Scar Revision FAQ

Patients who currently have a scar on their scalp due to strip FUT are often curious if there are any options to remove or reduce a scar of any size on the scalp. The following are some of the most frequently asked questions about scar revision procedures:

Am I going to have a scar after my FUT procedure?
Follicular unit transplantation (FUT) is done by removing a strip of scalp skin and this always leaves a horizontal scar in the donor area after the strip wound has healed. The size of the FUT scar depends on the method of wound closure, skill of the surgeon, the integrity of the skin and wound healing ability of the patient. The resultant scar may appear thickened (hypertrophic) or stretched depending on a person’s individual genetic characteristics.

How can scars be minimized or reduced during surgery?
The amount of scarring in the donor area can be eliminated or greatly reduced by:

• Avoiding strip FUT procedures whenever possible. The new techniques of FUE (Follicular Unit Excision) have minimal visible scarring.
• When strip harvesting cannot be avoided, there needs to be a proper estimation of the size of the strip before removing it. When the scalp is too tight, scalp exercises should be performed for a few weeks before the hair transplant is performed.
• Careful wound closure that prevents the edges of the wound from having too much tension. Two-layer closure, as well as materials such as staples, can help with proper closing and reduce the chances of large scarring.
• Trichophytic closure which allows hair to grow inside the scar and also minimizes the visibility of the scar.

I am planning to keep my hair short after my strip transplant. What is the likelihood of having a visible scar?
Patients will have a linear scar after strip FUT but it can be well hidden by a small FUE procedure that is performed to place grafts directly in the scar. If you are concerned with having a scalp scar, you need to discuss other options such as FUE with your hair transplant surgeon. FUE hair transplant is the only way to ensure that you will not have a linear scar after your hair transplant.

How successful is scar revision?
The success of a scar revision surgery depends on the type of procedure that you undergo and the size and type of your scar. It is almost impossible to completely eliminate a scalp scar. However, scar revision methods can minimize the visibility of the scar. You may need more than one method and more than one procedure for maximum improvement of your scalp scar.

How can I choose my scar revision technique?
Your hair transplant doctor will make the decision after your evaluation. Your hair transplant physician will discuss which type of revision would be best to revise your scar. Here is a list of pros and cons of each method used for scalp scar revision:

• FUE hair transplants into the scar transplants hair directly into the scar through an FUE procedure. The hair grafts that are transplanted cover the scar with hair that grows just like normal hair and give the scalp a natural looking appearance. FUE scar restoration is the best method due to the new advancements in FUE hair excision. Small punches could also be used to minimize the risk of scarring or hypopigmentation due to FUE hair harvesting.
• Simple scar revision of the scar can completely excise the scar. The scar is often closed internally with dissolvable sutures and closed on the outside with sutures or staples. The sutures on the inside reduce the tension from the deep tissue that can result in further scarring. The outside staples will help prevent further stretching of the scar. Patients who tend to stretch their scars will most likely stretch the new revised scar as well.
• Scar revision with trichophytic closure or its alternative, partial trichophytic closure, is where the surgeon trims one or both edges of the scalp before closing the wound. This special trimming allows the hair to grow into the scar and cover it with natural looking hair.
• Scalp Micro-Pigmentation (SMP) induces dermal pigments into the scar in the shape of little stubbles. This method minimizes the contrast between the scar and surrounding scalp and minimizes the visibility of the scar. This method is ideal if the patient wants to shave his head. The disadvantage of this method is that it should be repeated every few years.
• Cosmetics like keratin microfibers are the basic ingredient in Toppik which can be used to temporarily thicken hair and give it a fuller appearance around a scar. Foundations such as DermMatch, which can give the scar the same color as the hair on the scalp, can temporarily minimize the visibility of scars.

Will the scar be completely removed?
While scar revision surgery can improve the appearance of a scar, it cannot completely remove a scar. Patients who want to undergo a scar revision of the scalp need to have realistic expectations about what the scar revision surgery can accomplish. The purpose of a scar revision surgery is to improve the appearance of the scar. However, there are rare occasions after a scar revision where it may remain unchanged in its size or appearance.

I have multiple scars on my scalp. What is the best permanent option for me?
FUE is the best solution for people who have multiple scars on the back and sides of their head. FUE scar revision not only adds hair into the scar, it minimizes the density of hair in the areas between the scar strips to create more evenness and less visibility of scars.

What is the survival rate of the grafts transplanted into the scar?
It depends on the type of scar. The growth is expected to occur without complications in a typical hair transplant scar. In atrophic or hypertrophic scars, the growth might be less than complete. If there is any doubt concerning graft viability, a test hair transplant with a few grafts could be done months before the actual full hair restoration procedure.

I do not have enough scalp donor hair. Can I use body hair to revise my scalp scar?
Yes! Hair can be harvested from any part of body and transplanted into the scar. The best option after a scalp-to-scalp hair transplant in men is a beard-to-scalp hair transplant. Beard hair is thick and has a somewhat analogous growth cycle in comparison to scalp hair.