Hair Transplant | A Previous Hair Transplant Left Me With a Large Scar - Can This Be Repaired?

A Previous Hair Transplant Left Me With a Large Scar - Can This Be Repaired?

I had a hair transplant back in 2001 that left me with an unsightly scar in the back that goes practically from ear to ear. I have to grow my hair at least two inches to cover it, and when it’s wet it look horrible. I’d like to see if this could be corrected. What should be my next step and can this be accomplished?
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There is always hope that a less than ideal donor scar can be improved. The best method for correcting an unsightly scar in the donor region will depend on several factors including: 1) the width of the scar; 2) the location of the scar with respect to how high or low it was placed in the donor region; 3) the elasticity of the surrounding scalp; and 4) the baseline follicular-unit density in the region immediately adjacent to the scar.

There are two basic modalities available for correcting the scar. One can undergo a scar revision at which time the scar is excised and the remaining incision is meticulously repaired. An open scar revision like this will depend on the width of the scar and the elasticity of the surrounding scalp. A tight scalp may preclude this option since there needs to be some redundant scalp available to stretch into the defect which is left following removal of the scar. Tension is one of the single greatest contributors to the creation of a wide scar following a strip harvest procedure. You will have a high risk for developing another wide scar if the revised incision is closed under tension. A scar revision of this type is usually performed in conjunction with a trichophytic closure. This particular modification of the closure technique is designed to bury follicles in the incision line so as to promote hair growth through the subsequently healed scar. Your surgeon may recommend a few months of aggressive scalp massage prior to any attempt at scar revision if you have a tight scalp. Scalp massages have been shown to produce significant relaxation of the surrounding skin which may permit wound closure under less tension. Less tension at the time of wound closure would lessen your risk of recurrent stretching.

Follicular-unit extraction (FUE) is the other method that can be used to help camouflage an objectionable donor scar. This method is useful when tension prevents correction of the offensive scar with a traditional excision-based scar revision. Using the FUE method individual follicular units are harvested with a fine punch that measures 1 mm or less in diameter. The grafts are then strategically placed into the scar so as to provide direct camouflage from the hair growing out of the scar. The number of grafts needed will depend on many factors such as the length and width of the scar, the texture and caliber of the hair, the contrast between the hair and the skin, and the preferred length that you wear your hair. Fortunately, grafts seem to grow well when carefully placed into scar tissue.

In general I prefer to correct a wide scar whenever possible with a traditional scar revision repair. Any reduction in width with this method is beneficial and it minimizes the need for harvesting grafts via FUE. Many times the best result is obtained by using a combination of the two methods – first excising the scar to achieve the narrowest residual scar possible followed by using a smaller number of FUE grafts to finesse the final camouflage of the remaining scar line. With time and meticulous performed surgery you should be able to achieve a significant improvement in the appearance of your current scar.

Raymond J. Konior, M.D.
Member, International Alliance of Hair Restoration Surgeons
Member, American Hair Loss Association

Scar Revision By Dr. Raymond Konior

That patient underwent a single procedure by an inexperienced surgeon who used a multiblade for the strip harvest. He developed significant stretching and cross-hatching in the donor scar as well as pitting and ridging in the recipient site. I performed a donor scar revision with a multilayered closure. He healed with a relatively fine scar which was further softened with placement of individual follicular-units directly into the scar about a year later. The grafts were taken from the original transplant zone which was also revised by the direct excision of more than 90% of cosmetically objectionable hairline grafts. He is able to wear his hair short again without evidence of the original scar.

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