected to cut his hair very short and get pigmentation into the scar. Although an additional session would be a good idea to camouflage the scar better, he stopped at what you see below (on the right). Now if he grows his hair out, the scar should be close to invisible. The red ‘blotch’ you see on the back of his head has been with him most of his life.

The photo on the left is before SMP; The photo on the right is after SMP. Click to enlarge:

I was wondering if you have considered using ACell combined with plasma and injecting it back into the scalp using a tattooing gun. This would create the necessary scaring effect allowing ACell to, in a since, rejuvenate the scar. What do you think?

Pushing ACell into a scar with a tattoo machine will not work to do what you’re probably looking to do. There’s still no hair present in the scarred area, as ACell won’t make hair suddenly sprout in scar tissue where hair does not exist.

While it’s an interesting idea, I’d be skeptical of any doctor claiming to do scar rejuvenation in the way you described. I’m not sure if you’re just curious about an idea you came up with or if someone out there is offering it already (believe me, I’ve read about some far fetched ideas that some doctors are selling to patients). Unfortunately, I’d have to see some really solid evidence to change my thinking on this.

Hey. I’ve had brain surgery back in 2000 and an additional one in 2004. I have a scar on the front of my scalp going from my right side of my head to the top of my forehead. Its not from left to right but almost there. And I have some kind of missing spot on the back of my head. I dont know where that came from. But I was wondering if u had any suggestions on getting hair to grow inside my scars so I have no noticible scars?

We (NHI) have been treating scars of all types on the scalp with hair transplants (especially brains surgery / craniotomy scars). The process is as simple as a hair transplant on the scar itself.

The entire process may take more than one procedure to fill in the scar, as hairs are transplanted directly on the scar and may not fully grow. Whether or not the scarring remains noticeable will remain to be seen. I wouldn’t want to make any wild promises without seeing you.