BigBill,
I wouldn't be too discouraged. While it is true that horizontal surgical scars have more of a tendency to widen when they are in that lower section below the occipital bump, I have had a lot of success with scars down there by limiting my excision to only being 5mm wide. If you leave the sutures in a little longer (2-2 1/2 weeks) and keep the patient from flexing the neck during the early weeks, I find that they are improved most of the time. When you go over 5-6mm in width, the scar stretches too much and, like a rubber band, just re-stretches to what it was or worse. If you gain and keep the 5mm reduction of scar width, then you can either do it again a few months later, or you can then FUE into the scar with better results. We often combine tattoo dots along with FUE to get the best result on a scar. If a patient wants more hair transplanted, I would definitely argue against taking any more donor hair contiguous with that lower scar, and would definitely warn against taking donor hair PLUS taking the whole scar out. I can almost guarantee you the scar will be much worse than it is now.
Improving donor scars is like sneaking up on a bear. You go slow and easy, and the bear doesn't turn around and bite you.
Mike Beehner, M.D.