Recipient area scarring after HT by Coalition Surgeon

[eyebrowqueen]

I am 4 months post-op eyebrow transplant by one of the top surgeons in Canada who is also a coalition member and recommended by this site. There were two different technicians who placed the grafts - one on each eyebrow. My left eyebrows is fine, but my right eyebrow has visible scarring. There are holes in my skin that are much bigger than the size of the needle that was used. They look like the type of scars you get from acne. I contacted the doctor about my concerns and his response was "There is always a minute level of scarring anytime you make an incision in the skin.Typically the scarring is invisible to the naked eye but it does exist; this is how the skin heals." This is contrary to what I was told prior to the procedure as I was told that this procedure would leave no marks on the skin. I went to see a local surgeon who told me that the holes I have is called "pitting". He told me that this is not caused by the incisions but by the placement of the grafts. He told me this happens when the grafts are placed too deeply. This makes sense since there were two technicians who placed the grafts and I only have these holes on one side. I am getting conflicting information and I would really appreciate other opinions as to what would cause this scarring. Could it be due to inexperienced technicians? I asked the surgeon how much experience the technicians have who placed my grafts and he did not respond to the question. It is hard to get a close up picture of the scarring, but I have attached a picture. You can see the holed above and below my eyebrow where it is not camoflauged by hair.

[Sean]

4 months, you may need a little more time to heal. However, i can see what you mean a little bit based on the current photo posted. Not sure of what could exactly be the cause, however, it would be relaxing if you didnt have to go through this. Regardless, what are your options right now? All you can pretty much do is wait. I would follow up with the doc again. Who extracted grafts and made the incisions for the eyebrow, doc or tech? Were the techs young or old? Good luck.

[eyebrowqueen]

Hi Sean,

 

Thank you for your reply. The doctor removed the strip and made the incisions. The technicians placed the grafts. One technician seemed to be less experienced that the other as she took an extra 40 min to place my grafts after the other technician had finished. This is the eyebrow that has the scarring. I have followed up with the doctor multiple times. At one month post-op, I was told that the holes were just delayed healing and would go away. At 3 months this was the first time I was given the response that there will always be scarring whenever an incision is made. I just followed up again (at 4 months) and expressed concerns about the difference between the two eyebrows. My left eyebrow has tiny pinprick marks which would constitute "minute scarring", however, the holes on my right eyebrow are much bigger and deeper. The doctor just gave me the same response as before and won't give me any reasons as to why the big difference. He is also saying that I was told before the procedure that I would have scarring on the recipient site, which is simply not true. Were you told before your procedure that you would have scarring on your recipient site? I feel like he is avoiding me and not taking my concerns seriously. I don't know what I can do?

[Sean]

Out of curiousity, How big was the strip? Do you know the number of grafts placed in either eyebrow? I can understand there may be some minute scarring during the healing process but it would be expected not to be visible or distinct to folks in person as you reach your healing timeframe. Why does one brow heal differently then the other one is a good question. If same number of grafts were placed in each eyebrow, i am not sure why one side took longer.

 

I had visible scarring in scalp recipient site that seemed to have healed a little bit. I tend not to look in that area in the mirror right now as i am hoping fir the best. Again, my post op photos showed considerable surgical trauma to my recipient site. Again, i had two procedures in similar recipient zone. I do not know if there is a varying heal time for eyebrows though. Not sure if the depth of incision on scalp is different from incision depth on eyebrows. If you clarified this with doc, I hope this resolves as you heal. was consent forms questioned and clarified? Question is, if you do your eyebrows later, change its shape, do you think the pitting would be distinct enough to cause limitations?

 

There may be some other eyebrow cases on forums and results within certain timeframes, those may help you gauge how it may or should look as the end result.

 

Ask whoever your doc was for a comparable healing timeframe from other brow results, and, for your options if by that timeframe things are still an issue. Hopefully, this is just part of initial healing and hope things are different in another month or two. Do you have a pic of the other eyebrow for comparison?

 

Keep and take high resolution photos Often for your records and send to the doctor month to month. If you use cellphone to take photos using the front camera, it may pixelate the photo making it hard to distinguish areas of concern. So, use a sharp focusing camera. The crisp the photo, the better it is to keep track and monitor and express your concern. If a doc doesnt answer frequently, then ask other surgeons who also do eyebrow surgeries for feedback too.

 

Regarding any visible cosmetic surgery, i think Scarring is less of a concern when it is not distinct or visible to the naked eye/to others around you. From your photo, it is a little blurry to see in better detail. Wish you the best and hopefully this is Just healing process.

[eyebrowqueen]

Hi Sean,

 

I actually had the same doctor as you. They took two small strips from behind each ear where my hair is the finest. I'm not sure the size of each strip, but the pos-op sheet I was given says that the size of my strip was 4.8 cm. They placed a total of 760 grafts. I know that very small needles were used to make my incisions - I think it was 0.8 mm and only single hair grafts were used. From what I was told, the healing time should be the same for the eyebrows as for the scalp, as should the growth rate. What is concerning to me is that there is no hair growing in the areas where I have the pitting so that makes it that much more visible. At this point, I don't think I will be able to shape them at all unless my recipient area heals considerably. The problem with this is that the shape is not symmetrical. One comes in farther than the other and one is a little lower. They were also done thicker than what had been drawn on prior to the procedure. I was shocked at how thick they were after the surgery and when I expressed this to the doctor, he told me that the marker smudged a bit so it made the line less defined. These concerns have become a moot point however because his response was that I signed off on the shape prior to the surgery. My other concern is that one of my eyebrows has considerably less growth than the other one. They have told me that this is normal but I am still worried as it seems strange that one would grow and not the other. I'm trying to figure out how to post another picture but when I click on the "insert image" icon it asks me to enter the URL of my image which I don't understand. I looked at your website and I saw that you did not have good growth from your first transplant. How did the second one go?

[eyebrowqueen]

Here is a photo of my left eyebrow. You can see the growth is considerably less.

[Rawkerboi]

Do you have blog on Rahal website?

There is a user named eyebrowqueen.

[MAGNUMpi]

It seems that one of the techs was better qualified than the other. I see this as a major flaw in the industry. I hope the pitting will eventually heal (not sure that it does). I don't like that your Dr. sounds like he is just sort of shrugging it off. He should step up and try to fix the situation. If he has a tech that is doing shabby work and potentially scarring people, that tech should be fired and the Dr. should be giving you free repair. His patients should not end up having scars on their face. Just my opinion, but it doesn't sound too unreasonable. Maybe things will even out in the next few months and the Dr. might be waiting a bit to be sure. Keep taking pictures and talking to them. And keep us posted. Good luck.

[eyebrowqueen]

Do you have blog on Rahal website?

There is a user named eyebrowqueen.

 

Hi Rawkerboi,

 

No I don't have a blog on the Rahal website. That is a different patient. I actually choose my username on here while I was still reseraching the procedure (before seeing her blog) so it is just a coincidence that we chose the same name

[eyebrowqueen]

Maybe things will even out in the next few months and the Dr. might be waiting a bit to be sure. Keep taking pictures and talking to them. And keep us posted. Good luck.

 

Hi MAGNUMpi,

 

Thank you for your post. My doctor said that I need to wait until 6 months post op to reevaluate. He has offered to fly me to Ottawa to follow up with him in person which I appreciate. He said that my skin changes will calm down in the next few months. Hopefully this is the case and I am just overreacting. There is not a lot of information about eyebrow transplants so I am somewhat in the dark about what is and is not normal. I am really self conscious about the condition of my skin right now and it is causing a lot of anxiety for me. I was told that this procedure leaves no visible marks on the skin so I was really not prepared for this. Sean told me that he had visible scarring on his recipient area that has healed a bit so I am hoping for the same. I think the fact that it's on my face makes it worse because I see it every time I look in the mirror. I will keep you posted on my progress.

[MAGNUMpi]

My doctor said that I need to wait until 6 months post op to reevaluate. He has offered to fly me to Ottawa to follow up with him in person which I appreciate. He said that my skin changes will calm down in the next few months.

That is great news. Yes, it normally does take 6+ months to really begin to see the final results. It sounds like your doctor is doing the right thing waiting a few more months. Hang in there. It's a waiting game. Try not to focus so much on them for now if possible. Lets hope for the best.

[Rawkerboi]

Well that is a nice gesture by Dr.Rahal, that he offered you to fly to Ottawa for a follow up!

I completely agree with your Doc, to wait and give your result at least a year time, before jumping into any sort of conclusion. May be your skin is taking lil bit longer time to heal.

Be calm and remember Patience is the key!

All the best and please keep us updated.

[MusoInOz]

Very interested to see how this all turns out for you!

 

Best of luck

[eyebrowqueen]

Hello,

 

I wanted to give everyone an update. I am now 4.5 months post eyebrow transplant. The scarring on my eyebrows has not seemed to improve. In addition to the pitting, I have two red, raised scars on the tail ends of my both my eyebrows. I tried to capture this in the picture but it is difficult because there is hair covering it. I know there is a risk of keloid scarring on the donor site, but has anyone ever heard of raised scarring in the recipient area?

[eyebrowqueen]

There was a message posted to thread by a user named "HareUpThere" that seems to have been deleted it so I am just reposting it.

 

"Eyebrowqueen, I also had an eyebrow transplant with Dr. R. and can relate a lot with what you are going through.

 

I think your brows look great, but I can see your concerns in your pictures if I take time to study them (ever so slightly). If you didn't mention the pitting/scarring I wouldn't have honestly noticed it at first few glances."

[hairthere]

I understand your anxiousness, especially with a facial feature as important as eyebrows. However, you really need to wait a full year for the area to heal and for the hairs to fully grow out.

[eyebrowqueen]

I understand your anxiousness, especially with a facial feature as important as eyebrows. However, you really need to wait a full year for the area to heal and for the hairs to fully grow out.

 

It's not a matter of whether the hairs grow to cover the scarring, I don't think I should have scarring like this to begin with. I don't see how these pits in my skin are going to go away. I was told this procedure would leave no visible marks on my skin and that I could shape my eyebrows however I want later. How am I supposed to shape them if the skin underneath is scarred? I have attached another picture of the area. The scarring is very visible and I've had no growth where the pitting is so I have nothing to hide it. Makeup doesn't work because it just sinks into the the holes. I am so upset I would rather have no eyebrows than have scars on my face. I am almost 5 months now, and my other eyebrow is fully healed with NO scarring.

[eyebrowqueen]

Hi everyone,

 

I was able to take a very clear photo of the "pitting" on my right eyebrow. The last picture I attached shows the scarring above my eyebrow, but this picture shows the scarring below my eyebrow. Dr. Rahal called this "minute" scarring which he said is invisible to the naked eye. What do you guys think. Can you see the marks I am referring to?

[hairthere]

Eyebrow, My point was that it will take time for the scar tissue to diminish and that it will hopefully do so to the point of not being visible. Remember that you had incisions made and grafts placed into a very soft/sensitive area of skin. While a seemingly simple outpatient surgery was performed, it was traumatic to your brow area.

 

I would suggest asking Dr. Rahal what type of creams/ointments he can suggest to use. I know my wife had great success flattening her C section scar using products like ScarGuard and Mederma. Just make sure they are safe to apply near your eye.

[JoeTillman]

Having eyebrows transplanted is no different than having the scalp transplanted. There will be redness and bumps for the first several months until the skin FULLY heals. I agree with Dr. Rahal that six months is needed but I've seen cases that have taken longer to fully heal, some have taken eight to ten months. The point is, the bumps most likely will heal and I think Hairthere had a good suggestion in speaking to Dr. Rahal about the use of scar reducers like Mederma.

[Chadley]

I've heard of people using lasers to treat minor scarring. Not sure if that would work in this situation. I think that's more for pigment issues, rather than pitting or bumps resulting from scars.

[eyebrowqueen]

Having eyebrows transplanted is no different than having the scalp transplanted. There will be redness and bumps for the first several months until the skin FULLY heals.

 

Hi Joe,

 

Thanks for your reply. I don't have any bumps on my eyebrow. What I have is holes or "pitting". I am currently at 5 months post-op. These holes have not improved since the procedure. Is it possible to have permanent scarring from an eyebrow transplant? If so, is this due to the incisions or the placement of grafts?

[JoeTillman]

Hi Eyebrowqueen,

 

I should have been a bit more comprehensive in my response but my current project has me distracted:)

 

When I was referring to the bumps I should have included any visual abnormalities that you see during the first several months. This includes bumps and the pitting you mentioned as well as dry skin, persistent redness etc. So all of these issues can resolve themselves with time. Will this be the case for you? I can't say for sure but I cannot count the number of cases I've seen over the years, and some eyebrow cases are included, where the issues you are seeing persisted for several months only to clear up with more time.

 

In general, the scarring from any hair transplant procedure can be caused by the incision making process, the placement of the grafts, or both. If scarring forms from the incision making process it is usually from the incisions being made too large. If scarring occurs due to the placement of the grafts then the pitting you see would be due to the grafts being placed too deeply. Better clinics will place the grafts with just a bit of tissue sticking out around the hair shaft. Once the tissue dries it will fall off and then the graft itself winds up being perfectly flush with the skin.

 

There are other ways that scar tissue can form but I think it goes beyond the scope of what you're dealing with and is not relevant. I really do think that giving this more time will help and of course follow the post-op requirements set out by Dr. Rahal. If there is anything I learned during my time with Dr. Rahal is that the aftercare and follow up is a priority so continue to communicate with the clinic with your concerns and questions.

[eyebrowqueen]

Hi everyone, I just wanted to give an update. I am not just passed the 6 month mark. The scarring on my recipient area has improved a lot in the past 6 weeks. I still have some lingering pinkness and microholes from the incisions, but the "pitting" I was most concerned with has smoothed over a lot. I guess it really does take 6 months for some people to heal fully. I think this is really important for eyebrow patients to know going into the procedure as it is a huge investment of time.

[eyebrowqueen]

Here is my 6 month photos. There are still some areas that haven't grown in but you can see that the condition of my skin has improved.