A: Widened scars can be improved in two ways: they can be re-excised to make the scar finer, or hair can be placed into the scar to make it less visible.

Excising a scar works best when the original incision was closed with poor surgical techniques. In this case, using better closure methods can improve the scar. When the scar is the result of a person being a naturally “poor healer,” a wide scar will be the result – regardless of how the incision was closed.

I often approach the problem by excising a small area first, to see if I can decrease the width of the scar. If so, I would then proceed to excise the rest of the scar. If not, I would obtain hair using follicular unit extraction (FUE) — extracting hair in follicular units directly form the scalp — and place this hair into the scar. The hair placed in the scar can also be obtained from the edges of a partially excised scar.

If a wide scar that is thickened (called a hypertrophic scar) is also excised, it will usually reoccur and may result in an even worse scar. Because of this, thick scars should be flattened with injections of cortisone prior to removing. This will decrease the chance of a recurrence.

Flattening the scar is also important to permit the growth of newly transplanted follicular unit grafts.

For more on this topic, please see the Bernstein Medical – Center for Hair Restoration web page on fixing scars.

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: Although dermabrasion can flatten elevated edges, it will not eliminate the round, white circular scars that results from old punch graft hair transplants.

The scarring in these procedures goes all the way through the dermis to the fat. Dermabrasion can only go down to the upper part of the dermis without causing further scarring.

Graft excision with suturing removes the plug as well as the underlying scar and will eliminate the tell-tale circular marks of the older hair restoration procedures.

A: The hair from the excised grafts is always re-implanted.

The grafts that are removed are dissected into individual follicular units and then placed back in the recipient area in a more natural distribution and angle. See this patient’s hair transplant repair in the Hair Transplant Repair Photo Gallery on the Bernstein Medical – Center for Hair Restoration website.

A: Follicular units in a plug are already compressed and scarred down. Trying to remove them individually will result in a worse cosmetic outcome as the underlying scar tissue will not be removed.

In addition, extraction of individual follicular units from scar tissue is more likely to cause damage to the hair follicles. Removing the entire graft is generally better for these reasons.