Hair Restoration Blog

Q:

Hi Doctor,

I am a class VI hair loss patient and have had one hair transplant in the past to get some thin hair on the front and top.  I am keeping my hair very short on the back and my primary goal was to camouflage the scar in the back of my head from previous hair transplants. So far, I have achieved this simply with longer hair, and the rest of my scalp was covered with Toppik-like products.

Cosmetically, it was successful, but usage of this kind of product is a bit messy and cumbersome. Thus I have shaved my head completely to try a different route. With the help of tattooing, I was going to go for a shaved head. Of course, the scar is a show-stopper and I need to consider my options. What I would consider successful is this: short hair covering my head completely, even with relatively light density. Combined with tattooing and a self-tanner to reduce contrast, that would be a success to me. I am not “greedy” about the sides at the front, and will accept a 3 or 3A pattern.

Is it possible in my case?

A:

It is good that you are not after high density and that you are realistic about the final appearance of your hair.  Being a class VI with limited donor hair, it should be possible to create some light density in the large balding area, but obtaining more density would be impossible or difficult due to your insufficient donor.  You need to know what your priorities are and how many surgeries you are committed to have.

• If you only need to revise the scar and get trichophytic closure to minimize the visibility of the scar, one surgery is adequate.  Double edged trichophytic closure is a new technique that can improve the appearance of the scar tremendosly.
• If you are after achieving higher densities and scar revision, you may need several hair transplant procedures if you have enough donor for them.

Through a consultation with an experienced hair transplant doctor, your donor hair can be easily evaluated and that can give you a good idea about what could be expected (in your case).

Here is a new article from Wang et al from PLA Burn Institute in China that has been recently published on hair transplant for cicatricial alopecia due to burn.

The investigators evaluated one hundred and sixty six burn patients that had some balding patched on the scalp as the result of the burn injury over six years.  Hair follicles were obtained from back and side of the scalp and transplanted into the hair-less areas of the scalp.  They then made size-matched incision and implanted the grafts into the scarring area. They evaluated the patients in person and through satisfaction survey.

The author of the article reports that in half of the cases, patients have been satisfied with only one hair transplantation procedure, while in another half they needed another hair transplant into the scar within a year after initial hair transplantation surgery.  96.5% of grafts have survived and grew.  The authors concluded that the technique of perforating and transplanting follicular-unit hair synchronously is safe and effective with minimal surgical injury and negligible bleeding. Transplanted hair on cicatricial alopecia area with this technique grow well with high survival rate.

I presented the article “Hair Transplants for Neurosurgical Scars” 3 years ago in the annual meeting of the International Society of Hair Restoration Surgery in Las Vegas Nevada.  In there we presented a case study of several patients with scalp scar from brain surgery, trauma scar or other neurosurgical scars that have been successfully treated with hair transplantation. Today we see more evidences of treating scars of the scalp, face and other hair bearing areas of the body with hair transplantation.

Q:

We discussed the possibility to close the scar, which I think is a good idea, but again, I had already achieved camouflage with longer hair. While it may only be a 2-hour operation, I admit being very weary of such an operation because my skin is already so tight. I understand that the skin exercises you recommended should help a great deal, but for whatever reasons I am not comfortable with such an operation, especially considering that I would like to cover the whole head with some hair anyway. Perhaps you will convince me on the scar revision, or maybe you will advise me to pursue the FUE plan which would cover the rest of my head. Assuming I have an “average” density in the donor area, how many grafts do you think you could extract from it? How good or bad would be the mini-scars scattered all over the back of the head? I am assuming the surrounding hair will camouflage them?

A:

If you don’t want to pursue scar revision, the only option will be an FUE transplant into the scar from neighboring areas.  I recommend for you to wait until we see you in your follow up visit with a little longer hair before continuing. You also need to schedule for the FOX test to determine your eligibility for a Follicular Unit Extraction procedure.  The answer to your questions about how many grafts could be harvested in one session of your FUE procedure will be answered the day we do FOX test and confirm your eligibility.

You need to contact US Hair Restoration to schedule the FOX test as soon as you are able.  FOX test’s are done quite easily and assisted by numbing a very small area on the back of your scalp. The small scars of the FUE are going to be scattered throughout a larger area.  That can minimize the visibility of those pinpoint scars.  If you keep your hair not too short it is generally not possible to see them at all, but with a shaved head the tiny scars might be detectable from a close view.