Scaring...

[newbie33]

Here's a question (mostly for the doctors here):

 

Can you tell anything about how a strip scar will look - and the possibility of it stretching - by looking at scars from other procedures the patient might have had?

[Dr Blake Bloxham]

Newbie,

 

Great question. And since you asked for doctoral opinion, I'll give you the most doctor answer possible: it depends.

 

Got to love it, right? Allow me to try and explain.

 

I actually get into discussions about "other" scars with patients pretty frequently. And of course this always involves a little bit of "show and tell." Some of the most recent ones during consultations include: a parathyroid (you asked for medical opinion!) surgery scar in the neck, a neurosurgery scar in the donor area, and some sort of gash in the forearm that was treated, at home, with tape. Why do these patients show me their scars? Because they have the same question you do: does the healing of scars on other parts of my body provide any insight as to how my strip scar may heal?

 

And this is my response: I start with the great "it depends," but explain that scalp truly heals like no other region of the body. Imagine taking a strip from your arm, leg, shoulder, et cetera, and expecting it to heal into a "pencil thin" scar. Unlikely, right? This is because the scalp has so much glide and intrinsic stretch (the two factors that make up "laxity") in the skin, and this allows it to usually heal beautifully. So in this sense, it's not very helpful to compare how a scar on your arm, back, or chest may heal compared to a scar on your scalp because the tissue is so different. All other areas of the body seem to have different tissue make up, more intrinsic tension, more pulling forces from movement, less vascularity, etc, etc.

 

However, I do think there is some correlation -- hence the "it depends" answer.

 

In my book, patients usually fall into two very broad categories when it comes to scarring post-hair transplant: "normal" healers and "not normal" healers. 95% of guys are "normal healers" -- in my humble opinion. What does this mean? They aren't prone to hypertrophic scarring, keloid scarring, poor wound healing due to other physiological factors (chronic smokers, diabetics, etc) and they will heal normally. I tell these guys that they can expect something between the true "pencil line" FUT scar to something more like a thicker "marker line" scar if I think they have the potential to stretch (and I can get some sense of this during the evaluation). However, I would consider this gradient of scars to be "normal" and still fall under the realm of being easily hidden down to about "3 buzz" on the trimmer.

 

"Not normal" healers are the guys I mentioned above; those who have a history of bad scarring, those with a collagen disorder (these are the very, very stretched FUT scars you sometimes find in the catacombs of the internet), and those with some other pre-existing medical condition that may lead to bad scarring. So if you see a patient with obvious keloid formation somewhere else on his body or a variety of hypertrophic scars, this may actually provide some indication that the scalp will heal in a keloid as well. Does it guarantee you'll get keloid or hypertrophic healing in the donor? Surprisingly, no. Like I said before, the scalp heals amazingly, and I've seen guys with keloids elsewhere on the body who still have great strip scars.

 

Conversely, however, if you see someone with a slightly stretched or noticeable scar on another area of the body with different tissue makeup, different tension forces, etc, it doesn't necessarily mean they'll have a more noticeable or stretched strip scar.

 

So my guess is that you would likely fall into the "normal healer" category and scars elsewhere on your body won't provide too much information as to how you may heal in the donor.

 

Hopefully this thread will catch Dr Lindsey's eye. He's a true expert when it comes to scar healing, and he'd be able to provide some excellent information as well.

 

If you'd like to see an array of strip scars in "normal healers" you may want to take a look at some of our "scar search" vidoes. We started filming them on just about every patient who came in for a repeat surgery for a while, and they show a pretty fair range of what you could expect.

 

All these guys are "normal healers" with different propensities towards stretching or not stretching:

 

 

 

 

 

 

 

Hope this helps!

[newbie33]

Thanks Blake. Very informative. I basically suspected as much, but it's always interesting to get a professionals take on it. And I'm sure as a plastic surgeon Dr Lindsey would have a pretty interesting take on it too.

 

"It depends" is not a bad answer. I think what most patients want is the information to be able to decide for ourselves. I think most grown ups know that very little in life is ever certain.