Opinions on Scar repair

[scarredbaldy]

Hello Everyone,

 

In 2011, I underwent FUT surgery with Dr. Rahal and while I am still happy with the overall results, my scar has always been very noticeable and this forces me to keep my hair rather long.

 

Recently, I went back to the Dr. Rahal for his opinion on the matter and inquired about having FUE done into the scar. While he did say it was possible and gave me an approximate cost for the procedure, I can't say I left his office convinced and I didn't feel like he seemed to think it was worth it.

 

I am naturally suspicious when it comes to money and that's why I am here to ask for other opinions.

 

I do understand that I might have to keep my hair long for the rest of my life but I would have like the possibility of going a little bit shorter.

 

My scar It is about 3cm long and 4cm wide at it's worst and I have included a picture. The only solution I have right now is to use Toppik but it is not ideal.

 

My general impression from other similar threads is that FUE inside a scar generally fail and a second strip excision will likely produce the same results...

[scar5]

...I underwent FUT surgery with Dr. Rahal... scar...very noticeable..

 

My scar It is about 3cm long and 4cm wide at it's worst

 

My general impression from other similar threads is that FUE inside a scar generally fail and a second strip excision will likely produce the same results...

 

OK..you mean 4mm wide, not 4cm wide, obviously.

 

Yep, well, 4mm wide at the worst point is pretty average. It isn't bad at all.

 

But still, you are now in a situation you a) don't wanna be in, b) you didn't expect to be in, c) you were led to believe you wouldn't be in and d) you are now being told by the guy who did it...well, meh..it 'aint too bad.

 

Man oh man.

I have been there befroe and been told that story a hundred times.

Welcome to the strip club. You are a guaranteed life-long member.

 

First of all. Just grow a pair, get over it and move on. Don't get stuck in the past!!

 

Just kidding.

 

Here's what you can do. Fill the scar with FUE and SMP and hope for the best. Expect several sessions over many years. Expect that further hairloss will compound the situation and will have you grappling for whether you should just open up the scar again for more hair or to cut your losses.

 

Seriously, just fill it with FUE, then consider SMP. If your scar is flat you might get away with it.

 

Also, if you have the time and inclination. Try to warn young guys about strip and its unpredictability.

 

Best of luck.

[scarredbaldy]

Hi scar5,

 

Thank you for your reply.

 

Your honesty is refreshing and given the facts, I rather save my money and avoid getting into a vicious endless cycle .

 

I can't say for the moment that It is causing me much psychological distress but you are right in saying that I was expecting a more ideal scar and that the industry does in somewhat feed into desperation and provide false hopes or at the very least irrealistic expectations. Only time will tell if this was a big mistake with diminishing returns.

 

As for the dimensions I posted, a more accurate measurement is probably 1 to 2cm for the width and not 4mm. As this relates strictly to the section that stretches beneath the main line . The line itself covers more than half the perimeter of the head and is of acceptable dimensions on the left half of my head.

 

Sometimes I wonder if the sowing was done by I different individual for each hemisphere or if it simply bad genetics.

 

Thanks again for your response

[seeker2014]

I think scar5 gave you some excellent advice. I am currently researching FUE into FUT and average yields are obviously below average when compared to a non-scarred area. Saying that, I have been pretty impressed by what some individuals have been able to achieve with so few little grafts. You have the advantage of the scar only being on only one side of your head and relatively thin (considering the average width is only 1-2 mm). To give you a better idea of the cosmetic appearance of the scar, it might not hurt to progressively shave the sides down (probably start with a 6 guard) just to determine when it becomes visible. My threshold is around a 3 guard which I would consider average (optimistically, slightly above average) for a FUT scar.

 

From the dimensions you provided and the one picture you posted, I would estimate that 200 FUE grafts would do a reasonable job concealing the scar at around a 2 guard. Something else you might want to consider (assuming you want to cut the sides shorter) is blending the surrounding hair. When I go in for a haircut, I get everything buzzed with a 2 or 3 guard and then have the barber keep the hair adjacent to the scarred area a bit longer (scissor cut to probably around a 3/8 to 1/2 inch). It is very challenging for the human eye to detect the difference between a quarter of an inch so it gives the illusion of everything being at the same length while effectively covering the scar.

 

If you do elect FUE, I would recommend at least 2 passes. The first pass should probably be around 100 grafts just to see how they respond and then a follow-up procedure to increase the density. If I decide to go down this path, I am going to use scalp hair since I have decided not to undergo any further procedures after my first one. However, you could use beard grafts if you plan to undergo further HTs. In terms of increasing the potential success of the FUE grafting, you can always look into fraxel lasers or dermarollers (a much less expensive option). According to other forums I participate in, both these options help reestablish blood flow to the scarred area, thereby increasing the chances of the grafts taking. I have not tried either one so can't personally vouch for their effectiveness. Sorry for somewhat rambling, but hopefully this helped!

[scarredbaldy]

Hi seeker2014,

 

Thank you for your response. I think it is clear that if I do want to attempt repairing my issue it will be a long journey of trial and error. With my work obligation and the 6 month delays between regrowth periods, it looks like this might be an impossible undertaking.

 

As for the minimum guard needed, I believe I have brought a bit of confusion regarding my scar, a 3 guard would definitely not even be close to sufficient.

 

I have included clearer pictures to illustrate my situation.

 

 

Thank you again for your support.

[seeker2014]

From the pictures you just posted, it does appear you experienced some scar stretching. If you don't mind me asking, how many grafts was the 2011 procedure? Completely understand the work obligations, but I still think you have a few options available. Number one, would you be opposed to temporarily shaving your sides down to a shorter length for a FUE procedure? Considering you would probably need around 200 grafts (preferably over two procedures) your down time shouldn't be that long. If you could get a week (maybe two weeks) off from work, very few people, if any, would probably detect anything different (possibly some redness in the recipient site). Number two, you could always try another concealer for the scar if you are not satisfied with Toppik. I have heard some positive feedback for DermMatch and, considering how black your hair is, this might be a good solution. Concealers have proven a bit more difficult for me since I have a more varied hair color--strawberry blonde which can significantly change based on sun exposure. Number three, you could consider a scar revision, but honestly I have no idea if your scar width warrants this option (with my limited knowledge, I would lean towards "no"). Number four, you could consider SMP into the scar, but assuming you want to keep your hair at its current length, this probably would not be the optimal solution. Also, SMP into scarred regions can be unpredictable with ink blotting.

[arussell]

FUE into scar tissue works very well. And to give an illusion of hair you don't have to achieve the same density as the hair around the scar. I would also plan on several sessions to completely hide the scar. If you do smaller sessions you may not have to shave the donor area, that depends on the clinic and their requirements. Did you speak to your clinic about the scar?

[scarredbaldy]

seeker2014, to answer your question I had 4566 grafts. Thank you again for all your recommendations, it is a lot to digest at the moment and I will have to take this all of this into consideration.

 

arussell, I did speak to my clinic and after a physical examination by Dr Rahal, I was told that FUE was possible, but judging more by his intonation than what he said, I had the feeling (perhaps erroneous) that it wasn't worth the trouble. I truly believe Dr Rahal is a very competent doctor and perhaps his evaluation led him to conclude that the risks outweigh the rewards, which may very well be the case. Considering I am only 32 , it is quite possible that I might need the extra hair follicles in the decades to come.

 

Like anything, hair styles are dictated by fashion, and keeping my hair long, or using visual illusions as described by seeker2014 in his previous post, might be the best solution for the time being.

 

Thank you all again for the information, it certainly has helped put things into perspective.

[scarredbaldy]

I have expressed my concerns with my doctor and he very generously offered to attempt a scar excision.

While doing my own research I found it extremly difficult to find any before and after pictures related to scar excision. I will be posting my progress in the months to come.

[leindub]

I'm one of those peoole who recieved a nasty FUT scar about 15 years ago, I was sold a pencil thin one my barber would have problems locating. Aside from having FUE placed into it, would anyone know how successful a trichophytic repair closure is to try minimise it before going ahead with FUE?

[arussell]

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I'm one of those peoole who recieved a nasty FUT scar about 15 years ago, I was sold a pencil thin one my barber would have problems locating. Aside from having FUE placed into it, would anyone know how successful a trichophytic repair closure is to try minimise it before going ahead with FUE?

 

lEINDUB,

 

i AM SORRY YOU HAD A BAD EXPERIENCE. It puts a bad taste in everyone's mouth and human nature is bad news travels faster than good news. First, can you let us know who the surgeon was? This is not to spread bad rumors about them but perhaps they have evolved and could do something to help you? Second if you would rather not see them, have you been to another transplant doctor who has a good reputation for scars and repairs? To answer your question, many times if the old tissue is removed the scalp retains a memory of the stretch and it just comes back, but have said that there are many variables. It will depend on the location of the scar (yes different surgeons can have different preferences), it also will be effected by the number of grafts you had done and the laxity you now have.

 

My best advise is to visit a good clinic and get an opinion. Another question would be if you are doing additional grafts during this incision?

 

I hope this helps.

[Td06]

Scarredbaldy,

 

That's great your doctor offered to repair the scar. I to may be in need of a repair from my recent procedure. My first procedure, the scar was very good in my opinion. The second one not very much so. Please keep us updated on your repair.

[Dr. William Lindsey]

This is a good thread. When I looked at that first picture, my nurse and I both thought... that's not so bad, but your later pictures do show the problem. I get it, I see what you are concerned about.

 

Listen, I've posted alot of this previously on the forums and having done 3800 facelifts, including one yesterday...I think that I suture better than most. BUT I get 4 crappy scars every single year, even with a 2 layer trichophytic closure.

 

Scar problems can generally be attributed to: 1. poor closure technique ( the main cause in the people that role in here for scar repair)

 

2. Poor healing...some people, possibly you, just don't scar well even when closed by very competent doctors. And often, its actually not the really tight heads that wind up the worst, but rather guys with easy closures that I think ought to get a great scar....that for some reason wind up in that 4 bad scars that I get yearly...

 

3. A combination of the 2. And that is the most frustrating... because you take a guy, similar to a fellow I recently saw who had a HT overseas and had a poor scar. Now was it because a poor surgeon closed him, or was it because he is a poor healer.... Looking at his body I saw lots of other poor scars so maybe he's just a poor healer, but I looked up his doctor and saw on his own website...what I'd consider poor scars that he was showing off. So maybe its both # 1 and #2....it is tough to know.

 

But in a guy like him, and possibly in you too...I'd probably avoid a scar excision, figuring you had a good closure the first time, and I'd be inclined to place grafts into the scar itself.

 

Here are 2 videos. The first shows a 3 layer scar repair. The second discusses putting hair into scars.

 

Take your time before you make a decision and good luck to you.

 

Dr. Lindsey

 

 

[Td06]

Dr Lindsey,

 

Great information and video. Would one be able cut their short again (#3 guard) after placing grafts into the scar? I don't really see a lot of before and after results when searching the web.

[fortune11]

Very interesting videos Dr Lindsey , good to see a well documented scar repair procedure like this. Looking forward to seeing progress on the 3-layer scar repair case . I am assuming you will post follow up videos as well.

 

I am actually in a similar situation as the OP where one 2-3 inch section of my scar is more pronounced than the others. Unlike the OP, I have had 2 other FUT surgeries in the past, both of which led to the typical 1-2mm scars (only the final scar remained obviously) .

 

This time with HT #3 (I am now month 7 post op) , there was a little bit of inflammation post op, in one section of the scar , which took some time to heal , and that same area is where the scar is about 8-10mm wide compared to 1-2mm everywhere else.

 

I have continued to apply Bio Oil in that section but don't think it has had as much effect, although i will say the initial , raised ridge like appearance that I saw in month 3-4 has now flattened out, at month 7, while at the same time the width in the problem section of the scar has increased from say 6-8mm to now 8-10mm. Rest of the scar has continued to thin.

 

Any thoughts here ? thank you

[NoTakeBacks]

This thread also interests me. First procedure I scarred well and could cut to #4 guard or even a #-3-4 fade. This second, I can barely make a #7, and it's also visible when my hair is wet. Even if I forego clippers and have it tightly scissored, when wet it blatantly stands out as it's a completely hairless band. The latter is what makes me the most sad...

 

With that said (and if you don't mind me jumping on the bandwagon of questions) Dr. Lindsey, do you recall the graft count used for the FUE repair pictured in the second video? Or rather, what would you say the graft count range most of the repairs you've done fall into? Even just a ballpark; I won't hold you to any specifics!

 

Thanks!

[Td06]

Dr Lindsey,

 

Another question, Could the type of sutures used to close the wound have any affect on the scaring? Like an allergic reaction.

 

I also continue to have this burning\itching sensation around the scar area past 12 months.

[fortune11]

Dr Lindsey ?

 

Any of his reps on the forum here ?

 

thank you

[fortune11]

Dr Lindsey ?

 

Any of his reps on the forum here ?

 

thank you

[wylie]

When I was getting butchered by the late Dr. Robert Thomas of Chicago (a man who had no business doing hair restoration) there was one thing he was good at, and it was suturing. I always remember the stitches being so tight they caused discomfort, but the end result of my many surgeries with him (all considered "small" at the time, but leaving behind scarring) was my scars are nice and flat and fairly thin. I have had roughly 1500-2000 beard hair grafts added, by two different doctors, and without the addition of these, there is no way I would be shaving to a #1 guard in the back.

 

I should also add that I had temporary SMP added to the region last year, and this also helped, but there is no substitute for adding hair to the scar. Yes, hair does grow in scar tissue, I have proof of it. Without adding hair to my scars I would still be wearing it long in the back, and even then the scars were visible thru my donor ravaged region. (There is still evidence of scarring in the back right now, but I have considered it tolerable, so I cut my hair short everywhere, including the scarred donor)

 

So remember, your problem is fixable, do your research and find someone who is experienced with this type of repair. Maximum effectiveness is the combination of FUE into the scar, and SMP added later.

[scarredbaldy]

Some post op updates. Week 1 and 2 .

[Td06]

Hi Scarredbaldy,

 

Do you know what type of closure the Dr used on your revision? Thanks for the update.

[Dr. William Lindsey]

Yes, the type of sutures used definitely influences results. Most doctors use sutures that have to be removed from the skin as they tend to cause less inflammation and yield a better scar, but there are guys who get good results with dissolvables. We put dissolvable sutures below the skin to hold the edges together.

 

You should have no problem in finding before and afters of scar pictures...I know I've posted HUNDREDS.

 

As to before and afters of hair into scars....I put up a video in the spring from a talk that I did at the ASHRS showing our track record of hair being placed into scar and I think we had 14 or so cases.

 

I'll try to find a link.

 

 

Dr. Lindsey McLean VA

[Td06]

Yes, the type of sutures used definitely influences results. Most doctors use sutures that have to be removed from the skin as they tend to cause less inflammation and yield a better scar, but there are guys who get good results with dissolvables. We put dissolvable sutures below the skin to hold the edges together.

 

You should have no problem in finding before and afters of scar pictures...I know I've posted HUNDREDS.

 

As to before and afters of hair into scars....I put up a video in the spring from a talk that I did at the ASHRS showing our track record of hair being placed into scar and I think we had 14 or so cases.

 

I'll try to find a link.

 

 

Dr. Lindsey McLean VA

 

When i had my 1 year follow up for my current procedure. I asked the Dr the same question, if the type of sutures used could have a negative effect on the scar outcome. I was told it does not.

 

Good to know that there could be a possibility.

 

Thank you for the links,

[MrGio-WHTCClinic]

Some post op updates. Week 1 and 2 .

Hi. Did you notice any difference in scalp laxity after your 1st FUT procedure and your scar revision procedure? Did your doc say anything about what to expect in the long-term?

 

Thanks for sharing your case.