Q: When a second hair transplant is performed, should there be a second incision or should it be incorporated into the first? – D.V., Inwood, N.Y.

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.

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