Large FUT Scar Repair - Exploring Available Options

[ABK]

Background:

• Date of Procedure: 9-18-2020 
• Procedure: FUT
• Grafts: 2,500
• Doctor: Dr. Arocha, Houston, Texas
• Age: 35
• Current Preventative Measures: Propecia, Minoxidil, Laser Cap, and Micro Needling

First, I want to say that my goal here is not to bash the doctor.  He has been receptive to my concerns and presented some possible solutions. My hope here is to tap into the community for guidance.

 

Issue:

Unfortunately, the procedure left me with a very wide FUT scar.  The scar is largest above the ears, but it is fairly prominent throughout. Prior to surgery, the doctor notified me that scars can be unpredictable, but I was also told that a reasonable expectation is to be able to be able to cut your hair with a guard 3 without the scar showing.  Currently, if I cut my hair with anything less than a guard 7, the scar is very visible.  Even with longer hair, multiple people have commented on seeing the scar when my hair falls to the side, and this has been a source of frustration and embarrassment.
 

Objective:

Repair the scar to the extent possible, while also leaving open the door for future procedures.  I am planning on getting another procedure (FUT or FUE to further fill in the frontal hairline, temples, and crown).  Combining both the scar correction and this second procedure is ideal. The next procedure will likely be 2,000 to 2,500 grafts.

 

Conversation with the Doctor & Proposed Solutions:

The doctor suggested that my wide scar may be due to the high elasticity of my skin.  He also suggested that merely sleeping wrong can result in a widened scar. Further, he pointed out that, though I do not have keloids (thankfully) the scar is slightly thickened. 

The doctor proposed the following solutions:

1. FUE Procedure to fill in the scar area, which would require about 300 grafts.
2. Another FUT procedure in hopes of cutting out the scar and using additional staples to help minimize stretching.
3. Combination of an FUT and FUE. The FUT would be near my neck, which has the least amount of stretching and the FUT would be used to fill in the point most prone to stretching, which is above the ear.

 

Option 1: FUE Procedure

• My concern here is the loss of grafts for future procedures, as well as the fact that so many grafts will be spent just to conceal the scar (300+).  I will likely need a third procedure as my hair continues to thin, and so I would like to maximize my available donor area to the extent possible.

Option 2: FUT

• If the procedure successfully cuts out the scar and can result in a smaller linier scar, then that would be ideal (especially considering that 80 grafts would be enough to conceal a small scar). The doctor suggested a special tempur pedic pillow that may help reduce head movement (and thus the chance of scar stretching). The issue is that I have evidence that my skin stretches, and I am also fearful of a keloid (though I do not have a history of this).
• In regard to my prior FUT, I was studying for a major exam for a few months after the surgery. My head was tilted downward while reading, which may have contributed to the scar? This is just a thought regarding one factor that won't come into play on my second procedure.

Option 3: FUT/FUE

• Here, the number of grafts in the wide areas around the ears would be around 100, while the remainder of the scar (near the neck area) would just be excised and more closely monitored. I am open to this option, but the optimist in me wants me to go with the second option (a complete FUT with scar revision) in hopes of attempting to excise the scar and remain extra vigilant. 
   

What do you think?

Your thoughts are appreciated.

In your experience, how bad is the scar?  Was there something that I or the doctor could have done to avoid this issue?

Is there an option that I am missing?  Should I consider another doctor for the procedure?  Note: I live in Houston, which makes Dr. Arocha especially appealing (particularly in regard to follow-up visits).  I have heard fantastic things about Hasson & Wong, but the distance is a concern.

 

This has been a source of stress, and any guidance the community can offer is really appreciated.  Thank you, everyone.

 

 

Edited October 12, 2021 by ABK

[aaron1234]

That's an unfortunate scar.  300 FUE grafts seem to be the best bet.  You could do a strip revision (I did and it turned out well) but the results of that would be unpredictable.

[shami26]

You also have the option BHT into the scar but you will need a doctor experienced with BHT to do it.

[Britanium]

Difficult choice. I have had 2 FUT and ended up needing a scar revision. And its still not great. That’s the risk of going in and taking even more FUT and/or revising the scar, it’s possible it may end up the same or worse. 
I’m going to get beard grafts implanted in to mine. 

[Forty Six & 2]

If I were you, I would never go the risky FUT way again. You are 35, not a high Norwood and your donor looks great. 300 seems like a good trade-off. As mentioned before, you could also go for BHT, but I don't think that is necessary.

[Gatsby]

As has been stated the risk of excising the scar is that it may stretch back in time. I have some bad scar in the back of my head and also along my hairline. I had surgery to remove old fashioned 'plugs' from my hairine and temples. Instead of performing an excision removal in one procedure (which could result in a very wide and more noticeable scar along my hairline), I had narrow 'strips taken so as to reduce the tension on the hairline scar. This was performed many times which has left me with a narrow (but very real) scar along my hairline. I really feel that FUE into the scar using beard grafts at the same time when you are having your next surgery would be your best bet. Also you may find you require two passes as scar tissue is not vascular and not all of the grafts may grow. I would also consider SMP first of all as it is the least invasive procedure. Wishing you all the best and I share your concerns when it comes to scars.

[BDK081522]

That's an unfortunate scar but luckily you have options. Honestly, I think another FUT with scar excision may be your best bet but I wouldn't go back to Dr Arocha. You need a scar specialist and I don't think there's anyone in the world better at FUT scars than Dr.Konior. Of course, there's always risk of the scar stretching again but in the skilled hands of a great surgeon you lower that risk. Your donor does look thick so you will have FUE options down the road but I wouldn't use those grafts at the moment to fill in the scar. 

[ABK]

Hey everyone, I really appreciate the guidance (particularly the personal stories). I'm still very conflicted, but at least I have some more perspectives to consider. Thanks for your feedback on this.

[Al - Moderator]

How many days did you have the staples in? If you have them removed too soon it can cause some stretch along the scar line. Even if the scar is healed enough where it won't open up, if you still have a lot of tightness then that's the first place that will stretch back as that's where the scalp is being pulled from both above and below the scar. I would do another FUT along the scar to remove it and get a few extra grafts to add density in other places where you need it with the following protocol:

1. Do some scalp stretching exercises every day for a few weeks before the procedure to create some laxity.

2. Do an FUT to remove the scar and get some extra grafts to fill in some other areas that you wanted filled.

3. Keep the staples in for at least a few days longer than you did the first time, so the stretch back will be forced to happen throughout the rest of the scalp and not along the scar.

 

The downsides to this is that you may not get very many additional grafts for filling in other areas. That really depends on how wide the scar is and how much laxity you have. You don't want to try to go too wide and have too much tightness because you don't want to risk the scar stretching again.

 

 

 

[1978matt]

Dr Konior in person evaluation of the problem is your best bet.

He will know if it is worthwhile to try another FUT or go straight to FUE.

[ABK]

Hey everyone, quick update. I reached out to Dr. Konior. I was very impressed by his thorough written response to my personal situation. 

Unfortunately, he appears to be booked until February 2023. I've asked to be on his waiting list, but that's admittedly much longer than I was hoping to wait on getting the scar situation corrected. 

 

I'll keep everyone posted on the next steps. Thank you!

[hairlossPA]

feb 2023??? jesus

[ABK]

Any thoughts on Dr. Wong for FUT scar repairs? I searched the forum, but I unfortunately found very little on that subject. 

[hairlossPA]

On 10/24/2021 at 11:02 PM, ABK said:

Hey everyone, quick update. I reached out to Dr. Konior. I was very impressed by his thorough written response to my personal situation. 

Unfortunately, he appears to be booked until February 2023. I've asked to be on his waiting list, but that's admittedly much longer than I was hoping to wait on getting the scar situation corrected. 

 

I'll keep everyone posted on the next steps. Thank you!

just curious, did Dr. K provide any feedback with which way he would go?

[hairlossPA]

my personal opinion, for someone having went FUT as well and have a very similar scar to yours, I am leaning FUE for future procedures and taking the tradeoff of putting 300-500 grafts in my scar using beard and scalp FUE.

[ABK]

15 hours ago, hairlossPA said:

just curious, did Dr. K provide any feedback with which way he would go?

He did! He suggested FUT to remove/repair the scar (while pulling about 500 grafts), followed by FUE for the remaining areas I was hoping to address (temples, scalp, crown).  Unfortunately though, Dr. K is fully booked, and I would really like to get it addressed sooner rather than later. 
 

Dr. Wong is available in December. He felt that he could do another FUT with around 1,500-2,000 grafts while also repairing the scar. I haven’t found many photos of his scar revision work, though I know his clinic is well regarded. 
 

if anyone has thoughts on Dr. Wong, especially when it comes to scar repair, I would appreciate it. 

[Britanium]

2 minutes ago, ABK said:

He did! He suggested FUT to remove/repair the scar (while pulling about 500 grafts), followed by FUE for the remaining areas I was hoping to address (temples, scalp, crown).  Unfortunately though, Dr. K is fully booked, and I would really like to get it addressed sooner rather than later. 
 

Dr. Wong is available in December. He felt that he could do another FUT with around 1,500-2,000 grafts while also repairing the scar. I haven’t found many photos of his scar revision work, though I know his clinic is well regarded. 
 

if anyone has thoughts on Dr. Wong, especially when it comes to scar repair, I would appreciate it. 

Having followed both H and W for over a decade I have always thought they both do some of the best FUT work I have ever seen. And mostly the scarring ends up pencil thin. I’m sure they would provide you with pics to back that up if requested. Along with Hattingen, Bloxham definitely good choices ! 

[Strongman]

I just got my FUT scar repair done at Eugenix with Dr Arika, fully satisfied with the procedure and now waiting for the results eagerly!

[Melvin- Admin]

I just got off the phone with Dr. Arocha, he gave me some background on the case. Unfortunately, one of the cons to getting FUT is the possibility of the scar stretching. Every single surgeon has had cases where the scar has stretched, scarring is physiological to an extent. While I respect everyones opinions on getting scar revision, the truth is that there are no guarantees. Scar revision is more invasive and is a gamble. I think you would be way better off getting FUE, having some beard hair transplanted to the scar, and then possibly some smp as well. I would not recommend getting another FUT or scar revision. In my opinion, Dr. Arocha is a highly ethical and capable surgeon. If you have a good relationship, I wouldn't count him out, but of course, getting another FUT with anyone will be a risk.