The Scalp Scar Revision – Revisited

Scare after Hair TransplantHair transplant surgeons have been dealing with scalp scars in strip hair transplants since the beginning of hair transplant invention. There are also other ways patients may end up having a linear scar after other scalp procedures such as neurosurgical operations or trauma to the head. Although most scars are hidden in patient’s native hair, some may become exposed due to their proximity to the hairline or when a patient keeps his hair short.

Depending on the size, type and location of scars, surgeons may have to use different techniques to minimize their appearance. We have created an algorithm that hair transplant or other cosmetic surgeons can use toward the most effective methods to address scalp scars and the proper surgical or medical approach to them.

Among the factors that are being taken into account for scalp scar revision are; the prior history of scar occurrence and the patients’ reaction to injuries in other parts of the body. A proper physical examination can reveal what proportion of the visibility of scar is due to stretching or hypertrophic reaction and what portion has to do with hair transection.

FUE Grafts around DonorThe scars that are wider than what is expected might have some components of stretching. To improve the visibility of stretched scars the surgeon needs to use a technique to minimize the contrast between the hairless scar and neighboring areas of the scalp by bringing hair inside the scar.

We will discuss trichophytic closure and its variants such as upper, lower, double edged or partial trichophytic closure, then evaluate the indications of each method. We will also evaluate the requirement for a FUE procedure that might be used in addition to trichophytic closures in select scars. We created a system so that surgeons can assess the right surface of scalp that is needed to be deepithelialized in order to bring the adequate amount of hair into the scar.

Every cosmetic surgeon should be familiar and knowledgeable about the cosmetic products or non-medical methods that could be used to improve scars. We evaluate the role of a variety of techniques that might be used solely or in conjunction with surgical procedures for improving appearance of scars. Among those we will discuss; microfibers, foundations, and coloring agents for skin and hair or tattooing of scalp. We will discuss a comprehensive algorithm that can be utilized as a guide for surgeons to produce a better appearance of scar, if they are inevitable, to conceal their visibility.

This publication was presented by Dr. Parsa Mohebi at the International Society of Hair Restoration Surgeries 17th Annual Live Hair Transplant Surgery Workshop in Orlando, Florida.