Scar Stretching

[HairNightmare]

First of all, i regret getting FUT. The main reason why i got FUT was because i didn't have enough money and i do not want to finance. Now that i think about it, i wish i had waited few months to save up for FUE. Anyways, i got my procedure done about two and half months ago and i am really stressing about the outcome of the scar more than the result of my hairline which was the primary reason of going into surgery. I will attach some pictures to this post so you guys can let me know if my scar is healing right and if it is stretching or not. Does anyone know what i need to avoid so it doesn't stretch and what i need to do to make it better? Any input will be very appreciated.

[hairthere]

HN, Sorry to say it does look like your scar has stretched. It also looks like you've experienced some shockloss, but that's normal and should grow back. There's not much you can do about it at this point unfortunately but wait for it to heal. Then you have a few options:

 

1) Scar revision. This is a gamble because you could go through another surgery and end up with the same result.

2) FUE. Less risky, but there's no guarantee the grafts will grow in scar tissue.

3) SMP. Also less risky, but there's no guarantee the pigment will take and your scar must be flat (not keloid, raised, or concave).

4) Do nothing and try to disguise the scar by growing existing hair longer, or using concealer.

 

I would also consult with your surgeon, assuming you went with a quality doctor/clinic, and get their opinion.

 

Sorry to see you going through this. Please keep us updated.

[HairNightmare]

Hi HT, thanks for responding. It's quite unfortunate to hear that my scar has stretched. I wish I knew as much I do now before considering FUT. I was more concerned about my hairline than the scar, reverse is the case now. My hair looks better when it is low cut but I guess I'll never have that option which is quite unfortunate. Thanks for highlighting all my options, I appreciate you taking the time out to do that. When do you think will be the best time to start considering those scar revision options? Which of the options has more success rate and do you have any doctor that you can recommend? Also is it possible for the scar to spread further than that? I started working out last week, I'm hoping that's not the reason for the stretch. Thanks again for your input!

[Mickey85]

Sadly, that does look like a stretched scar... If your doctor was not adept at donor closure, then you might get a good result by getting it revised by a top notch surgeon like Ron Shapiro or Hasson and Wong who are excellent at donor closures. However if you did go to a good surgeon chances are it was your physiology that form the poor scar. FUE grafting into the scar may work to disguise it and reduce the visibility, it could even improve the general color of the scar as the blood flow reestablishes itself. Unfortunately it seems like it is a keloid scar when the scar has inflated... FUE and SMP will not reduce that...

[hairthere]

I'm not too sure how soon you can actually do a revision, but it wouldn't hurt to start consulting docs now. Was the doctor who did your surgery one recommended on this forum?

 

As far as success rates, I don't have any hard evidence of which would be most effective, and it will vary from person to person. It's also tough to say if the stretch was from doctor error, working out too soon (stress on the neck usually causes this), or your physiology. I've had two separate strip scars made, by two docs (one lousy, one top) and both stretched. For me it's a non-issue because I wear my hair long enough to cover them up. However, if I wanted to do something about it I would probably try FUE first and perhaps supplement with SMP. But I have a pretty good idea that it is physiology in my case.

 

As far as the scar stretching further, we have seen cases of much wider scars, so I suppose it is possible.

 

Don't be too hard on yourself regarding not doing enough research. I made the same mistake. I'm not anti-strip, nor anti-FUE. I think both surgery types have their place. That being said, I also think the strip patient has the right to know that the scar could potentially stretch. Of course that wouldn't be good for business, so most docs likely won't tell you that. Hence the importance of these types of forums.

 

Best of luck in whatever course you take, and again please keep us in the loop.

[HairNightmare]

Thanks guys for taking out time to explain all these to me, i wish I had done this before going under the knife. Yes, the surgeon that did my HT was one of the doctors recommended on this website. I wish the doctor would have told me about the possibility of the scar being noticeable, stretching, keloids etc. He said I should be fine since I was only repairing my hairline with 800 grafts but I ended up getting 1300 (I am a Norwood 2 by the way). Any other suggestion or advice will be highly appreciated. Thanks guys!

[Mickey85]

I see your doctor was Dr Diep.... I've really had enough of him... This is a guy who excised a strip in 4 minutes flat with no care for scalp tension or transecting grafts with the scalpel. This is a doctor who was advertising FUE as a 'no scar' procedure on his Youtube videos(until I was vocal about it). This is a guy who extracts grafts well outside the safe zone when performing FUE. This is a guy who extracted grafts OUT OF THE CROWN of a Norwood 4! I don't believe Diep is ethical by saying the patient 'should be fine' simply because the target was only 1,300 grafts. I don't believe Diep is performing state of the art and refined work, by it strip or FUE. Not to the levels this forum predicates and prides itself on. I'm calling for Dr Diep's recommendation on here to be questioned seriously and his removal considered because this is not the first time his work has been concerning.

 

To HairNightmare,

 

Fear not. You can have FUE grafting done into the scar by a surgeon who is adept at getting good yields via FUE like Lorenzo, Erdogan or Hakan. This will go a great way into reducing the visibility. I PERSONALLY would not have Diep do this, even at no charge. My opinion.

 

On the flip side, you could go to a great strip surgeon like Ron or Paul Shapiro or Hasson and Wong and they could perform a scar revision. I personally think those doctors are leaps and bounds ahead of Diep in donor closures so I think there is a possibility your scar would be improved by going with them. Hasson and Wong are probably the best at donor closures in the world in my honest opinion. If the scar revision goes well, it will reduce alot of the keloid scarring but you still my get keloid formation, although it would be thinner.

 

Either option is not guaranteed to work, but they are avenues for consideration.

 

I'm really, really sorry for your outcome. It angers me to no extent that people like Diep continue to be able to perform on patients when their skill and ethics are questionable at best and downright poor at the worst.

Edited October 30, 2013 by Mickey85

[hairthere]

As Mickey noted, you should talk to some other top docs about revision. Even though it's a risk it could stretch again, I don't think it will get much wider. If the revision does not work, you could try FUE or SMP.

[HairNightmare]

Thank you guys so much for your inputs and advises. It honestly means a lot to me despite the damage has been done. You guys taking time out of your lives to address my issue/concern and caring about my results means so much to me. I will start exploring the options you guys listed and keep you posted on my journey. Thanks again!

[MAGNUMpi]

HairNightmare, So sorry to see you in pain over this. Hope you get it fixed. Keep posting as you move forward, you can get some good advice here.

I personally think its crazy to see a NW2 who only got 1300 grafts with a stretched scar like that. It just seems wrong to the core.

 

I also think the strip patient has the right to know that the scar could potentially stretch. Of course that wouldn't be good for business, so most docs likely won't tell you that. Hence the importance of these types of forums.

Yes! Ive consulted with 5 top doctors so far and they all said I would get a "pencil thin scar" and not to worry about it. Bah!

 

Good luck HairNightmare. Hope it all works out. Hairthere and Mickey85 gave some great places to start your repair. all the best. M.

[greatjob]

I'm not sure that your scar stretched, it looks more like keloiding to me. If Dr. Diep did not discuss this as a possibility with you it is inexcusable IMO. Keloid formation is very common in African American patients, if he didn't ask you about your previous scars or inform you of this issue I would not be happy.

 

With all that said it is still early, so there isn't much that you can do at this point except hope it improves and start researching ways to remedy the problem if it doesn't. Along with some of the other doctors suggested by the other posters, if you're located in southern California you might want to go see Dr. Umar to see what he thinks, he is one of the best repair surgeons in the world. Also in the mean time you might want to check out dermmatch, it's a concealer that might help you camouflage the scar a little.

[Blake Bloxham]

HairNightmare,

 

First, I want to state that I'm sorry you're concerned with the scar. While I think you are still very early in the healing process, I understand that these issues can be scary. If there is anything I can do to help, please let me know!

 

Second, because there are a lot of issues at play here, I want to let you know that I took the liberty of contacting Dr. Diep and informing him of this thread. I think this will give him the opportunity to review the situation, leave a reply, and hopefully offer some helpful assistance.

 

Hope this helps! Please feel free to reply here or send me a private message with any concerns.

[MAGNUMpi]

First, I want to state that I'm sorry you're concerned with the scar. While I think you are still very early in the healing process, I understand that these issues can be scary. If there is anything I can do to help, please let me know!

 

Second, because there are a lot of issues at play here, I want to let you know that I took the liberty of contacting Dr. Diep and informing him of this thread. I think this will give him the opportunity to review the situation, leave a reply, and hopefully offer some helpful assistance.

 

Hope this helps! Please feel free to reply here or send me a private message with any concerns.

Wow that's amazing. This forum has some really good people who do care.

[Garageland]

Greatjob is right it looks like Keloid to me and is common in patients of African descent. It may well happen again and perhaps a revision would not be the best idea here.

 

I wish you all the best.

[Number47]

I think that you should seek medical attention if it is keloid and not wait anymore. If I was you I wouldn't seek hair transplant doctors at this point but I would go to a doctor probably a good dermatologist and seek possible treatments.

 

It's a dam shame that this happened for such a small amount of grafts on a nw2 but that's a conversation for the forums you should be visiting a dermatologist ASAP to put your mind at ease faster and see what you should do.

 

Here is something I found that might be a good read till you get evaluated by a good doctor.

 

Scars are composed of new connective tissue that has replaced loss substance of the skin secondary to injury or disease. This is part of the normal healing process. The size and shape of a scar is determined by the form of the previous wound. Scars can be thick or thin and may become wider by stretching, especially if they close under tension or if they cross a joint portion of the body, such as an elbow or knee. Often these widened and thickened scars are known as hypertrophic scars. These hypertrophic scars do not extend beyond the original wound as a keloid does.

 

Frequently, there is spontaneous improvement of a hypertrophic scar during the first six months, while a keloid does not improve. The most prominent distinction is the claw-like projections of new growth beyond the wound of a keloid, which is not found in a hypertrophic scar.

 

A keloid is a firm, irregularly shaped, raised, thickened, fibrous hypertrophic scar that extends beyond the original scar and often sends out claw-like prolongations of new growth. The overlying skin of a keloid is smooth, glossy and thinned because of the underlying pressure. During the early stages of growth, a keloid is red, tender and itchy. It feels like rubber and over time turns brown. Keloids are most commonly found on the chest, neck, ears, and extremities of the body. They are rarely found on the face, hands, feet or scalp.

 

Why certain persons develop keloids is unknown; however, some races seem to have a predisposition to such scarring, such as Afro-Americans and those of Mediterranean origin.

 

In most cases, multiple injections of corticosteroids directly into the keloid itself approximately every six to eight weeks will flatten the keloid and decrease the itching.

 

Various types of laser treatments have been used with varying degrees of success.

 

X-ray irradiation has also been used with limited success in permanently removing the keloid. Surgical removal of the keloid followed by injections every two weeks can help to reduce the size of the keloid, but they often grow back.

 

Other types of scars can often be revised or reduced with minor surgery without any complications. Because of the small nature of the scar that results from surgical hair restoration, they are rarely even noticed. In addition the hair at the back of the head completely shields the scar from view.

 

If anyone thinks they might have unusual scar tissue I suggest you consult a medical professional for an examination.

[Bill - Seemiller]

HairNightmare,

 

Thanks for sharing your experience, concerns and photos of your scar on this forum. I happen to agree that there may be some keloid formation, which is more common in African Americans. It's also possible that there is some scar stretching occurring and/or shock loss.

 

While these types of issues are highly unfortunate, the reality is, a physician can use state of the art techniques, do everything right and problems can still occur. Having personally met and interviewed Dr. Diep along with seeing dozens of examples of his work, I feel confident that he is utlizing all the advanced techniques in hair restoration to produce only the best results. However, there's no doubt that your scarring is a concern and should be addressed.

 

At this point, I strongly recommend contacting Dr. Diep private and seek his immediate guidance on how to treat any potential keloid formation. While I do suggest immediate medical attention to avoid any permanent issues, I would suggest waiting on any scar revision procedures, which includes FUE, SMP or excision.

 

As Blake already noted, we have contacted Dr. Diep and we trust that he will be reviewing this topic and leaving a reply. Again, I strongly suggest calling him on the phone to discuss your concerns. In my opinion, Dr. Diep cares about his patients and will do everything he can to help resolve your concerns.

 

Best wishes,

 

Bill

[Bill - Seemiller]

Guys,

 

I spoke with Dr. Diep on the phone a few minutes ago and he intends on posting a public reply on this topic. He stated that that while he took all the steps necessary to produce minimal scarring, he is concerned about the progress of your scar and will do all that he can to make things right for this patient.

 

I know some members get tired of hearing how genetic factors and other unknown variables can create problems and less than desireable outcomes. Some also feel that these are too often used as excuses by surgeons who don't want to take responsibility for their failures. While this may be true for some doctors, the physicians recommended by this community have been prescreened and have demonstrated their state of the art technique and ability to produce excellent results. In my opinion, Dr. Diep has proven himself as a quality recommended physician and I see no reason to point fingers accusing him of producing poor outcomes.

 

Ultimately, no physicians bats a thousand. What separates the best from the rest is those who stand behind their patients in the rare instance problems like this occur.

 

Dr. Diep will be posting a reply on this topic. However, in order for a resolution to occur, I strongly encourage Dr. Diep and HairNightMare to speak on the phone to discuss how these concerns can and will be resolved. I also encourage both HairNightMare and Dr. Diep to keep us posted by presenting a reply on this topic.

 

Best wishes,

 

Bill

[Number47]

Guys,

 

 

 

I know some members get tired of hearing how genetic factors and other unknown variables can create problems and less than desireable outcomes. Some also feel that these are too often used as excuses by surgeons who don't want to take responsibility for their failures. While this may be true for some doctors, the physicians recommended by this community have been prescreened and have demonstrated their state of the art technique and ability to produce excellent results. In my opinion, Dr. Diep has proven himself as a quality recommended physician and I see no reason to point fingers accusing him of producing poor outcomes.

 

Ultimately, no physicians bats a thousand. What separates the best from the rest is those who stand behind their patients in the rare instance problems like this occur.

 

 

Best wishes,

 

Bill

 

Personally I am not tired of hearing about genetic factors, unknown variables and no one bats a thousand all these are true and prospective patients should know them so that they don't take these procedures lightly and go in as nw2's having strips just to fix their hairlines.

 

What I am tired of is doctors still doing it knowing all these factors all too well and the higher risk ethnic groups and not sending them home until they really need a transplant to justify the risk a bit better. That's what I think separates the best from the rest not just standing behind their patients, even the hacks offer you a procedure to fix the old one if thing go wrong. I am sorry bill, I know situations like this are sad for you too but some things need to be pointed out and sometimes judgement should be harsher on doctors to avoid seeing more cases of low norwoods ending up with a bigger problem than their minimal hair loss could ever be.

Edited November 1, 2013 by Number47

[Dr. John Diep]

First of all, I wanted to send my sympathy to my patient. I am concern about his scar and will do my best to fix it. My office has contacted the patient and is waiting for his response. This is a very rare case of bad scar. We all feel bad for the patient and hope things will turn out better for him.

This type of donor scar is not typical of my work. And one bad case does not represent my quality of work. Most of my hair transplant surgeries result in fine thin donor scar. I have attached photos of donor scar, 1 year post-op for you to review.

The fact is, Strip or FUT hair transplant surgery will leave a linear scar and the scar can stretch over a period of time. All hair transplant surgeons at one time or another will experience this type of situation. I don’t know of any hair transplant clinics that don’t run into type of problem. For this patient, it looks like, it could be due to genetic factor and exercise as he had stated in his writing.

For those of you who don’t know who I am, I would like to take this opportunity to introduce myself. I am a very caring and passionate person when it comes to practicing medicine. I care for my patient’s well being, and that is the most important factor. I would never practice medicine that would endanger my patient or their safety. In this patient’s case, I have taken every precaution there was, and used all available state of the art technology to ensure that the scar remains thin post-surgery. After all, who would want their patient to have a big scar? For 1,300 hair grafts harvesting, there was no tension during closure using Trichophytic closure technique. The cut was small so closure was not a problem. And any experience doctor would know this. I never rush through my surgery. I always take time to work on the patient. For those of you who have never been in my surgery room and don’t know how I operate, I invite you to come to my clinic one day to observe my work. From there you can make a judgment of me.

As stated by the patient, he started exercise last week and was wondering if the stretch is due to exercise. Early exercise and weight lifting can cause the scar to stretch bigger. That could be one factor. The other factor is genetic. If a person has the genes to produce large scar, he or she will have wide scar post-surgery regardless if the best surgeon or techniques were used.

I always recommend FUE for patients with mild to moderate hair loss and Strip harvesting for clients with advanced hair loss such as Norwood 5-7. For this client, from the beginning, I had recommended and highly encouraged him to go with the FUE procedure. Since he could not afford FUE procedure, he elected to go with the Strip procedure, despite knowing the risk of having permanentlinear scar. As with all my clients, during consultation, I always state the risks and benefits of having Strip vs. FUE procedure. From there, the clients make their decision own decision.

It is very unfortunate that my patient encounters this rare side effect of hair transplant. I feel for him and will help him with his concerns. I thank you for your positive thoughts and encouragements towards my patient and about this case. Thank you.

[Dr. John Diep]

In addition to my previous email, I just realized that I did not explain the meaning of genetic factor. Caucasian tends to produce small scar, while African American tends to produce larger scar. On some rare occasion, some client has the gene to produce hypertrophic scar or Keloid. As part of my practice, I do not perform surgery on any client with history of Keloid.

[fuepower]

Wow that doesn't look very ideal at all.

 

Realistically, what kind of path forward does Hairnightmare have? From the photographs, it appears he might have some keloid formation occurring in the donor area. In brutal honesty, he's probably going to need keloid treatment and a successful HT. Forget the monetary currency, think about the time/emotional investment!

 

Hairnightmare, you should revisit your pre-operative forms to check for any warnings pertaining to keloid scarring. If there weren't any keloid warnings in writing, requesting for a 100% refund is a perfectly valid course of action.

 

As Mickey85 pointed out, some of Diep's videos do have some troubling ethical issues (no scar fue claims, 5 minute strip extraction, extracting from NW4 crowns). The doctor's message may seem genuine, but IMO, the evidential cards are stacked against him.

 

Regardless, I wish you the best in resolving this issue.

fuepower