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Update 1-28-2009
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Here are pictures after 6 months.

Thumbnails:

http://www.kfzy.com/hair/thumbnail_1.jpg
http://www.kfzy.com/hair/thumbnail_2.jpg
http://www.kfzy.com/hair/thumbnail_3.jpg
http://www.kfzy.com/hair/thumbnail_4.jpg
http://www.kfzy.com/hair/thumbnail_5.jpg
http://www.kfzy.com/hair/thumbnail_6.jpg
http://www.kfzy.com/hair/thumbnail_7.jpg
http://www.kfzy.com/hair/thumbnail_8.jpg
http://www.kfzy.com/hair/thumbnail_9.jpg

Full size:

http://www.kfzy.com/hair/DSC_0001.JPG
http://www.kfzy.com/hair/DSC_0002.JPG
http://www.kfzy.com/hair/DSC_0003.JPG
http://www.kfzy.com/hair/DSC_0004.JPG
http://www.kfzy.com/hair/DSC_0005.JPG
http://www.kfzy.com/hair/DSC_0006.JPG
http://www.kfzy.com/hair/DSC_0008.JPG
http://www.kfzy.com/hair/DSC_0009.JPG
http://www.kfzy.com/hair/DSC_0011.JPG

I've already sent these questions to Dr. Ross, but if I could get some responses here, I'd be appreciative!

1) Is this a normal result for one surgery, or not because it is scar tissue? It doesn't seem thick enough to be normal.

2) Do you think a second surgery help significantly, or not really?

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Hello all,

I am an 18-year-old male in southern California area. I was born with a condition called "aplasia cutis" - I had a round bald spot about 10 cm2 in area at the crown of my head.

The skin of the bald spot is scar tissue. There were never any hairs in the area.

Picture:
http://www.picvault.info/images/537076154_pic1.jpg

In 2006, I had two plastic surgeries to try to remove the bald spot. Immediately after both surgeries, there was no sign of the bald spot, but it soon stretched. Now the bald spot is about the same size, but a different shape. I also have a fairly thin scar down the back of my head where they cut a flap to try to make the scalp reduction easier.

Last year, my family moved to California and I went to see a local plastic surgeon and see what the next step would be. She recommended hair transplantation, saying it would work even in scar tissue (which I didn't know before).

Since then, I have had consultations with the following practices/doctors:

Ziering Medical
Dr. Chang (Natural Hair Transplant Medical Center)
Ross Medical Hair Restoration
Dr. Reed (La Jolla Hair Restoration Medical Center)

I've had mixed responses as to whether hair transplants would grow well in my bald spot (scar tissue).

Ziering Medical and Dr. Chang were optimistic about it working well.

Dr. Ross's technician (after examining it) said something along the lines of, "I think there's a chance it would work," but by the end of the consultation, was much more optimistic, for some reason.

Dr. Reed was not as optimistic about it working well. He said my bald spot scar was thin and that that made it less likely to work. He recommended that if I did it, I only do 300 grafts for the whole bald spot and scar line. Dr. Ross's technician recommended 600.

(I'm not sure about Ziering, but the rest recommended transplanting follicular units of 2-4 hairs each)

So, my questions boil down to...

1) What's the story on scar tissue and hair transplants? I've read multiple times that it works but not quite as well as normal tissue. However, Dr. Reed made it sound as if it may work significantly worse.

2) Has anybody had experience or heard anything about the doctors/practices I mentioned? Ziering is significantly more expensive than the rest and I'm wondering if they're really any better.

Thank you so much!

Keith

Keith,

Welcome to our forum community and thanks for the post.

Simply put, transplanting hair is a lot like gardening.

Transplant hair into a healthy scalp with good circulation is much like planting crops into fertile soil. As long as the crops aren't damaged during the planting and taken care of they will grow. However, transplanting hair into damaged skin (like scar tissue) may result in poor hair growth much like planting crops into poor soil. Sure, some may grow, but some may not.

That said, it is clear that you are getting some mixed input from hair transplant physicians you've consulted with. I can't imagine how trying a hair transplant would make things worse however, I certainly understand why surgeons would want to proceed with caution, trying out a lesser number of grafts to see if they grow.

It seems quite clear that you may be taking a gamble on this. Whether or not you choose to gamble is up to you.

Dr. Reed is frst rate and an elite member of the Coalition of Independent Hair Restoration Physicians. Dr. Ross is currently being considered for recommendation on the Hair Transplant Network.

If you choose to proceed, select your surgeon wisely based on evidence of consistent results.

Best wishes,

Bill

__________________
Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog and the Hair Loss Forum and Social Community

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To learn about how I restored my hair, view my my hair loss website.

Remember, true beauty radiates from within, not from the skin.

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

The doctor who performed my surgery also does a lot of transplants for patients with scars with excellent results. However, he is in Michigan, which is quite a distance. I'm sure you could find a great surgeon closer to you who could produce the same results. I definitely think your a candidate but proceed with caution. Do your research and find a good doc who has done many transplants into scar tissue with great results.

__________________
My Hair Loss Weblog - Hair Transplant with Dr. Tessler

I would seriously consider a session (if not sessionS) of FUE, if you do decide to try to fill in this peculiar area. Personally, I'm not sure I would brave anything else than FUE trying to rectify this situation.

__________________
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*A Follicles Dying Wish To Clinics*

1 top-down, 1 portrait, 1 side-shot, 1 hairline....4 photos. No flash.

Follicles have asked for centuries, in ten languages, as many times so as to confuse a mathematician.

Enough is enough! Give me documentation or give me death!

Hello HTN Community. My partner Dr Tim Carman told me about this post and I thought it might be useful to the discussion as well as to the young man initiating this thread to make a few remarks.

I saw this young man with his mother yesterday. They aren't interested in expanders which, though they be the best solution, is an understandable opinion in view of what expanders entail. The scarred areas are 10cm2 with half being a long thin scar not shown adjacent to the large scar that is shown in the photograph. A steep angle of insertion for the long thin scar and paper thin scar tissue for the central 50% of the larger one shown in the photo are the important considerations. Both of these considerations decrease the density of grafts that can be placed. Thirty grafts / cm2 seems a reasonable estimate of achievable density. For ten cm2 this equates to 300 fugs.

The scar is in an unfortunate spot cosmetically and stylistically, hence my caution for its lack of appearing normal if it serves as the termination of the partline and hence my reservations about his being completely satisfied with pursuing hair transplantation. The grafted hair will never appear exactly like the adjacent normal scalp but it can contribute to decreasing the "contrast" that the bald spot has with the adjacent scalp. It would be best to style with the partline on the other side which can be done in his case and would add to his satisfaction by not having the partline end in the grafted area.

Perhaps knowing that there is another long thin scar will have Dr. Feller be less adamant about the exclusive indication for FUE. With multiple scars already present, perhaps another scar which will be only a little over an inch long is not as big an issue as he would feel it to be otherwise.

Best regards,

Bill Reed, MD

__________________
William Reed, M.D.
Member of the Coalition of Independent Hair Restoration Physicians

Dr. Reed:

I don't think Dr. Feller responded, unless I've missed it. Perhaps you are referring to thanatopsis_awry's post above, who while a great wordsmith isn't a doctor as far as I know.

__________________
100? 'mini' grapfts by Latham's Hair Clinic - 1991 (Removed 50 plugs by Cooley 3/08.)
2750 FU 3/20/08 by Dr. Cooley

My Hair Loss Website - Hair Transplant with Dr. Cooley

Current regimen:
1.66 mg Proscar M-W-F
Rogaine 5% Foam - every now and then
AndroGel - once daily
Lipitor - 5 mg every other day
Weightlifting - 2x per week
Jogging - 3x per week

I agree with fue allthe way

I don't think you can go wrong either way--strip or FUE to be honest---it is highly unlikely that he will be able to buzz down--although the one case for FUE is to select larger grafts, 3's and 4's b/c it will be just "whatever" comes out of the strip----That would be the only reason I would do FUE

Again, I still believe either method will produce good results should he choose this method.

Jason

__________________
Go Cubs!

6721 transplanted grafts
13,906 hairs
Performed by Dr. Ron Shapiro

Dr. Ron Shapiro and Dr. Paul Shapiro are members of the Coalition of Independent Hair Restoration Physicians.

Yes, please don't mistake my mumblings for that of a doctor, let alone the esteemed Dr. Feller -- I would hate to misdirect someone away from a fin script and they have a seizure.

Though, Dr. Thanatopsis.....has a nice ring to it! If only I didn't drop out of school.

__________________
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*A Follicles Dying Wish To Clinics*

1 top-down, 1 portrait, 1 side-shot, 1 hairline....4 photos. No flash.

Follicles have asked for centuries, in ten languages, as many times so as to confuse a mathematician.

Enough is enough! Give me documentation or give me death!

Hello everyone. I performed surgery on this nice young man yesterday, and he has agreed to allow me to post his pictures in this thread. The total number of grafts we placed was 632, with the following breakdown:

The large crescent-shaped scar received 357 grafts @ approximately 45 grafts per cm (area of roughly 8 square cm). I was pleasantly surprised that the tissue in this area was reasonably thick, which allowed me to make the graft sites without them being overly shallow and/or with very acute angles.

The other 275 grafts were placed throughout the remaining thinner scar @ approximately 45 grafts per cm (roughly 6 square cm). Blood flow to all of the scarred areas in question was very good and I expect his results to be excellent.

Brandon Ross, MD

Attached Images

scar.jpg (278.3 KB, 160 views)

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Dr. Brandon Ross is a member of the Coalition of Independent Hair Restoration Physicians