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Can Hair Transplant be Performed on Scar Tissue from Prior Surgery?

October 13th, 2005

Q: I have had some surgical procedures on my head that left a fair amount of scar tissue. Can hair grow there? Is it a more difficult procedure? Are there any complications?

A: Transplanted hair will grow in scar tissue as long as the tissue is not thickened. Thickened scar tissue can be flattened with local injections of cortisone.

Once the scar is smooth, the hair transplant procedure is relatively straightforward, however a few things must still be kept in mind.

Since the blood supply of the scar tissue is less than in normal tissue, the grafts should not be placed as close.
As the grafts from the hair transplant grow, new blood vessels are formed in the area.
Additional density can then be achieved in a subsequent session by adding more grafts.
After the hair restoration procedure, care must be taken with grafts transplanted into scar tissue, as the scarred scalp doesn’t hold onto grafts as well as normal tissue and they are more easily dislodged.

If grafts are packed too closely into scar tissue, poor growth can result. If sites are placed properly and the post-op care is diligent, good growth should be expected.

Posted by Robert M. Bernstein M.D. at 10:48 am

What is Effect of Multiple Hair Transplant Procedures on Scalp?

October 12th, 2005

Q: I have had 4 hair transplants with strips taken out for a total of 2600 grafts over 15 years. The last one was 1,650 grafts. My doc says my donor site is good for a few more but I think it has been probably stretched to its max. Is it believable that the skin can be stretched to such extremes safely?

A: The scalp is very resilient to stretching, particularly in those with a loose scalp to begin with. After removing a strip, the laxity often returns to normal or very close to it within 6 months to a year.

The problem with multiple hair transplant procedures is not only that scalp laxity may decrease, but that the donor density decreases as well. If too much hair is harvested, the donor area may eventually appear too thin. This may happen with either Follicular Unit Transplantation (FUT) or Follicular Unit Extraction (FUE).

Therefore, it is important the doctor not only assess the scalp laxity, but the residual donor density.

Topic: Multiple Sessions

Tags: Donor Area / Donor Hair Density / Donor Hair Harvesting / Follicular Unit Extraction / Follicular Unit Transplant / FUE / FUT / Multiple Hair Transplant Sessions / Scalp Laxity / Scalp Stress / Scalp Stretching

Posted by Robert M. Bernstein M.D. at 2:20 pm

Is There a Second Scar with Second Hair Transplant?

October 7th, 2005

Q: When a second hair transplant is performed, should there be a second incision or should it be incorporated into the first?

A: It is a very common practice to make a second separate scar in the second hair restoration procedure. This is done to maximize the hair in the second session, and it is technically the easiest to perform. If you incorporate the old scar in the new incision, there will obviously be less hair. As long as the upper incision is still in the permanent zone, the hair quality will be good.

That said, in my practice I almost always use only one scar. The subsequent procedure would incorporate the first and extend the scar to one side or the other (or both). I generally use the old scar as one edge of the new strip so that there is only one incision into virgin scalp (rather than two).

There are a number of reasons for this technique.

The hair will always be taken from the mid-portion of the permanent zone, so we utilize the thickest, most stable hair
A line scar in this location is generally the least visible and most easily camouflaged with the persons existing hair
One avoids making a scar too low that increases the risk of widening the scar
One scar will be easier to camouflage with Follicular Unit Extraction (if this is ever necessary)

Topic: Hair Transplant

Tags: Camouflage Donor Scar / Donor Scar / Follicular Unit Extraction / Incision / Line Scar / Permanent Hair Zone / Second Hair Transplant

Posted by Robert M. Bernstein M.D. at 11:24 am

Hair Transplant Starting with Crown?

October 5th, 2005

Q: What are your thoughts on performing a hair transplant to the crown first?

A: It depends upon the person’s age, how bald he is likely to become, and the donor supply.

As a general rule, the crown should not be transplanted in a younger person (under 30) as the extent of his balding is hard to predict and crown thinning at this age often suggests that the person will become at least a Norwood 6.

If a person has enough donor hair (i.e. good donor density) and scalp laxity, so that coverage of the entire bald area can be accomplished if the patient becomes a Norwood class 6 (and it is unlikely that he will become a Class 7), then transplanting the crown before the front is reasonable.

If a person has a family history of baldness limited to the crown, even at an advanced age, and the person in question is following this pattern, then earlier treatment of the crown may be considered.

Lastly, if you do treat the crown in a younger person, or one with whom the extent of hair loss is uncertain, the crown should be transplanted with light coverage only. That way a limited amount of hair will be used up in this area and there will be enough left over for the more cosmetically significant top and front of the scalp.

For a complete review of this topic please read: Follicular Transplantation: Patient Evaluation and Surgical Planning. Dermatol Surg 1997; 23: 771-84. A copy in PDF format, and other hair transplant publications, can be downloaded at the Bernstein Medical – Center for Hair Restoration Medical Publications page.

Topic: Crown (Vertex)

Tags: Bernstein Medical - Center for Hair Restoration / Crown / Donor Hair / Donor Hair Density / Family History / Follicular Transplantation: Patient Evaluation and Surgical Planning / Hair Transplant Age / Hair Transplant Medical Publications / Norwood Class 6 Hair Loss / Norwood Class 7 Hair Loss / Norwood Hair Loss Classification / Scalp Laxity

Posted by Robert M. Bernstein M.D. at 1:43 pm

Do You Use Anesthesia During Hair Transplant?

October 5th, 2005

Q: Will I be unconscious during the hair transplant procedure and do you use general anesthesia?

A: All of the surgical hair restoration procedures at Bernstein Medical are performed under local anesthesia. The fact that general anesthesia is not needed is what makes hair transplant procedures – even though they are long – very safe.

Patients are given a sedative to help them relax, but they are not put to sleep. Most patients watch TV, see movies or just chat during the procedure.