Tight Scalp and Dr Feller Video

[TrixGlendevon]

Hello!

 

Dr. Feller has released a good video on Youtube called "For Hair transplant Doctors ONLY" (I watched it anyway as I am a rebel :rolleyes:) and in it he mentions that a tight scalp is BETTER for having a thin scar after FUT. I was shocked and thought I'd misheard. I would have thought a tight one was more likely to pull the two sides apart and stretch the scar. Can anybody who knows more than me about the subject (won't be that hard) explain to me how this is the case as Dr. Feller did not explain why and I can't find an answer on Google.

[Dr Blake Bloxham]

Trix,

 

I thought I saw a non-doctor view on that video. Shame!

 

Allow me to answer this one for you:

 

The "tightness" or "looseness" of a scalp is usually broken down into two categories: 1) the adherence or strength of attachment to the deeper tissues (I consider this "glide") and the intrinsic characteristics of the skin. Together, these make up what I personally refer to as "laxity."

 

Now, the glide of the scalp can be affected by a number of factors and yours can personally be improved by scalp exercises before an FUT procedure. This isn't the "tightness" referred to in the video. And in my opinion, this has less to do with scar formation that it does with factor 2: the intrinsic skin factors.

 

Now there are actually a variety of elements in something called the extracellular or interstitial space that makes up the integrity of the tissue. But for the purposes of this explanation, I'm going to refer to them as collagen-like elements.

 

Basically, patients with more of these collagen-like elements have a tougher, harder skin, that tends to lock down and form into a very fine scar. Patients with less of these have a looser, less rigid type of skin that leads to more "scar stretching." Now, scar "stretching" isn't actually stretching at all. Most people assume that the large scars that "stretch" occur because the two lips of the incision area are brought together, they heal, but the tension on the wound physically makes the tissue stretch out and it creates this larger scar appearance. Not true. The scar itself is actually new tissue. When the body heals a cut like that, it actually lays down new collagen-like elements to build new tissue in the gap left behind when the two lips were brought together. Patients who already have a lot of these elements tend to lay down new collagen in lesser amount and in a more organized manner; hence, a better scar. Patients with less of it -- and the more "stretchy" skin -- tend to lay down more of it in a less organized manner and hence a larger scar forms. No actual stretching of tissue involved, just the way the body lays down new tissue in different skin types.

 

And this new tissue formation is present in FUE as well. That's why it's somewhat silly when people state that "strip scar healing is unpredictable" but FUE scar healing isn't. These same principles are the reasons why some people get very organized small dot scars that are actually smaller or the same size of the punch diameter and why others get more "amoeba-shaped" FUE scars that can be 1.5mm or greater.

 

Now, tissue type is a "catch 22:" while people with harder skin tend to get better scars, they also don't have as much "laxity" and this generally results in smaller strips and fewer grafts. People with the stretchier skin can provide much more tissue, but they tend to heal with larger scars. Now, the real ideal situation is someone who has lots of glide AND the harder skin characteristics, because they tend to get good graft numbers and heal with a fine line that is hard to pick up.

 

Hope this helps!

[TrixGlendevon]

Trix,

 

I thought I saw a non-doctor view on that video. Shame!

 

 

Did you ring a little bell when you said that?

 

I had to read part of it twice but yes, it was great. Thanks. I suppose the obvious question is, is there a way to test for glide and hardness/looseness of skin? I imagine the latter is much easier to check and I think I fall into the hard skin category - it barely moves at all and I can barely pinch the skin at the back of my head.

[TrixGlendevon]

Ideally, neither do I. Both procedures leave scars though. I will leave it to the surgeon to give me their opinion and then make a decision. You can hide linear scars with even a number 2 which is still pretty short. I am more concerned with the result up top than the scar(s) though so I will see what the experts say.

 

I am in my early 30s and a NW3v so I may even wait another couple of years. Dr Feriduni recommended to me that I wait 3 more years for the crown and if I can, another year or so for the frontal third but that he may reconsider that upon an in-person consultation. Dr De Reys also told me to wait if I could. Dr Maras the same. Dr Keser said I could go now but that he wouldn't touch the crown, but he only does FUE. I have 2 live consultations in June so far with two other doctors, they may suggest the same thing.

[Gasthoerer]

 

 

And this new tissue formation is present in FUE as well. That's why it's somewhat silly when people state that "strip scar healing is unpredictable" but FUE scar healing isn't.

 

Thank you for sharing this information. My questions:

 

Does this mean, that folks who are prone to larger scars will have larger scars in an FUT and (!) FUE (this is what I believe). Or will it only affect FUT results (this is what a clinic told me and I had a hard time to believe). It was a FUE and FUT clinic by the way.

[BaldingBogger]

FUE scars are generally most impacted by the size of the manual punch. I would always recommend people use a clinic that uses a small manual punch of 0.8. Anything larger than 1mm leaves much more visible scarring and moth eaten appearance.

 

FUT scars cannot be hidden by grade 2. That is a total fallacy.