Bernstein Medical - Center for Hair Restoration - Scar Thickening
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Q: I have a diagonal scar in the middle of my donor area that I got during a childhood accident and I am concerned that it will limit my options for hair restoration. Will this type of scar prevent me from having either FUT or FUE? Do you recommend one or the other? — R.F., Upper West Side, NY

A: Traumatic scars in the donor area do not preclude us from performing a hair transplant. With an FUT/strip procedure, we can remove all or part of the scar when we excise the donor strip. In Robotic FUE, the ARTAS Robot can be programmed to avoid a scar during harvesting. In either procedure, we can improve the appearance of the scar by implanting follicular unit grafts directly into the scar tissue. The hairs will grow permanently in the scar, just like ones we implant in the recipient area, and the scar will become harder to detect.

It is important to note that transplanted hair will not grow in a thickened scar. If your scar is thickened, the doctor can thin it out (soften it) with injections of cortisone. They are usually repeated at 4-6 week intervals in advance of the procedure. The number of injection sessions required depends upon the thickness of the scar and your individual response to the medication.

The presence of a traumatic scar should generally not determine which type of transplant you have. That should be decided in consultation with your physician based on factors such as how much volume you need, how you intend to style your hair, how short you would like to keep it, how soon you need to return to strenuous physical activity, and other general considerations for a hair transplant.

We recently posted photos from a patient who had a robotic hair transplant with a scar in his donor area. The photos include images of his donor area (with scar) before his procedure, immediately after robotic graft harvesting and 11 days post-op. View this patient’s before after photos.

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Q: If you have already had a hair transplant, once cloning becomes available, will you be able to transplant the cloned hair into the first transplant’s scar on the back of the head? I like to wear my hair short, especially in the summer, and also would feel more comfortable knowing there is no scar in my head. — H.I., Rockville Centre, N.Y.

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.

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Q: I just started to lose my hair but it’s just in one spot, like a circle on the left side of my head. Do you ever do a hair transplant just into a bald spot and not the whole head? — D.F., Esher, U.K.

A: It is possible to have a hair restoration procedure into a single bald spot. However, it would be most beneficial to first determine the cause of the condition.

Bald spots caused by alopecia areata (an autoimmune disease) are best treated with injections of steroids into the scalp, rather than with a hair transplant. In fact, the transplanted hair can be rejected in patients with this condition.

Traumatic scars (i.e. from an accident) can be treated with follicular unit hair transplantation as the hair grows quite well in scar tissue, as long as the scar is not thickened (hypertrophic).

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Q: I am Hispanic and I have thick, black coarse wavy hair. Do you transplant Hispanics and are there any difficulties in performing hair transplants in them?

A: Yes, we treat Hispanic patients. There are no specific issues unique to Hispanics when performing hair restoration procedures. However, things to consider are:

  1. Hispanics have a slightly greater incidence of forming a thickened donor scar than Caucasians (but not as great as African-Americans)
  2. Hispanics often have coarse hair, but a low donor density, so fewer absolute numbers of grafts may be available for the restoration. The coarse hair, however, will make the restoration appear fuller.
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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? – Darien, C.T.

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.

  1. Since the blood supply of the scar tissue is less than in normal tissue, the grafts should not be placed as close.
  2. As the grafts from the hair transplant grow, new blood vessels are formed in the area.
  3. Additional density can then be achieved in a subsequent session by adding more grafts.
  4. 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.

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