Hair Restoration Blog

Q:

I had a hair transplant in past and planning to have another one. Part of the scar from the first procedure is often visible on the right side of the back of my head even when my hair is pretty long. It’s just a small section, but during the second procedure would it be possible to minimize its visibility further by transplanting a small amount of hair into that area (not sure if this is safe or not if the grafts are being removed from a nearby area) or through other means?

Stretched Hair Transplant Scar

A:

In order to minimize the visibility, we will do a double-edge trichophytic closure on the donor scar. We generally have more flexibility with our trichophytic closure during the second procedure due to the fact that we now know how aggressive we should be in bringing hair into the scar. The second time around, we know how your body scars and can anticipate what kind of stretching will occur. Going further, in the future we can place hair into the scar if needed with filling the scar with FUE transplant or even use SMP (scalp micropigmentation), which will minimize the visibility of the scar by placing pigments in it. Everything discussed above will be addressed in the future if necessary.  Whether to use FUE or SMP to minimize the visibility of hair transplant scar is discussed in another blog post.

Follicular Unit Extraction (FUE) and Slap Micro Pigmentation (SMP) could be both used to minimize the visibility of the scalp scars after a strip hair transplant procedure.  At US Hair Restoration, we offer both these techniques.  However, there are pros and cons to each that the patients need to know before proceeding with the procedure.

FUE for Scar Revision

FUE transplantation into the donor scar: Left side - Intact scar, Right side - FUE grafts transplanted into the scalp scar

Since the extraction of individual follicular units (FUs) is done individually it is perfect for the small procedure of revisioning a hair transplant scar from a previous hair transplant. The surgeon can extract a small number of grafts from the permanent zone and artistically and strategically place them in the scar. This process of using FUE uses hair to obscure and blend the margins of the scar to the surrounding scalp.

SMP for Scar Revision

SMP to minimize donor scar visibility after hair transplantation - Picture is taken immediately after the SMP procedure

Scalp Micro-Pigmentation is the process of using special pigments and fine needles to create the shade of stubble or shaved hairs on the scalp. SMP utilizes dermal pigments that match the patient’s hair color. Used in scars like FUE it can artistically applied revises the margins of the scars. This revision results in the obscuring or blending of the scars margins to the surrounding scalp.

SMP vs. FUE for Scalp Scar Revision

choosing FUE rather SMP for revising the scalp scar has to do with the type, location and size of the scar.  It also has to do with the patient preferences.  If patients are willing to keep it very short or they want to completely shave it.  It is good for the patients to educate themselves with pros and cons of each technique in order to make a more informed decision.

FUE and SMP

FUE and SMP are two methods that can also be used in conjunction with one another to revise a hair transplant scar. Recommendations and the preference of the surgeon most often provide the best results. These modern advances in scalp scar revision are performed in Los Angeles leading hair transplant centers like US Hair Restoration.

Q:

Dr. Mohebi, I had a surgery in 1991. At the time it was better than being bald I thought. But the joke even in my house is “Doll Head.” Is there any help for guys like me; can you repair older plug-like transplants? I am anticipating your answer.

  A:

Absolutely, there is hope for you.  In fact, we perform a few repair hair transplant surgeries every month.  Mostly for people like you with plug hair transplants from the past; modern advancements and techniques have really increased your options.  Most people could use Follicular Unit Transplant (FUT) to restore the appearance of their hair significantly.  Here are some of the procedures that could help someone with an outdated plug surgery:

Creating a transitional zone consisting of refined follicular unit grafts in front of the plugs

1. Filling in between the plugs and even out the area so they won’t be as noticeable.
2. Thinning out the plugs by removing some of the hair units through follicular unit extraction techniques.

Unlike what some people think, plug transplant results from old hair transplant procedures are easy to repair in most cases. That means you and many people can enjoy a natural undetectable look after a hair transplant repair surgery no matter how un-natural their current hair may be.

Q:

Hi Dr. Mohebi,
I saw on Channel 4 News a new type of hair restoration called the Fleming/Mayers flap method. What is your opinion on this procedure vs FUT?

A:

The Fleming/Mayer Flap method used to be one of the more solid options for treatment of frontal hair loss in patterned baldness, but with today’s more advanced methods of microscopic follicular unit transplantation, flap surgery does not have any place compared to hair restoration surgery. The result is unnatural, causing an awkward hair angle and unusually high density in the narrow strip at the front. There is an exposed linear scar on the front of your hairline.

There might be some occasions when the flap surgery might be beneficial, but for a routine patterned hair loss hair, restoration it is not recommended anymore. In fact, we do repair the scar of the patients who had a flap surgery in the past and create a transitional zone consisting of single and double hair grafts in front of the flap (this is only possible if the flap is placed high enough). Unfortunately in cases that the flap is not high enough we cannot do much to repair them and at times we have to remove some hair from the flap area to thin it out and make it look more normal.

Dr. Mohebi,

You performed a hair transplant on me to make a female hair line as part of my male to female transgender process.  I recently decided to do a scalp surgery that may require a scalp advancing procedure.  My Dr. Will transplant hairs along the scar in hairline.  I am not convinced this will be enough, and we may need to do one final pass after all is done to be sure, possibly the middle of next year.  I’ll have to wait and see, money is also an issue.

A:

Good luck with your scalp advancement surgery. Please do your research and make sure your plastic surgeon does perform hair transplant on a regular basis before letting him place hair on your hairline.  It is especially important that he has experience with creating hairline for transgenders.

If he is not doing hair transplant on a regular basis as is the case for many cosmetic surgeons, it might still be OK to have him put the hair removed during the scalp advancement surgery on the top areas, where you still need more reinforcement.

Hairline is very meticulous specially for male to female trans gender patients.  We can easily repair the hairline in front of the scar of your scalp advancement surgery.  It will be more difficult if there is less than perfect transplanted hair on the hairline area.  that requires removing the hair grafts that are transplanted out of their normal locations and reuse them in the other areas.