Scar repair - revision v FUE

[WeeBeansysBro]

Hi all, 

Would appreciate a second opinion on this! I have a scar from a hair transplant 10 years ago. It is about 4cm long by 1cm wide and is raised above the skin. It is the result of a HT by a plastic surgeon with no experience in hair transplants so this may be the reason why it is so wide. In additional it could have been caused by me not being careful after the HT, I really can't say. I have had just one strip surgery and plan on having fue in the future but no FUT.

 

My goal is is to wear my hair short in the future. To get the best possible results at the end of this I am definitely leaning towards revision then FUE. I didn't mind the healing time etc if it means a good results at the end.

 

The reason for revision first Is that yes it could not get smaller but it could also be improved in the right hands. Further I can do revision then FUE if the former does not work out but can't do fue then revision right? Not interested in SMP. 

 

Thanks

[Britanium]

A decent clinic/Dr would be able to do a scar revision and hopefully reduce it to pencil thin. Depends where your looking to get it done ? As a lot of places are now   FUE only. However there are still a lot of US clinics doing FUT/Revisions. 
Another option would be Dr Bisanga/BHR. Dr Bicer has a scar revision case on the forum which is very good. I believe @DrTBarghouthiis another good option. 

[WeeBeansysBro]

3 hours ago, JohnAC71 said:

A decent clinic/Dr would be able to do a scar revision and hopefully reduce it to pencil thin. Depends where your looking to get it done ? As a lot of places are now   FUE only. However there are still a lot of US clinics doing FUT/Revisions. 
Another option would be Dr Bisanga/BHR. Dr Bicer has a scar revision case on the forum which is very good. I believe @DrTBarghouthiis another good option. 

I am in Europe John. Was thinking of going with Feriduni. Bisanga and also Lupanzula would not do it due to risks of it rewideninig. Ball at the Maitland clinic suggested it. Having some docs say no and some say yes to revision only leads to my confusion! ha 

[Britanium]

Keep up the consultations 👏 you will get a short list of Drs that will do it. Feriduni is a very good option. I believe there is a slow down in getting a surgery date at his clinic since coronavirus. Were you already able to consult with them via zoom ?

[WeeBeansysBro]

6 hours ago, JohnAC71 said:

Keep up the consultations 👏 you will get a short list of Drs that will do it. Feriduni is a very good option. I believe there is a slow down in getting a surgery date at his clinic since coronavirus. Were you already able to consult with them via zoom ?

Yeah spoke with him over zoom last month, had set that up last year so there is a quite a wait for Zoom consults at least. He said his clinic has caught up on bookings now. Think there is a 3/4 month wait for procedures at the moment

[1978matt]

The scar seems to be in the wrong location to take a strip.  For that reason (my non doctor guess) is that it's probably better to FUE into it.

Probably needs 200 grafts or something.

[Al - Moderator]

I agree with @1978matt. If you are only looking to fix the scar right now and not ready to do additional work yet, then I'd look into taking about 200 grafts from your beard and placing them into the scar. That way you don't touch the rest of your scalp at all.

 

[aaron1234]

Do you plan on getting more HT's down the road? This might factor into the decision, but since the scar is oddly placed then Matt is probably right about FUE being the best option for you.  I did have a scar reduction via strip and it worked out well, but it was traditional FUT scar. 

[DrTBarghouthi]

Thank you for the mention @JohnAC71

@WeeBeansysBro while your widened scar may have been caused by several reasons: technique, skin type, skin laxity etc., I do note that it is somehow in an atypical plane. There is usually a reason why most strip scars you see are sort of curved and not a straight line from one end to the other. This is mainly to accommodate for the ligns of tension in the scalp which gives better closure and scarring. If you close skin in the right anatomical plane then this gives you the best chances of having a decent scar. There are other things that can help and that is having trichophytic closure in order to allow some hair to grow in the scar edges. From what I can see, the plane of incision seems too horizontal instead of curving and following the plane of your tension lines. I am not implying that this is the main cause, but I do think that repair in such a case will probably not be complete as it is wide and skin there is usually under more tension. 

[WeeBeansysBro]

1 hour ago, DrTBarghouthi said:

Thank you for the mention @JohnAC71

@WeeBeansysBro while your widened scar may have been caused by several reasons: technique, skin type, skin laxity etc., I do note that it is somehow in an atypical plane. There is usually a reason why most strip scars you see are sort of curved and not a straight line from one end to the other. This is mainly to accommodate for the ligns of tension in the scalp which gives better closure and scarring. If you close skin in the right anatomical plane then this gives you the best chances of having a decent scar. There are other things that can help and that is having trichophytic closure in order to allow some hair to grow in the scar edges. From what I can see, the plane of incision seems too horizontal instead of curving and following the plane of your tension lines. I am not implying that this is the main cause, but I do think that repair in such a case will probably not be complete as it is wide and skin there is usually under more tension. 

Thanks Dr. Would you not recommend a tricho closure then? I am thinking the worst case scenario of a tricho closure would be a scar that is just as wide but smoother and flatter than currently is which would help for future FUE.

[WeeBeansysBro]

5 hours ago, 1978matt said:

The scar seems to be in the wrong location to take a strip.  For that reason (my non doctor guess) is that it's probably better to FUE into it.

Probably needs 200 grafts or something.

May be bad location but still could be reduced in width by tricho closure  if all goes well do you think ? 

[1978matt]

37 minutes ago, WeeBeansysBro said:

May be bad location but still could be reduced in width by tricho closure  if all goes well do you think ? 

Not sure it would work unless the incision is at right angles to the direction hair flows.  Yours doesnt follow the usual path of a strip scar.  Kinda falls toward the ear if you get what I mean.

[Melvin- Admin]

2 hours ago, DrTBarghouthi said:

Thank you for the mention @JohnAC71

@WeeBeansysBro while your widened scar may have been caused by several reasons: technique, skin type, skin laxity etc., I do note that it is somehow in an atypical plane. There is usually a reason why most strip scars you see are sort of curved and not a straight line from one end to the other. This is mainly to accommodate for the ligns of tension in the scalp which gives better closure and scarring. If you close skin in the right anatomical plane then this gives you the best chances of having a decent scar. There are other things that can help and that is having trichophytic closure in order to allow some hair to grow in the scar edges. From what I can see, the plane of incision seems too horizontal instead of curving and following the plane of your tension lines. I am not implying that this is the main cause, but I do think that repair in such a case will probably not be complete as it is wide and skin there is usually under more tension. 

Great response 

[DrTBarghouthi]

1 hour ago, WeeBeansysBro said:

Thanks Dr. Would you not recommend a tricho closure then? I am thinking the worst case scenario of a tricho closure would be a scar that is just as wide but smoother and flatter than currently is which would help for future FUE.

Trichophytic closure will not flatten the scar but could possibly cause more hair growth around the edges of the scar. The elevation can simply be due to your skin type being prone to hypertrophic scarring. I think the scar can be removed in a curved way but that might leave the lower part of the existing scar not fully removed and that can be difficult to suture as it will be under tension etc. It is really harder to asses by photos only as you will need to asses how elastic the skin in that area is also. 

[Britanium]

9 hours ago, DrTBarghouthi said:

Thank you for the mention @JohnAC71

@WeeBeansysBro while your widened scar may have been caused by several reasons: technique, skin type, skin laxity etc., I do note that it is somehow in an atypical plane. There is usually a reason why most strip scars you see are sort of curved and not a straight line from one end to the other. This is mainly to accommodate for the ligns of tension in the scalp which gives better closure and scarring. If you close skin in the right anatomical plane then this gives you the best chances of having a decent scar. There are other things that can help and that is having trichophytic closure in order to allow some hair to grow in the scar edges. From what I can see, the plane of incision seems too horizontal instead of curving and following the plane of your tension lines. I am not implying that this is the main cause, but I do think that repair in such a case will probably not be complete as it is wide and skin there is usually under more tension. 

Thanks for your response @DrTBarghouthi always appreciated 🙏