Hello I folks. I was wondering what are some of the best methods to fix scarring? Can surgery be done to remove some of the scarring on the back of the head? I know that hair can be transplantd back into the area that it was taken from to build up density. But are there other ways to help with this problem?

The Top doctors use the T closure method which can be utilized on an existing scar by removing it and closing using this method. As you mentioned you can also insert grafts into a scar to cover.

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Every case is different and requires a different approach. I think a lot depends on the current condition of your scar. As previously mentioned, scar grafting (via FUE) is a possible option. If the scar is not too wide, grafting can do wonders to blend the area with the rest of the donor.

One thing to keep in mind is the likelihood of you needing more hair transplants down the road. It might not be prudent to graft the scar if you or your physician feel you will need to remove that tissue with another strip surgery in the future.

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Bowlforthedog,

You've been given some good information from our forum members.

See more information about hair transplant repair.

Best wishes,

Bill

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

If someone presents to a hair surgeon with a donor scar that is too wide, there are two ways to treat this problem: FUE grafts into the scar, or excision.
A trichophytic closure should only be used at the time of the scar excision if the full width of the scar is excised. If a patient has pretty good laxity of the scalp around the scar, my preferred approach is to excise only a 5mm strip of the scar tissue out, and then re-evaluate the patient a few months later to see if any stretchback occurred. If a good reduction was achieved, often it is enough to make the patient happy and he doesn't request any more surgery. If the scar was quite wide to start with and there was an improvement from the first excision and good laxity still exists, then a second narrow excision can be done. If the full width of the scar was only 5mm wide to begin with, then a trichophytic closure could be done, but it does involve excising (at partial depth across the hairs within that section) an extra 1.5mm of scalp in addition to the other 5mm. I find that by limiting myself to taking a narrow section of scar tissue only, stretchback doesn't occur in the scar. In my experience stretchback does happen most of the time if an ambitious excision of a wide scar is attempted.
If the patient has already had one attempt at reducing the scar before he gets to you, then it is almost always futile to attempt another excision, and FUE into the scar is the preferred way to camouflage the scar.
Also, if there is any question as to the adequacy of the scalp's laxity near the scar, then FUE of hairs above or below the scar and planting them into the scar is the best course to take. FUE usually has to be done twice a few months apart, because scar tissue cannot deliver the necessary blood supply to densely planted FU grafts.
In my own practice, I find that the FUE approach for wide scars is best in around 60% of cases. Of course the best way to not see wide scars is for all hair surgeons to be conservative in the width that they harvest at any given transplant session.
Mike Beehner, M.D.

Whats the average amount of grafts you obtain when only going for scar tissue in a reduction .Ear to Ear no sides

Dear Dr. Beehner,
Before even getting to the point where one may need reparative work, would you be willing to provide information about how to prevent stretching in the first place.

It appears from your post that two of the more determining factor in stretching are
a) the width of the strip taken and
b) the elasticity of the scalp.
Both of these factors are obviously beyond my control. All I can do is contact my doctor, which I intend to do.

What then is within my control? I ask because one side of my donor area is inflamed, ridged, and it hurts (pins and needles in addition to a dull pain). I am 4 weeks post-procedure, and while others on the site say that the inflammation, etc., is normal, rather than waiting (especially if it is simply postponing the inevitable because the signs of potential scarring and stretching are already manifesting themselves), I would like to know NOW how I can be proactive about reducing scarring and stretching. Should I be applying neosporin (sp?) on the donor area? Should I use maderma (again, sp?).

Thanks for taking time out to respond, by the way.

Dear "Female Hair Loss"
The dice are pretty well cast as to how your scar is going to turn out. It's a combination of your natural elasticity (too much is almost a worse thing to have than too little, by the way)and the width of the donor strip you had taken. Both of these contribute to how much tension existed in bringing the two edges together.
One thing that some hair surgeons believe can help before surgery, which is pro-active and something you can do, is to do scalp massage/stretching - pushing and pulling the scalp together and apart in the up and down plane. After surgery, the only thing I know that can theoretically help a little is leaving the sutures or staples in a little bit longer, to give time for the hair-bearing scalp above and below the scar to stretch out a little and reduce the tension that will exist at the scar when those sutures holding it together are removed.
Applying Neosporin, etc probably won't affect it. An ointment vehicle can help reduce the crusting and itching of the donor scar in the early weeks however. Around 10% or so of all patients are allergic to the Neomycin in Neosporin and can get a nasty allergic reaction, so that may not be the best thing for everyone to use.
I suppose avoiding positions and activities that bend the head and neck extremely forward, such as sit-up/crunches and reading in bed with your head bent on a pillow looking down at a book, may also lessen the tension on the scar in the early weeks, but mostly it is now out of your control. It is common to feel some localized tender areas and a little bumpiness along the scar, and, as long as there is no swelling or redness, it is usually nothing to worry about.
Mike Beehner, M.D.

Female,

I agree with Dr. Beehner. The only thing you can really do "post-op" at this point is minmize tension to the donor area and give it the proper time to heal. The scar may look wider at only 4 weeks due to the inflammation and possible donor "shock loss". The Ridging is also typical with a tricho scar in the first few months but typically flattens over time. On one side of my head however, I do have very little (but present nonetheless) ridging - however it is not noticable to anyone visually. I can feel it but I would doubt that anyone else would be able to feel it unless I put their fingers directly on the spot.

Just to add what I have learned however about donor elasticity. It is not that a lot of elasticity is a bad thing in itself. BUT, from what I have heard from Dr. Epstein, a lot of elasticity MIGHT be a sign of "thin skin" due to the lack of supporting collagen. Due to the lack of supporting collagen, one might be at greater risk of scar stretching. Dr. Beehner - does this sound accurate?

Female - the best thing you can do however at this point is give it the proper time to heal and don't strain the area.

Great discussion!

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

View our hair loss articles on EZineArticles.com

Follow us on Facebook | Twitter | YouTube

Subscribe to our Newsletters | How We Recommend Physicians

-----

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.

Bill,
Your description is fairly accurate. The extreme form of this is a syndrome called Ehlers-Danlers Syndrome, in which the skin is ridiculously stretchable. These patients usually have hyper-mobile joints and other body idiocynrocies. In the "hey day" of scalp reductions, the surgeons (including myself) loved those patients with the super-lax scalps, but we learned over time that these were the very ones that had significant stretchback and five months later looked almost the same as before the scalp reduction. This same pheonomenon occurs at the donor scar in hyper-elastic patients.
Mike Beehner, M.D.