Scar Revision FAQ

Patients who currently have a scar on their scalp due to strip FUT, or any other cranial procedures, are often curious if there are any options to remove or reduce the scar. 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) traditional method is done through removing a strip of scalp skin which 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 and the integrity of the skin/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:

  • Proper estimation of the size of the strip before removing it. When the scalp is too tight, scalp exercises should be performed for few weeks before hair transplant.
  • Careful wound closure that prevents the edges of the wound from having too much tension. Two layer closure and 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 minimizes the visibility of 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 placing 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 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?
You shouldn’t. Your hair transplant doctor should make this decision after your evaluation. Your hair transplant physician will discuss with you 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:

  • 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.
  • FUE hair transplants into the scar transplants hair directly into the scar through FUE. The hair grafts that are transplanted cover the scar with hair that grows just like normal hair giving the scalp a natural looking appearance. This method is the best for patients who tend to stretch their scars since a simple scar revision likely will not work.
  • 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 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 that can color the scar the same color as hair 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 seek a scar revision of the scalp need to have realistic expectations about what the scar revision surgery can accomplish. The purpose of a revision is to improve the scars appearance however; on rare occasions after a scar revision it may remain unchanged.

I have multiple scars on my scalp. What is the best permanent option for me?
It has to do with how far the scars are from each other. If the scars are closely positioned and you are willing to place more hair, the scar revision and the hair transplant can be combined. An additional strip procedure could remove both scars within the strip then close with a trichophytic closure. If the scars are not close in proximity, the only way to improve the appearance is to perform FUE and remove grafts from other areas of scalp and implant them in the scar.

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 complication 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 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.

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