I was interested if the tightness of a persons scalp in the recipient area can have an effect on the cosmetic outcome of grafting into the area in regards to the appearence of the scalp surface. Would a tighter scalp be more prone to a raised bit of tissue around the grafts. Do the techs placing grafts have to apply longer pressure when inserting to set the grafts? Would a lateral slit or a needle making the insertion sites also be a factor when trying to avoid bumpiness taking into account using FU's properly trimmed ?

I don't believe that surface tension should affect the final appearance of the graft. Of course, this is assuming a capable surgeon.

Mine were inserted in scar tissue (which has additional surface tension) along the hairline and the appearance is undetectable from the non transplanted hairs.

The limitation of a tight scalp will be density, as the doctor won't be able to pack the grafts as tightly.

In my opinion a tight scalp will not influence final density, in regards to placement. Tight scalps may be a factor in how many grafts can be harvested, which is a factor in density, so in that regard, yes a tight scalp may influence density. That's my opinion.

I have heard that the lateral slit gives the best cosmetic result on the scalp surface (least chance of bumpiness, etc). If this is true, it is a big reason to consider doctors who use the lateral slit technique.

Dr. Parsely,
I read a post (I think by Dr.Cole) that the primary difficulty with grafting into scar tissue was surface tension, not limited blood supply. This was a while ago, so my memory might be playing tricks on me.

During my surgery with Dr.Wong, he explained that he was inserting grafts within the scar tissue with less density than otherwise might have been the case. I assumed that this was because of the increased surface tension that scarring causes. Might I have misread this? Thanks.

Jim

I have found that the cause of the scar and the thickness of the scar have a great deal of bearing on the outcome. Scars caused by foreign bodies such as transected hairs and artificial fibers cause a thickened scar that is often still active. These type scars have a higher frequency of poor growth. Fibrotic ridging at the hairline is therefore a problem. Thickened scars from scalp reductions can sometimes be a problem. If the increased surface tension are part of the above conditions, then I find they don't accept grafts well.
In my experience burn scars, radiation therapy scars (or loss), and split thickness grafts allow hair to grow well.
I think that the bulbs of the planted grafts need to be below the scar and not implanted into the middle of them. No studies, just my experience.

Thanks for your response.
Jim

it appears that scalp tension due to scarring and tightness that occur just through nature are looked upon differently in the HT world.

As I've previously posted, my growth along the hairline and within the scar tissue has been magnificent. I assume then that Dr.Wong's application of the lateral slit, the use of custom blades for the tightest possible fit and the proper spacing all contributed to the success.