wrapper,

Welcome to our community and congratulations on selecting an excellent physician for your hair transplant.

While I can't speak for Dr. Pathomvanich, I don't believe he typically creates a second scar with subsequent procedures. However, I know some physicians take this approach on the occasional patient to harvest a greater number of grafts for the second procedure (with the patient's consent). While the obvious advantage is the possibility of more density or coverage (depending on where the extra grafts are placed), the disadvantage is that you'll have a second pencil thin strip scar extending from ear to ear. I recall another physician discussing this approach on this forum in the past.

Overall however, this is not common practice. Perhaps Dr. Pathomvanich was referencing the second scar that replaces the first one?

Our forum co-moderator Dave has contacted Dr. Pathomvanich asking for his input on this topic. Hopefully he'll have a chance in his busy schedule to share his thoughts on creating more than one scar on this thread.

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

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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.

Hi Bill,
The reply I received from Dr Path' yesterday confirmed that he does make a 2nd scar, the email goes on to state the advantages of this method, I explained this yesterday and also that no decision will be made before consulting and discussing with the patient, he definitely wasn't as you put it Bill, "referencing the second scar that replaces the first one", I'll send you the email reply if you want, I fear I may not be too popular with Dr Pathomvanic and his staff now, I fully intend going back there in one years time and believe they have done a marvellous job on me and will do so again in one years time but I cannot apologise for researching and trying to find out as much as possible especially in this case where the treatment being recommended seems to go against the norms, as I said before I spoke more about scarring than my actual new hair during consultations, surprising then that I'd be recommended a procedure that could give me more scarring, I look forward to reading Dr Path's response to the forum co- moderator and to his input on this subject.

wrapper, you raised a very legitimate concern as taking two scars is not common practice, and I wouldn't worry about this having an adverse affect on your relationship with the clinic. After all, it's your head on the line! I think we all look forward to a response from Dr. Path in regards to this.

__________________
HT #1: Karamikian Unknown # of grafts Sept.2006

HT#2 Nov.23rd, 2007
Dr.Feller
Almost 3200 grafts via strip

HT#3 April 2010
Fue 200/side into temple points

HT#4 February 2011

My Hair Loss Website - Hair Transplant with Dr. Feller

Yea, Im very curios to see his response...I don't want to beat a dead horse, but of all the consults I had with the 5 plus coalition doctors, eventually going with Dr Rahal, ALL were replacing my old scar and wanting to leave me with just one scar!! Interesting!!

__________________
Newhairplease!!
Dr Rahal in January 19, 2012
4808 FUT grafts- 941 singles, 2809 doubles, 1031 triples, 27 quads

My Hairloss Website

Hi wrapper,
i had 3 sessions with dr path.
because i had a botch surgery in uk which left me a very low scar i got dr path to leave it and he took a higher strip to achieve 3000 grafts
then i returned 1 year later and i wanted maximum amount grafts so dr path cut a 3rd strip scar higher area where it was denser to achieve 2700 grafts.
so i had 3 scars,
i then returned for dr path to joing the first and second scar together revision into 1 neat scar,its still healing now but looks great so far so good.
my higher scar didnt heal as well as i wanted but it is well hidden
dr path will tell you straight,no bullshit.
so far now i dont see any problem having 2 scars on my donor as its well hidden.
as long as your getting the grafts you want and your donor hides it nicely then 2 scars is no problem in my own view

Thanks bigcow,
Good to hear the other side of the argument, when I had a consultation with a uk clinic in October, the guy from that clinic had 2 ht scars, I asked to see them, they were both slim and you had to look for them, if in one years time before my next surgery, my first scar is undetectable and the likeliehood was that a 2nd scar would be simarily undetectable but produce a good deal more grafts then maybe it's not such a bad proposition, I would be in the same positon regarding scarring as I was in a year earlier, ie one undetectable scar with a new surgery to come as opposed to no scarring but about to have my first surgery, the fact is though there are very knowledgable people on this forum even Bill the managing publisher suggested I may have misunderstood Dr Path' as the idea seems so against normal practice. this forum is where I learn about Ht's but I'd be surprised if anyone on this forum is as experienced as Dr Path', for me I done the correct thing by raising this issue, I'd love to hear from anyone else whose had a 2nd scar and think it's a good idea.

wrapper,

I suspect if Dr. Pathomvanich regularly employs this technique, that he's a firm believer in it and wouldn't have a problem sharing his comments and point of view with the community. After all, this community encourages 100% transparency, especially as it relates to physician technique.

While there are some potential dangers with creating a second scar, I have every faith in Dr. Pathomvanich's technique and don't feel he would steer anyone wrong.

That said, it's important that patients are aware of the particular strategic hair restoration plan that both the physician and patient should be a part of. This includes whether or not to create one or two scars and discussing the advantages and disadvantages of both.

I do hope Dr. Pathomvanich shares his expert opinion on this important subject.

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.

There's no doubt that one scar is the best for multiple HT sessions. However, subsequent sessions makes the single scar wider depending on the width of the strip that is excised. A 1 cm width strip will leave a minimal or an invisible scar on average, whereas a wider strip will leave a bigger scar. The outcome of a single scar after 2 strip techniques usually results in a scar that is wider than the original since the total width is doubled, more or less.

Excising the scar from the first HT session is not easy since the hair follicles within the scar are not aligned in the same direction as do normal hair follicles since they are embedded in scar tissue. Even with trichophytic closure, the hair follicles within the scar are in danger of transection. Careful dissection is very important to avoid damage to these follicles even though I use my open technique with the aid of skin hooks. I still have a hard time in some cases to try to dissect the follicles that are within the scar to avoid transection, since the hair direction of the follicle is distorted due to fibrosis. If we excise the strip and the scar is included at the center it would be much easier, in the same manner as if we avoided dissecting inside the scar. However, slivering a strip inside the scar is more difficult. When you encounter the scar, there is the potential for follicular transection.

In my opinion, if the scar is invisible, why bother to incise the same scar causing more potential for follicular transection. If we make a second scar, we do not encounter the old scar and there will be less potential for transection. If the patient needs further sessions, the two scars can be incorporated into one.

If the scar from the first HT session is a little bit wider, I will use a single scar by excising the first scar and incorporating the scar inside the strip to prevent an even wider scar when it heals.

I always discuss with my patients prior to surgery whether he would want a single scar or 2 scars. Whether to do one or two-scar strip is still a debate. However, majority of the hair surgeons as well as patients will select a single scar, if possible. Majority of my patients still have a single scar after subsequent sessions.

I did not say that I recommend 2 scars for every patient.



Dr. Damkerng Pathomvanich

Thank you Dr Pathomvanich for your thorough response and for clearing this matter up, I feel so much more knowledgable now, sometimes it is not possible during consultations to gather and take in all the information given to you, this site is invaluable for educating prospective hair transplant patients, I look forward to meeting you again in 1 years times for hair transplant number 2, no doubt we will discuss in more detail my next procedure, thank you for taking such good care of me when I visited your clinic in Bangkok and for doing such a good job on my head, post op I've had absolutely no problems whatsoever, as you know I wasn't even at my hotel when you called on the evening of my surgery to check on my wellbeing, I felt ok then to go out that evening and it's been a steady improvement since, all my grafted hairs are growing well and none have shedded yet, couldn't be happier, thank you.