using tissue expander for FUT scar revision?

[norcalguy]

Hi,

 

I am a white male in my early 30's who has had FUE done several years ago and was very happy with the results, but for further improvement for my hairline and crown, and because it was cheaper and arguably more "effective" in terms of survival rate, I opted to have an FUT procedure done last year. Outside of my crown which is visibly thinning, I would say that I have no other visible signs of hair loss anymore, which is great. I have a thick donor area, and I think I will be able to get more transplants done as my crown continues to thin.

 

That said, I am very unhappy with my FUT scar. I actually heal quite well from surgeries (I've had a few others in the past few years and in all cases heal very, very well), but in this case there was too much tension on the left and right (the strip area is very wide). The doctor had to loosen the suture after a couple days, unfortunately. The scar is about 1.5cm wide on the right side and 1cm wide on the left. The middle is ok, but these areas on the side are noticeable. Every trip to get a haircut is an ordeal, as I have to give very special instructions about how to conceal the scar, and my hair doesn't look great long as it's quite wavy.

 

I have regret about choosing FUT over FUE, but there's no going back now, so I'm exploring options to revise my scar. From what I've read, folks recommend FUE into the scar most because of the risk of failure of scar excision, but I'd like to save my FUE grafts for future transplants, especially as my crown continues to thin (yes, I know the risks of chasing a thinning crown w/HT...thankfully progression has been slow).

 

One plastic surgeon (who I've done other work with and been very satisfied) suggested using a tissue expander to stretch the area around the scar and give that area more laxity so they can then go in and remove the scar and re-suture it with enough laxity that the resulting scar should be much thinner. I understand this means I'd have to wear a hat for a few months because the tissue expander would show a visible bump, but I'm willing to do almost anything for the best result.

 

Googling, I've had a hard time finding this method for hair transplant scar revision, and that surprised me given how effective it seems to be at increasing laxity.

 

My questions are:

(1) What are expert/professional opinions about the method of tissue expansion for HT scar reduction?

(2) What is your best recommendation on reducing a 1-1.5cm scar for a patient that typically heals very well? If FUE, should I go back to the same doctor for this reduction, given I was happy with doing FUE with him a few years ago?

 

Thanks,

Norcalguy

[rev333]

Hi,

 

I am a white male in my early 30's who has had FUE done several years ago and was very happy with the results, but for further improvement for my hairline and crown, and because it was cheaper and arguably more "effective" in terms of survival rate, I opted to have an FUT procedure done last year. Outside of my crown which is visibly thinning, I would say that I have no other visible signs of hair loss anymore, which is great. I have a thick donor area, and I think I will be able to get more transplants done as my crown continues to thin.

 

That said, I am very unhappy with my FUT scar. I actually heal quite well from surgeries (I've had a few others in the past few years and in all cases heal very, very well), but in this case there was too much tension on the left and right (the strip area is very wide). The doctor had to loosen the suture after a couple days, unfortunately. The scar is about 1.5cm wide on the right side and 1cm wide on the left. The middle is ok, but these areas on the side are noticeable. Every trip to get a haircut is an ordeal, as I have to give very special instructions about how to conceal the scar, and my hair doesn't look great long as it's quite wavy.

 

I have regret about choosing FUT over FUE, but there's no going back now, so I'm exploring options to revise my scar. From what I've read, folks recommend FUE into the scar most because of the risk of failure of scar excision, but I'd like to save my FUE grafts for future transplants, especially as my crown continues to thin (yes, I know the risks of chasing a thinning crown w/HT...thankfully progression has been slow).

 

One plastic surgeon (who I've done other work with and been very satisfied) suggested using a tissue expander to stretch the area around the scar and give that area more laxity so they can then go in and remove the scar and re-suture it with enough laxity that the resulting scar should be much thinner. I understand this means I'd have to wear a hat for a few months because the tissue expander would show a visible bump, but I'm willing to do almost anything for the best result.

 

Googling, I've had a hard time finding this method for hair transplant scar revision, and that surprised me given how effective it seems to be at increasing laxity.

 

My questions are:

(1) What are expert/professional opinions about the method of tissue expansion for HT scar reduction?

(2) What is your best recommendation on reducing a 1-1.5cm scar for a patient that typically heals very well? If FUE, should I go back to the same doctor for this reduction, given I was happy with doing FUE with him a few years ago?

 

Thanks,

Norcalguy

 

some guy had a tissue expander for a FUT scar revision on a show called BOTCHED! on E!

 

it didn't work

 

it did expand the skin and the re-sow was very easy according to the docs but the stretch shrunk back after the cut out of the scar and the re-sow and the patient wasn't happy

 

google it

might be on youtube

 

it was this season's show

[norcalguy]

Thanks - better to have 1 data point than 0 I guess.

 

If there are any HT doctors that have thoughts on the subject, I'd greatly appreciate your feedback.

[SFGiantsFan]

I'm about three weeks past a strip procedure. Due to tension issues, my HT surgeon had to leave my donor site very open, and also had to loosen a suture a couple of days after the surgery. I'm looking at a 1.5 cm scar on my left temple, and about a 1 cm scar at the back, and a half cm scar on the right. Not quite the 2mm scar I was shown during consultation.

 

I know it's early for me, as my scar has to mature, but I have been encouraged to see a plastic surgeon at some point. I'm worried about the lack of laxity at the time of a future scar revision surgery, so I'm also curious about the use of tissue expanders.

 

If you learn any more about this, I'm be grateful for any info. Also, I'm looking for a good plastic surgeon, so if you don't mind sharing his/her name, that would be great. I'm in California, too.

 

If I learn more, I'll share, too.

 

I hope everything turns out okay with you and eventually the donor scar is revised to your satisfaction.

[Ali Emre Karadeniz]

Here is my advice on approaching wide strip scars:

 

The first question to answer is, why is the scar wide? Bad surgical technique (transections along the incision, bad wound closure technique...), too wide strip excision or unlucky tissue character.

 

The second question is, is there any skin laxity left?

 

Now,

1. Bad surgical technique + skin laxity => Go for a scar excision and trichophytic closure.

2. Bad surgical technique + no skin laxity, or too wide strip excision with no laxity and unlucky tissue character probably doesn't benefit from a scar revision. All three situations could be improved by FUE on the scar and/or SMP. In the first two situations a tissue expander could be considered.

 

I have not used tissue expanders for the repair of an FUT scar however I have used it on severe burn patients who had scars on close to half of the scalp. It is a very effective method. On the other hand the whole process of putting an expander under the scalp, inflating it twice a week by saline injections, having to camouflage a lump on the head which looks strange to other people, having to adjust sleeping position, this going on for many months and then having another procedure to remove the expander is not easy for the patient.

[norcalguy]

@SFGiantsFan I understand - having to leave one of the sites open or loosening the sutures will very likely result in a wider scar like it did for me. That said, I did go back to my HT surgeon at the 1 year mark and got his opinion. The good news is that he was optimistic that if I do scalp laxity exercises for 3 months, that I can come back and if my laxity is good, he thinks I'd have good results with an excision to revise it. I've been doing the exercises 15-30 minutes a day (which is a pain! I have reminders in my phone 3x a day), but after 1 month there is a very strong noticeable difference in my laxity. I did some research on how effective the exercises are and there's clear data that they work. So that's what I'll continue with, and if in 1 more month my laxity improves again, we'll do the excision. I'm optimistic, as I didn't do the laxity exercises before the HT and I think that's why the tension was as bad as it was. I will let you know how it goes... don't give up hope!