Hypertrophic? Scar After FUT Procedure

[Superteeth]

Hello all, it's been a while since I've posted but I had a question about the status of my FUT scar after healing (2 years after procedure). It appears to be hypertrophic, and possibly (slightly? if that's possible) keloidal (slightly meaning it doesn't appear to be growing so large it's eating the rest of my scalp, like some keloidal scars in other areas of the body do). It does seem to have spread beyond it's original boundaries slightly on the left side above my ear, but I can't be sure because I'm not entirely sure how wide the excised strip was (but surely it was not too much larger than the typical strip size).

The left side above my ear is where it's at its worst, but I can feel around the scar all the way to my right ear and can feel that it is slightly raised all the way around (more so in the middle, but barely detectable everywhere else), just not extremely wide like it is above my left ear. It feels to be about the width of a typical FUT scar.

Now, I'm not particularly concerned about the cosmetic issue of the scar, because I wear my hair long so it's always covered up. But it almost looks like the scar above my left ear probably killed some hair follicles as it spread, because obviously there's no hair in the scar.

So my question is this: I have good scalp laxity (after two years of healing, and I've added scalp laxity exercises to maximize the laxity), and as I said am not too concerned about the potential of another scar (because it's inevitable after multiple strip procedures to get bigger and bigger scars, to my understanding). Would a hair transplant doctor be able to cut far enough above and below this scar to get a sufficient number of grafts for another procedure? Considering that I apparently do scar in this area, does it disqualify me for another procedure? I'm really concerned I won't be allowed to get another transplant, as I think one more (using about 2,000 grafts) will be enough to give me what I want, so it'd be disappointing if I could not have another procedure. Would corticosteroid injections prior to another FUT procedure improve the scar such that another FUT procedure could be done? Would it even be necessary?

 

I kind of get conflicting information searching about keloidal scars and hair transplants, with some saying that if you're genetically predisposed to such scars that hair transplants are not advised, but if it's only because of the cosmetic effect of the scars I really would rather have a gnarly scar that's covered by hair in the back and hair in the front! Thanks to everyone who offers their input.

 

Edited May 17, 2020 by Superteeth
Another Question

[LaserCap]

 

can you photo the entire scar? Does it go all the way around to the other side? It'll be interesting to see if it is wide throughout.

What caused the scar to widen? Did you go to the gym and started exercising right after the procedure? What was your sleeping position post op?  A number of things could have caused this.

So, you've had one procedure and have plenty of give. Hmmm.  Let's talk about wound physiology.  

Much of what doctors do during a procedure is routine for them  If the doctor is good, most times the scars will heal just fine.  But that's it.  Everything else is up to you and would physiology.  You heal how you heal.  So, if you did not go to the gym and started a physical regimen, and slept sitting up and not creating unnecessary tension, then you have to thread lightly.  If it happened before, it is likely it will happen again. Is it worth a try? Speak with the doctor and discuss all possibilities.  If he stitches under and above, for example, this could help minimize the tension.  Also, an elliptical cut may help taper the ends.  If not a good idea, consider SMP.

How many grafts was the procedure?

Have you visited with the doctor since? What have they said?

 

 

 

[Superteeth]

On 5/18/2020 at 10:23 AM, LaserCap said:

 

can you photo the entire scar? Does it go all the way around to the other side? It'll be interesting to see if it is wide throughout.

 

So it's really hard to take a picture of the entire scar because my hair is long, but from feeling along the scar I can see that it is only that wide above my left ear. It's slightly raised all the way around but thin in width everywhere else. Not sure why it stretched/went hypertrophic where it did. 

That said, I don't much care about the scar, not enough to keep me from getting another transplant. Would I prefer no scar? Of course. But I know that's not possible with me planning for a third (and final) FUT surgery. But my laxity after two strip procedures is surprisingly good. 

Edited May 27, 2020 by Superteeth

[Dr. Glenn Charles]

Did you ever have any type of treatment like a Kenalog (steroid ) injection to attempt to flatten and shrink the scar?

[Superteeth]

1 hour ago, Dr. Glenn Charles said:

Did you ever have any type of treatment like a Kenalog (steroid ) injection to attempt to flatten and shrink the scar?

No, but I was reading about the use of cortisone and corticosteroid injections to do so. How effective are Kenalog injections, and are they typically the suggested course of action for such scars? I'm guessing it's too late to save the hair follicles that have been covered up by the expanding scar? In which case, all the Kenalog injections will do is improve the cosmetic appearance (but future strips the include this scar will still be composed partially of scar tissue and thus useless for producing usable grafts)? Or will the Kenalog injections do something else that will help future FUT procedures? Thank you very much, I wanted the input of doctors more than anything (although personal experience doesn't hurt either!)

[Melvin- Admin]

It looks stretched, it may be due to keloid scarring. However, you would know if you have keloids. Have you ever had keloids anywhere else? Was this a trichophytic closurev 

[Superteeth]

13 minutes ago, Melvin-Moderator said:

It looks stretched, it may be due to keloid scarring. However, you would know if you have keloids. Have you ever had keloids anywhere else? Was this a trichophytic closurev 

It was a trichophytic closure. Not sure if it was done correctly, I should hope it was. What do you mean when you say I would know if I have keloids? Are they that noticeably different from normal scars (other than the description of the inflammation and pain)? Because to my knowledge I've never had keloids elsewhere based on how they're described. I really hope they're not keloids, but I am scheduling a virtual consultation with a hair transplant doctor that's part of this network's suggested doctors so he can tell me if it's a keloid scar and if I'm a candidate for another procedure. Based on what I'm reading about keloid scars vs. hypertrophic scars this appears to be closer to a hypertrophic rather than a keloid scar. Crossing my fingers on that one.

 

At the end of the day if I can control a keloid (assuming that's what this is) with early intervention and/or steroid injections I would much, much rather have a permanent scar on the back of my head along with more hair in the front than not be able to get another procedure. Which is why although I've read of surgeons stating that they do not perform surgery on people with a history or genetic predisposition towards keloid scarring (I am of South Asian descent), I hope there are plenty of good surgeons that will allow the patient to decide if the scarring is something they'd be willing to live with in exchange for more hair.

 

Edit: I attached a picture of a scar I have on my right index finger. It was a pretty deep wound that sloughed off a good bit of skin, and has scarred as a result. It hasn't grown past the borders of the original wound, which leads me to believe it's a hypertrophic scar rather than a keloid. That's the closest thing I have to a bad scar on my body (other than the hair transplant scar!)

Edited May 18, 2020 by Superteeth

[LaserCap]

5 hours ago, Superteeth said:

So it's really hard to take a picture of the entire scar because my hair is long, but from feeling along the scar I can see that it is only that wide above my left ear. It's slightly raised all the way around but thin in width everywhere else. Not sure why it stretched/went hypertrophic where it did. 

I do weightlifting, but I didn't go straight into it after the procedure, I waited the 10 days suggested by the surgeon and then started out at half the weight I had been doing for all exercises and slowly worked my way back up, so I'm not sure why the scar would stretch so much.

That said, I don't much care about the scar, not enough to keep me from getting another transplant. Would I prefer no scar? Of course. But I know that's not possible with me planning for a third (and final) FUT surgery. But my laxity after two strip procedures is surprisingly good. Now, I didn't talk to the surgeon about the scar, partially because I don't think it'll change anything. I specifically chose not to go back to that surgeon (despite good reviews on him) because my last consultation with him planning the third surgery he suggested that I needed 2,000-2,500 grafts to thicken my hairline and fill in my temples. 

I KNOW for a fact that I don't need that many grafts to do that. Taking into consideration my hair characteristics and the areas we were discussing (being as small as they are) I don't believe I need more than 1,500 grafts. He specifically said he was trying to achieve 60 grafts/cm2 in my hairline, which is odd since my Asian ancestry means my hair isn't super-dense as it is, so to create the illusion of density at 50% original density I don't need 60 grafts/cm2. I don't understand why he's suggesting I use my limited donor hair to do that. Not to mention that when I stated I "had a budget" (hence part of the reason I was keeping it at 1,500 grafts, not just because it was really all I needed) he stated his advisor would call me with price details worked out and then I wasn't contacted further. It's like if I wasn't getting a big enough procedure for him he didn't want to waste time on me. So I moved on.

Ahhhh.  If you do this again, AVOID weightlifting for at least 6 months post op.  The longer the better, particularly anything that stretches the neck.  Leg presses, push ups are OK.  

It is likely you will not be getting many grafts if the scar is wide throughout.  Just get a revision and give it time to heal and gain elasticity.  And please, NO weightlifting.

[Superteeth]

On 5/18/2020 at 5:48 PM, LaserCap said:

Ahhhh.  If you do this again, AVOID weightlifting for at least 6 months post op.  The longer the better, particularly anything that stretches the neck.  Leg presses, push ups are OK.  

It is likely you will not be getting many grafts if the scar is wide throughout.  Just get a revision and give it time to heal and gain elasticity.  And please, NO weightlifting.

10-14 days is the common figure I see quoted for time before returning to heavy weights after an FUT procedure. It would in fact be impossible for me to avoid physical activity because my job is manual labor (although the doctor said it should be fine to go back to work after 10 days)! That said, I will be more careful by avoiding exercises that involve neck movement for an extended period of time. Hell, it gives me a reason to not skip leg day, anyways! 

Edited May 27, 2020 by Superteeth