A: Yes, as long as the scar is not thickened, cloned hair should grow just as normally transplanted hair would and would be a great way to address any residual scarring from the procedure.

Although hair can be transplanted into widened scars, hair does not grow well in thick scars – this would apply to hair restoration procedures performed via traditional means as well as those using cloned hair.

A: Minoxidil has been prescribed (off-label) in combination with other medications, such as topical retinoic acid (Retin-A), to enhance its penetration into the skin and thus increase its effectiveness. This combination of medications, however, can significantly increase the absorption of minoxidil into the bloodstream and may increase the risk of potential side effects, including changes in blood pressure and severe scalp irritation that has, on occasion, led to scarring.

If person wants to add Retin-A to the minoxidil regime, the Retin-A should be applied only once a day, since the Retin-A will bind to the skin and will last for at least 24 hours.

Applying Retin-A more frequently will not increase its effectiveness (in facilitating the absorption of minoxidil); it will only increase the incidence of side effects. Retin-A can be applied to the scalp at the same time as Minoxidil, or by itself.

Retin-A should not be compounded with minoxidil (mixed together by your pharmacist or your doctor) for the following reasons:

1. Minoxidil works best when used twice a day. Retin-A is best used once a day.
2. Using Retin-A twice a day wastes money and increases the incidence of side effects
3. If you develop side effects from the Retin-A, it is best to stop only the Retin-A. If they are compounded, you would need to stop both and will lose the benefit of minoxidil.

Explore the pro’s and con’s of Minoxidil — also known by its over-the-counter product Rogaine — at the Rogaine/Minoxidil page on the Bernstein Medical – Center for Hair Restoration website or by viewing minoxidil-related posts on the Hair Transplant Blog.

A: Graft excision generally works better than FUE in removing old plugs and mini-grafts. In these grafts, the hair is not aligned due to the scar tissue that forms from the large recipient sites. Because the hair direction is altered from the scar tissue, there is much more damage when the grafts are removed with FUE.

Another benefit of graft excision is that we can remove the underlying scar tissue and improve the appearance of the skin.

Finally, graft excision sites are sutured closed so they heal with an imperceptible scar. FUE sites are left open and the white scars at the hairline can be visible.

A: Hair can grow well in a scar. Since scar tissue generally has a somewhat lower blood supply than normal tissue, we have to make some adjustments in the technique.

When we perform a hair transplant into a large scar, we place the grafts into the perimeter first i.e. the outer edge of the scar. This allows new blood vessels to develop and permits additional hair to be added more centrally at a later date until the whole area is filled in.

If the scar is small or thin it can be transplanted as with normal tissue.

A: Follicular Unit Extraction is ideal in very tight scalps, provided that there is enough hair to extract without leaving the donor area too thin and provided that the follicles are not too distorted from the scarring.

With strip harvesting, undermining techniques may be helpful to close the wound edges once the strip is removed.

In undermining, the surgeon uses either a sharp instrument (scalpel) or blunt instrument (the dull edge of scissors) to separate the upper layers of the scalp (dermis and epidermis) from the lower part of the scalp (fascia). The hair transplant surgeon accomplishes this by spreading apart the fat layer of the skin or by cutting through scar tissue.

Undermining allows the upper layers of skin to literally slide over the lower layers and can significantly increase the ability to close a tight wound. However, if not done carefully, it may increase the risk of bleeding and injury to nerves and occasionally may damage hair follicles.

Undermining is usually used with a layered closure where the deeper tissues are brought together first with a layer of absorbable sutures before the surface of the skin is sutured closed with sutures that are removed.