This young lady was brought by her parents back in the spring with a history of a 50cent sized hypertrophic scar, without hair, at her posterior hairline. They stated this occurred after repeated pulling off overly tight hairbraids. We discussed various options including doing nothing but wearing the hair down to cover this area. I asked them to think about this for several months, as she is in a high risk group for scar problems since: she already has a bad scar formed, she is black with a history of bad scarring, and she is just at the age when her female hormones will really start fluctuating--another factor attributed to poor scarring.

We had several phone calls and in person meetings and agreed on excising as much of the scar as possible, then sequential exams monthly and possible steroid injections. No guarantees were made and we probably will need a second procedure next year to remove any remaining scar.

Shown are preop, intraop and day 7 pictures. We got about 80% of the scar and the entire load is on deep sutures; so hopefully she'll have minimal scar hypertrophy. I'll try to put up pics from her monthly exams if possible.

We chose not to FUE into this scar primarily due to the really thick tough scar itself. I felt that it would have little blood supply and indeed on excision the scar didn't ooze at all.

Dr. Lindsey McLean VA

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William H. Lindsey, MD, FACS
McLean, VA

Dr. William Lindsey is a member of the Coalition of Independent Hair Restoration Physicians

Dr. Lindsey would you explain why scar tissue has such poor blood supply? Thank you.

Nice result Dr Lindsey.

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Blake (Future_HT_Doc)

Forum Co-Moderator and Editorial Assistant for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

All opinions are my own and my advice should not constitute as medical advice.

Scar tissue has more fibrous connective tissue than normal soft tissue. In cases where the scar becomes hypertrophic or even a keloid, there is significantly more scar tissue and I've had many cases where the scar itself wouldn't even bleed when transected. When its that tough and avascular, I have a hard time thinking that a graft will take. But grafts will grow in many scars, it just takes some clinical guesswork and experience to avoid the really tough scars for implantation.

Dr. Lindsey McLean VA

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William H. Lindsey, MD, FACS
McLean, VA

Dr. William Lindsey is a member of the Coalition of Independent Hair Restoration Physicians