Doctors ? about stretched scars

[PLEASE GROW PLEASE]

Could any doctors please answer any of these questions.

1. Should trico even be used on people with prior stretched scars?

2. Can subcutaneous sutures do more harm then good as far as inflamation?

3.Are there signs that a patient has the possiblity of a wide scar BEFORE surgery?

4.Are staples better then sutures?

5.Are deep permanent sutures helpful.

[PLEASE GROW PLEASE]

Could any doctors please answer any of these questions.

1. Should trico even be used on people with prior stretched scars?

2. Can subcutaneous sutures do more harm then good as far as inflamation?

3.Are there signs that a patient has the possiblity of a wide scar BEFORE surgery?

4.Are staples better then sutures?

5.Are deep permanent sutures helpful.

[Arrie]

Good questions, this seems to be a hot topic as of late.... I hope we can get some answers.

[PLEASE GROW PLEASE]

Dr Feller, What was the final consensus of your staple cycling experiment?

[Bill - Seemiller]

PGP,

 

I hope that a hair transplant physician will answer your questions.

 

To address question 3 - Dr. Epstein of our Coalition stated in one of our live chat sessions that extreme scalp laxity may be an indication of "thin skin" which could lead to the possibility of scar stretching. This is due to the lack of supporting collagen in the skin and according to him, this is found more frequently in younger hair transplant patients.

 

This is not saying that scalp laxity is a bad thing by any means. For those with normal skin with the appropriate amounts of supporting collagen, a lot of scalp laxity is extremely beneficial for excising a greater number of follicular unit grafts. But "thin skin" could be a potential problem that increases the risk of scar stretching.

 

I look forward to physician input on this or any of the rest of these questions.

 

Bill

[omy]

Are internal sutures better for previously stretched scars ?

 

Example : Some clinics use a set of dissolvable sutures in conjunction with a second set of non-dissolvable sutures .

[PLEASE GROW PLEASE]

I was told internal sutures can cause MORE harm then good ,due to inflamation.

Alot of doctors have adbandoned internals,and just use staples

[Dr. Ricardo Mejia]

There are no good clear well controlled studies indicating which is best. Some studies have been done comparing one side (half the occipital area) with internal and the other without. There was no discernable difference. IN cosmetic Plastic surgery and dermatologic surgery, it is common to use internal sutures to reduce the tension on the wound for a better cosmetic result. WIth larger graft sessions,you need to take a wide area of donor and this increases the risk of tension. I have found in my own personal experience better results with internal sutures. During my initial fellowship, we did not use a significant amount of internal sutures, and I had more stretch scars. Many other excellent surgeons will tell you the opposite. Which ever technique is used is the one the doctor has the best experience and results with. It certainly speeds up the operation not to use internal sutures. Unfortunately there is not alot of agreement. You are going to get some inflammation with any type of suture and from the healing process. Just look at all the pictures posted onthese sites. The red scars is the inflammatory healing phase. I have not had a problem with internal sutures. They only time you will have problems is when there is too much tension. This is usually due to the width of the excision being removed.

 

Ricardo Mejia MD

Jupiter Dermatology and Hair Restoration

[Dr. Ricardo Mejia]

Plesase grow: See my previous post.

1. Trico can be used on previous stretched scars. The main thing is to reduce the tension when trying to do a scar revision. Ideally, this would be to take out only the scar and very minimal if any hair. However, most patients do not want to undergo a procedure strictly for scar revision and doctors will try to combine a hair transplant and scar revision simultaneously. If you have a 5 mm wide scar and you are trying to do another full hair transplant session, the extra 5 mm is alot on the tension when you bring the wound back together.

2. Loose scalp laxity is a double edge sword. It allows you take a good wide donor strip. However, there are some individuals that have a genetic tendency toward wide scars with looser scalp. This is believed to be a genetic variant of a collagen disorder called Ehlers-Danlos.

3. See my previous post regarding internal sutures. You will get different opinions.

4. Staples are just as good as sutures in some studies conducted. One study indicated no difference, although there was more pain reported. Staples are faster.