Transplanting hair into areas with severe scarring


Scarring occurs 100 percent of the time after hair transplant surgery, but if it can’t be seen or doesn’t impact hair growth, it’s not a problem. Scarring can occur in either the donor or the recipient areas. Donor area scarring is pretty much a given in patients whose hair is harvested by the strip harvesting technique, but it may be minimized by certain surgical techniques that can make them almost undetectable in most patients. However, keep in mind that some patients will always scar more than others.

Scarring in the recipient area is very rare with modern techniques. Having a scar removed later may result in another scar in the same place, although specialized surgical techniques may make cosmetic improvements. The degree of scarring after a first surgery where the wound measures more than 3 millimeters occurs in about 5 percent of patients. After a second surgery, this risk doubles. Scars of this size generally can’t be seen if the hair length in the back of the head is 1⁄3 inch or so.

Although the major effect of removing hair from the donor area is decreasing the amount of available hair for use elsewhere, when scarring is severe, the scar itself may become a cosmetic problem. This is most likely to occur when the scar is placed too high (in the non-permanent zone), is placed too low (near the nape of the neck or over the ear), is excessively wide in any location, or is raised and results in a hypertrophic scar or a keloid.

Transplanting hair into areas with severe scarring can cause graft elevation or depression, loss of grafts after the surgery, and poor hair growth. Mild scarring may result in subtle textural and visual irregularities in the skin around the grafts, distort the hair direction, and cause a change in quality of the hair shaft, all reducing the chance of a cosmetically satisfactory result.

Laser hair transplantation, more aptly termed laser site creation, represents the epitome of purposeless scarring. The laser is nothing more than a marketing gimmick; it’s basically a glorified punch that creates recipient holes or slits in the scalp by removing (vaporizing) tissue. Regardless of how little damage is done to surrounding tissue, the recipient tissue directly under the beam is totally destroyed. (The laser has the additional disadvantages of increased set-up time, greater cost, and potential eye hazards.)

Laser operators lack the precise tactile and visual guidance to adjust for depth and angle when making sites on a curved scalp. Most important, the laser destroys tissue, produces third-degree burns, and unnecessarily increases the recipient wound size.

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This article was sent to us by: Kelly Makay at 06212010

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