hypertrophic scarred scalp from car accident

[michealscott]

Im new to these forums but I recently was in a car accident that required me to have brain surgery and plates were put in the back of my head. This happened about 8 months ago. I now have 2 scars: A scar in the back of my head approximately 2 inches in length and 1 inch in width and a scar where the incision was made from the front to the back of my head. The scar from the front to the back of my head is really thin about a few millimeters in width and maybe a little less then 1 foot in length? Not sure just guessing. The scar from the front to the back of my head doesnt seem hypertropic b/c the scar didnt rise at all once it healed. The scar in the back of my head rose maybe a few millimeter and went down over time now it is almost entirely smooth.

 

Anyways to my point, I wanted to know whether I would be able to get a hair tranplant in these two areas. I have read up alot in the hair loss forums but there are very few threads about my situation. In the back of my head there could be a plate underneath where it is scarred. Will I be able to transplant hair in these two scars? I might need a scar reduction and possibly FUE procedure since I have a history of hypertrophic scarring? I have read somewhere I may possibly not be able to have a hair transplant or may have to have a scalp lift (which I am definetly not doing). Thanks for reading any response would be appreciated =]. O yes I forgot I am a 22 year old male.

[michealscott]

I think i found the anwser to my own question. I possibly have scarring alopecia, I am going to check with a dermatoligist to find out asap.

[Bill - Seemiller]

michaelscott,

 

I think consulting with a dermatologist is a good idea. If you want specific input from us, consider posting some photos of the scarring. Ultimately, consulting with a few leading hair restoration surgeons will give you a better idea as to whether or not you're a candidate for hair transplant surgery.

 

Good luck my friend.

 

Bill

[michealscott]

Is postoperative (pressure) alopecia a candidate for hair transplant surgery? I think thats the type of alopecia that I have. Tried looking online but couldnt find any kind of treatment for postoperative (pressure) alopecia since it is a rare type of alopecia.

[imissthebarber]

Michael - sorry to hear of your situation. I hope that you are otherwise fully recovered from your accident. Bear in mind that because you are so young any HT you opt to take must be done with the possibility of more common male pattern baldness effecting you as you get older.

 

For example many people decide not to address the crown even if they get a HT to the front. However if your scars are in the crown (even partly) and you densely fill them now then if your crown thins out later it will look unnatural.

 

All the best with whatever you decide.

[michealscott]

Here are some photos of my scar.

Top of my head where the incision was made for brain surgury:

Side view of top of head:

Back of head where I think the plates were put in:

Close up of Back of head:

 

 

In the back of my head you can not see but I have few hairs growing maybe about 4-10. These scars were from my car accident about7-8 months ago.

 

The scars seem to be hypertropic scars. The swelling of the scars went down alot now they are almost completely smooth.

 

Does anyone know if in these two areas they may be able to implant hair? I have read up a little on hypertrophic scars and they said excision of the scalp is what they usually do for hypertrophic scars. The surgery looks pretty scary and it seems like my facial features may get messed up by doing that surgery. I really would like to avoid this surgery.

 

If I am able to implant hair in this area how many graphs do you think I need? (big guesstimates are fine)

 

imissthebarber: Thxs for the response, your name cracked me up btw =p. anyways yes I have fully recovered from the accident =] I am actually really happy how well I recovered they diagnosed me with paralyzed vocal cords and told me I may not be able to speak correctly for the rest of my life. About 2 months later a serious miracle my voice came back. And it was not gradual it came back within like a day or 2.

 

And yes I have had some thought about transplanting hair around my crown area. Im wondering how unatural does it look when I start to bald and I have had a previous hair transplant. If theres a thread that shows someone having a previous hairtransplant and then going bald a link to the thread or website would be appreciated. It will definetly help me make my decision on whether or not I would like to densly pack the back of my head or not.

 

O and thank goodness I found this forum I was considering Dr. a|r@mani (i messed up the name a bit b/c i know he has a lawsuit against this forum)to transplant my hair. He is reaaly expensive and from what I have seen and heard he doesnt seem that consistent with his work.

 

Any staff or hair transplant doctor with any advice about my situation would be greatly appreciated. Thxs for the responses

 

o btw I use to cut my hair really short like 1/8 inch on the side and 7/8 inches on the top but since the accident I have grown my hair out alot so I could cover my scars up. (I really hate long hair =/ ) I hope with hair transplantation I can start cutting it short again.

[imissthebarber]

First off I'm glad to hear that you're otherwise fully recovered.

 

If you go for a strip surgery then the shortest you can hope for is 3/8 and in many cases it is much more than that. If you want to go ahead with transplants then FUE might be better BUT:

 

IMO I think you should look into scar excision a bit more. The width of the scar on the top is much narrower than the strip that a surgeon would take out via the traditional strip method.

 

If you have a transplant you asked Will it look weird? Think of an old guy totally bald except with hair in the places where you currently have the 2 scars. I would think it would look very weird. If that did happen you could laser the hairs to kill them off but that seems like a waste.

 

As I said I think you should look into excision a bit more. Also once the scars are fully healed using scalp exercises could increase your laxity which would help with the excision process.

[rpachigo]

I would look into serial excisions of the scars.

[Dr. William Lindsey]

I did not read the entire post word for word. But it doesn't look like a hypertrophic scar as much as a scar that just widened out.

 

I would excise the scar if it is as I suspect, and it doesn't look so big. I think you could likely get it all in one setting.

 

Dr. Lindsey McLean VA

[Cam Simmons MD ABHRS]

michaelscott

 

First, I am glad that you have had a full recovery from your accident.

 

A personal consultation with a recommended physician would definitely be worthwhile.

 

As Dr. Lindsey said, these may not be hypertrophic scars but could just be wide surgical scars.

 

If you can style your hair to hide the scars now you may be better off to leave them alone until they can't be hidden any more. Living with medium length hair may not be the worst option.

 

You are 22 and may or may not develop genetic hair loss (Androgenetic Alopecia) later. 50% of men have AGA by age 50. Any plan for transplantation into your scars would have to take into account possible future loss from AGA. A recommended physician can examine your scars and can check for early signs of AGA at the same time. If there is AGA, medical treatment could be started early to prevent a lot of loss.

 

The plate itself would likely not be an issue for transplantation but the skin may be tighter as a result of your previous surgery.

 

One concern about scar revision of your sagittal (front-to-back) scar is that the hair direction could be altered by the revision so that the hair could part along the scar and be directed away from the scar on each side. This is called a slot deformity and more surgery (like a triple-flap procedure) could be required later to fix the altered hair direction. If you later developed AGA and had hair loss in your crown, these scars could become visible.

 

Long-term planning is critical for any 22 year-old and is even more critical for you. To get really good advice you need to see a recommended physician in person.

 

I hope that this helps.

[michealscott]

Thank you Dr. Lindsey and Dr. Cam Simmons for your reply. I have been giving scar excision alot of thought and had a few questions about it. Will scar excision alter my facial features? I am wondering if I had the excision if my face would permantely look like I had a face lift or have a suprised look on my face after the surgery. And what is the success rate of scar revision? Are there any consequences of scar revision that I should be aware of?

 

 

My second question is if I would be able to FUE into the scar instead of scar revision. I have heard FUE into scars produces low yield of hair growth but I was thinking of first having a trial session to see if the yield of hair growth was good and then trying a FUE session for the entire scar. This is the options I am leaning toward more since I do not know the possible consequences of scar revision.

 

If the trial session does not produce a good yield I will look into scar revision more. Sorry for the late reply been focusing on my schooling. And thank you for the replies they have been very helpful. =]

 

O and thank you for your response imissthebarber, yes I do need to look into scar excision more thoroughly as of right now I have not been getting much information about the possibly side effects of scar excision so that is why I am a bit hesitant to have the surgery. I want to know the possible consquences of the surgery first. and yes I do agree that it would look very strange if I had a hair transplant now and then go bald when I turn 50 and still have hair growing into the 2 scars. But I would definetely not mind lasering those hairs out, to me I dont think it would be a waste; they grew for 30 years that would be well worth it for me to still have the procedure done today. Thanks again for all the comments.

[Severn]

Originally posted by michealscott:

I am wondering if I had the excision if my face would permantely look like I had a face lift or have a suprised look on my face after the surgery.

 

 

 

 

I had 3 scalp reductions about 14 years ago(over a period of a year or so) They were in almost the exact same location and length as your scar. I also had a lot more scalp removed than what you would be doing. The scalp is very elastic and you do not end up with a distortion of the face. You get that on a facelift but that is pulling the skin up vertically from the forhead insead of from the sides on top.

 

The only thing my scalp reductions did were pull in the temporal corners a little bit. It made me look like my temple recession was a little bit worse than it really was but that only lasted about a month before it went back to normal.

[Cam Simmons MD ABHRS]

Hi michaelscott

 

There are pros and cons to

1)hair transplantation into the scars

2)scar revision

and 3)opting to do nothing right now.

 

I have already said that I would lean toward waiting if you can currently hide the scars fairly well with hair-styling. If it becomes more difficult to hide the scars later that could be the time to act.

 

If you are leaning toward FUE and transplantation into your scar it is quite sensible to try a small area first. You should not only judge how well the hair grows but whether there is enough hair to hide the wide and raised scar underneath. Unfortunately, I have seen other patients who had FUE into scars and successfully grew hair but not enough to hide the scars or to be able to change their hairstyle. They still had noticeable scars but had some hair growing in them.

 

At the 2008 ISHRS conference, Dr. Martinick mentioned what could be a good idea for transplanting into scars. That is, instead of creating slits, she actually may remove a small circle of full-depth scar tissue that is smaller than the graft that will be transplanted. Going full depth may make it easier for neo-vascularization (i.e development of circulation) of the graft. This would also remove some of the scar tissue while transplanting. I don't think there have been any studies comparing this technique against other techniques for transplanting into scars and I haven't had the opportunity to try it myself but it may warrant consideration.

 

Good luck with your decision.

[Dr. Glenn Charles]

I agree with Dr. Lindsy and Dr. Simmons that from the photos and what you describing these do not appear to be hypertrophic scars. I do think that FUE could be a viable option for you. There is more variability when transplanting into a scar, but I have had some success in patients with similar scars. I strongly recommend using PRP with what ever option you choose. Especially if you go with a scar revision. When removing the old scar tissue and attempting to reclose the wound under minimal tension the PRP may allow the new collegen fibers to align properly leading to a smaller scar.