The Truth about FUT scarring...

[cargo65]

I would really like to know the real deal about FUT scarring.

 

We've all seen the videos/photos from various clinics including many reputable ones that show patients with almost imperceptible scar lines in the back of their heads.

 

Having researched and read many threads and comments, it seems scars look their best 4-6 months post operation (which I'm assuming is when a lot of these photos are taken) but have the tendency to stretch-out/widen as time continues on.

 

Are we being misled by the doctors a bit regarding what we can truly expect in terms of scarring?

 

I understand individual physiology, contributing factors by the patient (not complying with post-op instructions), doctor's skill in closing wounds, et cetera all can play a role.

 

But generally speaking, what can one expect from a typical FUT procedure with a trichophytic suture?

 

Thanks in advance for any info you can provide.

[Davis91]

Scars look their best right after the procedure -1 month. Around 3-4 months they can start to widen. Any clinic worth their salt shows the scar from a couple different angles one year out (not just showing the thinnest part).

[RodG]

Hi,

 

My scar is fine and is about 1mm in width. I've read a few comments on the forum about scars stretching but mine is fine.

 

Regards rod

[HARIRI]

Damn, 1mm Only? You must be very very lucky. My original scar is 8mm and the new one is 5mm at the sides from Rahal.

[cargo65]

Damn, 1mm Only? You must be very very lucky. My original scar is 8mm and the new one is 5mm at the sides from Rahal.

 

 

Do you have hair growing within that scar or is just hairless scar material?

[michaeljames]

As you've stated, there are many different factors involved into why each person's scar is different. When looking at a doctors results, the best are seen a year later and beyond. Dr. Mohebi intentionally used staples for most patients over sutures because the long term results are much better. The patients are usually in a lot of pain for the first 9 days while having staples, but the long term results are what make a patient happy with the work done on them. Again, as you've stated, there are individual factors involved which make a huge difference when done properly and directed by a quality surgeon who has a great understanding of the art and science of hair restoration.

[Janna]

 

Having researched and read many threads and comments, it seems scars look their best 4-6 months post operation (which I'm assuming is when a lot of these photos are taken) but have the tendency to stretch-out/widen as time continues on.

 

Are we being misled by the doctors a bit regarding what we can truly expect in terms of scarring?

 

 

Hmm, I've never heard this before where the scar looks the best at 4-6 months post op.

 

We generally don't take pics or think about the donor scar because the patients care mainly about the their result on the top of their head and they just say their scar is great, that it's a non issue. It's difficult for patients and clinics to take pics of the donor scar as the hair is too long to see the scar most of the time. Of course if the scar has stretched, then it's addressed.

 

It's difficult to answer as to why one patient gets an undetectible strip scar while another patient's scar stretches. Those with great laxity can have a scar stretch even though the same closure technique was performed. So the technique and physiology both play a big part in how the scar heals.

 

The trend in the last few years is that not only are we producing very, very thin line scars but some patients receive a scar that's truly undetectible. And, I've seen these beautiful non-scars at all stages of healing - 3 weeks post op, to 12 months and beyond.

[Jotronic]

I agree with Jana. I haven't heard about scars looking their best at 4 to 6 months. I think by the 7th month the scar has settled down enough to where the redness is gone and has most likely turned to the familiar white color we all expect so this is when I believe the scar looks it's best. However, there are some people that say that donor scars will stretch over time. I can't recall seeing this phenomenon. I know there are some cases where a wide donor scar got worse with time but there has to be a stopping point, right? If not then we'd have patients with donor scars 9cm wide covering the entire donor zone:) And to clarify, you said you assume most photos or videos are taken around the 4 to 6 month mark due to this being the best the scar will look. Most of our photos and videos are taken on average about ten months out or later.

[cargo65]

To clarify, the "4-6 months" comment is not referencing the look of the entire wound area or including redness, surrounding hair (shockloss), et cetera. The comment is strictly speaking of the appearance of the linear scar line at around that time range.

 

Is it not accurate to say that the linear scar left after the excision will be pretty much healed by that point if not weeks earlier?

[Jotronic]

I think "healed" is subjective but I think as early as four months is premature. The scar may look fine but I feel that it has more healing to do because there is more going on in the deeper layers of the donor area. This is why we feel that one should not resume scalp laxity exercises until a bare minimum of six months but preferably seven months or later if they are going in for another surgery.

[cargo65]

I think "healed" is subjective but I think as early as four months is premature. The scar may look fine but I feel that it has more healing to do because there is more going on in the deeper layers of the donor area. This is why we feel that one should not resume scalp laxity exercises until a bare minimum of six months but preferably seven months or later if they are going in for another surgery.

 

I think that's kind of the point I'm making. Assuming that certain clinics are showing patient scars a mere 4-6 months post surgery, the scars look good aesthetically (which is the deceptive part) at that point in time, but as the healing process continues the scar eventually widens out with time.

 

I'm not rigidly sticking to my speculation about the 4-6 month time frame either. It's merely a conclusion I've come to from gathering information from reading through threads on this and other forums.

 

I'm guessing the individual doctor's skills, the patient's physiology and other contributing factors all play a major role in scar appearance.

[scar5]

It isn't just thinness that makes a 'good' or 'bad' ear-to-ear scar. Color and and flatness are a big part.

 

The width thing* has always settled between 6 - 12 months for me. The first six to eight weeks is amazingly good.

The color thing, well that is a bigger gamble and I've had patches of pink for years

The depth and contour thing, that is really hard. I've had ridges and valleys for 20 years so it is safe to say, they are permanent.

 

*Remember that if the scar is re-opened for seconds or thirds, it may widen.

 

Clinics will say, 'Wait, but it might not', but they'll also say, if it widens, 'yeah, well, it has been re-opened so less laxity'

[stinger99]

hariri, you scar is 8MM wide from dr rahal? wow i thought dr rahal was regarded as a top dr for FUT scar as i have seen many past patients showing very thin scars. please comment.

[cargo65]

The depth and contour thing, that is really hard. I've had ridges and valleys for 20 years so it is safe to say, they are permanent.

 

*Remember that if the scar is re-opened for seconds or thirds, it may widen.

 

 

 

But with the surgery(ies) you had 20 years ago, did the surgeons use a trichophytic closure?

 

If not, could that have been part of the problem ("ridges and valleys")?

[cargo65]

hariri, you scar is 8MM wide from dr rahal? wow i thought dr rahal was regarded as a top dr for FUT scar as i have seen many past patients showing very thin scars. please comment.

 

I believe he was saying his original scar (from another doctor) was 8 mm, but Rahal was able to get the scar down to 5 mm after revision.

[scar5]

But with the surgery(ies) you had 20 years ago, did the surgeons use a trichophytic closure?

 

If not, could that have been part of the problem ("ridges and valleys")?

 

My worst 'valley', which creates an indentation across the right side of my scalp, right up to the temple and draws attention to the scar was the result of a revision that was not tricho as far as I remember. It replaced an exceedingly wide scar, which was pretty flat and white.

 

Another scar I have, the most noticeable scar I now have, was created only 4 years ago, for the sake of a few hundred grafts can you believe, was definitely a two layered, tricho. It was carefully done by an excellent surgeon and it looks awful. It was also a revision of sorts. But the doc insisted, bless his little heart, on tearing up my best scar rather than addressing my worst. 'I don't wanna go there' he said, referring to the possibility of re-opening the worse side of my scalp. Who am I to judge?

 

My best scar, almost text book thin, was created somewhere between 1992-1995. It's not tricho, and was created by the same doc that made a massively wide 12mm scar in me back in 1988. Go figure.

 

My conclusion is that scarring is not predictable and that clinics play a game of information cards with their clients and would be clients. Deep down the pack lies the card that says, 'no guarantees' . Way up top there are cards like 'trichophytic' and 'comb through' pics that don't reflect the extent of the damage whilst hair is shingling over the scar in a comb through. Just IMO

[nicksam086]

Hi Jana,

 

In one of your reply above, you mentioned - "very thin line scars but some patients receive a scar that's truly undetectible" . Could you please share the pics of 'truly undetectible' scars.

[Spanker]

Hi Jana,

 

In one of your reply above, you mentioned - "very thin line scars but some patients receive a scar that's truly undetectible" . Could you please share the pics of 'truly undetectible' scars.

 

I don't have the links but I have seen some strip guys that I would say are undetectable at a 2 cut. But I would say not to bet on this. I think that I could cut mine that short, but I don't want gamble on it.

 

No strip, and very few FUE cases are actually truly undetectable when shaved.

 

you rarely see FUE patients with their hair cut shorter than would have hidden their final scar. Sometimes, but not often.

[hsrp10]

It all comes down to individual patient physiology and scalp characteristics and also how much they adhere to the post-op instructions.

An immaculate scar by the very best FUT surgeon on a patient with a high laxity scalp who starts to do heavy weight training within one month post-op is going to stretch...

There are no guarantees when it comes to stretching and an honest doc will advise of the risks.

 

As Spanker mentions though, most guys are not intending to shave their head to grade 0-1 especially informed patients post-op FUT.

[Paulygon]

*Remember that if the scar is re-opened for seconds or thirds, it may widen.

 

Clinics will say, 'Wait, but it might not', but they'll also say, if it widens, 'yeah, well, it has been re-opened so less laxity'

 

My doctor plans to do the tricho closure for me the second procedure so my scar should be even less apparent after the next round.

 

Some docs are really good with wound closure. Part of the reason that I picked Mohebi was that I read some of the Johns Hopkins academic work he did on wound closure, and being an academic myself, I was sure that he was the man for my FUT surgery.

 

Pick a reputable doc, see some of his past work and don't worry too much about the FUT scar if you don't plan on shaving your head below a 1-2.

[Mickey85]

 

Pick a reputable doc, see some of his past work and don't worry too much about the FUT scar if you don't plan on shaving your head below a 1-2.

 

Even the best surgeons have stretched scars. The outcome of a strip scar is not guaranteed and is a gamble, much like anything else in the hair transplant industry. Going to an excellent strip surgeon will lessen the chance of a scar stretching but absolutely DOES NOT eliminate it. A surgeon has zero control over your physiology, that is one of the main factors of a scar outcome. I had strip with a very renowned strip surgeon and I can't shave my head past a grade 6 convincingly. What do you say to that?

Edited May 9, 2014 by Mickey85

[gillenator]

The scarring can happen and yes is one of the primary risks with FUHT methods. Yet I have seen guys that had FUE and cannot buzz down either primarily because they had FUE from someone learning it or that used large punches, and even had issues healing from it. Obviously these were larger cases of FUE but my point is that bad scarring is not exclusive with FUHT.

 

FUE is still the best way to go if the individual has any desire to wear their hair short or has minimal classes of MPB in their family histories and/or seeking smaller areas of restoration. And more surgeons are becoming more proficient with FUE, doing larger cases, allowing more guys to wear the shorter hair styles that they desire.

 

I am also very interested in seeing more cases using Liposimil ATP and if it helps to minimize scarring in either method of HT surgery...