Trichophytic closure intra-op, 1 week, 2 month pics showing hair truly growing throug

[Dr. William Lindsey]

I have posted lots of topics on scar and closure techniques. Indeed, I’ve posted a couple of fairly frank threads on my personal results showing representatives of my own scars ranging from near perfect to poor. The last several years we’ve done roughly 130 cases involving strips. Based on patient in office followup and pictures that I get emailed to me from travelers, I see about 100 of my own scars at the 2 month scar check and at a year. Out of that number I have seen pretty consistently over at least the last 6 years that I personally get 8 really perfect scars, 4 scars that I’d grade as a C- or D+, and about 88 that are what I’d grade as a B or B+. Now mind you that I am trying to be, but am possibly not totally unbiased…but I do tell every prospective patient these figures, and that sometimes emailed in pictures might be better or worse in person… I’m doing the best assessment that I can.

I get lots of questions on what a trichophytic closure is, and have posted a bunch of threads on how it was invented to camouflage browlift scars, by letting hair behind the forehead cut grow through and in front of the scar so that its harder to detect. Only later on was it “discovered” by hair doctors and put to excellent use in helping to camouflage strip scars.

 

Here is an example of what I’d call a perfect trichophytic closure at the 2 month scar check. It’s a narrow line that still has reddish pigment (normal at 2 months) and clearly growing on both sides of the scar and right through the scar itself, is nice thick hair. Now there is no way to tell if it will be a perfect scar at 1 year…but on average a good scar at 2 months will likely be a pretty good or really good scar forever whereas a poor scar at 2 months will only improve if its poor due to shockloss(second case shown, showing scar with left sided shockloss at 2 months, and resolution of this at 6 months).

 

Lastly, while this is really a great scar…I don’t have any way of predicting who will be the recipient of those 8 poor scars we do each year. The best predictor is how an individual or family member has scarred previously, but still that is an educated guess at best. There is no way to guarantee a perfect scar. We do the best we can to get an excellent scar through preop stretching if needed, a limited strip width intraop, and a tension free 2 or 3 layer closure. Our sutures are removed at day 7 on average, and we suggest our patients use vitamin E for 2 months postop on the scar itself. Despite all that, we still get a few poor scars per year. Just another example of how people are individuals and bring their own physiology to the OR table. There are no guarantees in medicine, but preoperative discussion of these and other issues, along with research on forums such as this, allow patients to get as much information as possible PRIOR to making a treatment plan.

 

Dr. Lindsey McLean VA

[Dr. William Lindsey]

Typo...I typed 8 poor scars in the last paragraph...correction, its as stated earlier. 8 great scars per year, and 4 poor per year at our office.

 

Dr. Lindsey

[HeadH]

Very informative write up Dr Lindsey.

 

What width (inch or mm) would a B grade scar have?

[tacolinowest]

Yes , how many mm is considered a good average and below average scar

[agenteye]

Thanks for the great thread Dr. Lindsey!

[Blake Bloxham]

Nice presentation! Thank you for sharing.

[Dr. William Lindsey]

Scar grading can be a subjective as English essays....

 

FOR my own scars:

 

IF its really thin and has hair growing through it and its hard to find, its an A or A+, depending on how its concealed by that individual's surrounding hair.

 

IF its the width of the comb teeth that I'm using, its probably 1mm or so, and its a B for me.

 

IF its much wider...I'm disappointed. and its a worse grade.

 

Remember, this is how I grade myself, not meant as a grade of other people's work.

 

Dr. Lindsey McLean VA

[MAGNUMpi]

Lastly, while this is really a great scar…I don’t have any way of predicting who will be the recipient of those 8 (4) poor scars we do each year. The best predictor is how an individual or family member has scarred previously, but still that is an educated guess at best

.

Dr. Lindsy, Thank you for this open and honest thread about scars.

I wonder if a perspective patient should/could look at other scars on their body (e.g., other operations, old injuries etc.) to help predict the possible outcome of his/her HT scar?

[Dr. William Lindsey]

Absolutely, there is no better predictor of how you will scar in the future than how you scarred last time...

 

But suture technique, and location on the body play a big role. I posted a case a few years ago that showed a guy with a large keloid (a white man aged 40) on his neck from surgery elsewhere, and we were fortunate to have an almost imperceptible scalp scar. But the patient and I discussed the chance of getting a bad scar before proceeding.

 

All things you should discuss with your doctor before signing up.

 

Good question.

 

Dr. Lindsey McLean VA

[nathaniel]

Absolutely, there is no better predictor of how you will scar in the future than how you scarred last time...

 

Very good to know, Dr. Lindsey. I had the impression from another doctor that the scalp was less prone to scarring than other areas of the body, even if one is already prone to keloids elsewhere. It is good to hear someone caution against a scar resulting procedure in light of previous scars elsewhere on the body.

 

Thank you!

 

- Nathaniel