Hi I have a quick question that hopefully somebody will be able to answer. I have had two hair transplants in the past 5 years both of which used the same scarline because my first transplant was minimal. My second transplant left me with a fairly noticeable scar and I cannot cut my hair with anything less than a 4 guard blade. I am still ok with this but I am considering getting my third and hopefully final hair transplant but my only concern is that this scar will worsen. Is there any chance of a third procedure worsening my existing scar?

Thanks!

bchap,

Welcome to our community.

Scar stretching is certainly a risk with hair transplant surgery but subsequent surgeries does not necessarily mean a wider and more obvious scar. Donor scarring depends on a number of factors including

* width of strip removed (wider the scar removed, greater possibility of scarring depending on donor elasticty)

* donor elasticity (the greater donor laxity, the lesser the risk of scar stretching UNLESS there is a lack of supporting collagen due to having thin skin)

* postoperative care (be careful not to do anything the first several months that will strain the scar)

* Unknown factors (hair restoration physicians admit that scar stretching mayh occur for reasons out of anyone's control that are unknown)

The first one is in the doctors control and will base their decision of strip removal based on hair restoration needs, scalp elasticity, and donor hair density. A first-rate hair restoration physician with a lot of experience will know how wide of a strip they can remove safely without causing too much tension on the skin that would increase the risk for scar stretching and infection

The third is in the patient's control. Use caution when doing anything too physical the first several months.

I hope this helps.

Falc

Dear Bchap,
I am assuming from your comments that the wide scar is throughout its length and not localized only at the two parietal corners, which are the most notorious sites for widening.
There are three approaches that could be taken. One would be to take three small strips that are not connected together, leaving an un-touched gap at the corners, to help stabilize things. If your wide, detectable area is primarily most noticeable at the corners and behind the ears, this would make the most sense, as these two areas would not be worsened. Since you had the widening with your second procedure, the width of these new strips should be on the narrow side to avoid tension on closing the wound. These small strips should be taken contiguous with your old scar, so you end up with a single scar and not "stacked" scars (which look hideous and much more detectable than a single wide scar).
The second approach is to simply remove a long, narrow strip along the top of your old scar, of sufficient length to provide the grafts you need, close it in two layers,leave the stitches in for two weeks, and then - assuming you are truly done with transplanting - come back a year later after some laxity returns, and have a narrow scar excision procedure done, removing a narrow strip of scar tissue the full length of your scar. If for some reason excision is not possible due to scalp tightness at that time, then FUE into the scar could be done instead.
The third alternative would be to have an all-FUE session done, which wouldn't put additional stretch and stress on your present scar, but such a session would be a lot more expensive and time-consuming, which is a prohibitive obstacle for many patients.
The last recommendation would be to make sure your expectations for additional hair are not outlandish, which would put pressure on your doctor to take more hair than possibly should be harvested from your scalp, given your desire to wear your hair on the short side and your propensity for scarring. Obviously, the best judge on these things will be your hair surgeon, who will examine your scalp and scar and decide which approach is best. These are some of the thought processes we go through when someone with a problem similar to yours presents.
Best wishes,
Mike Beehner, M.D.