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Hi Guys, great blog. With regards to hair transplantation, I understand that there will be a scarring of some type in the donor area. My question is, with regards to the recipient area, once the grafts have initially dropped out, are there scars in the recipient area where the grafts were placed?


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There is always scarring with any cut on the skin, but the visibility of the scarring depend on not only the surgeon’s skills, but also the individual.

The recipient area can usually appear red (in a fair group of people) for several weeks, but most patients will show no visible scarring in the recipient area after about 1 to 3 weeks.

Tags: hair transplant, hairloss, hair loss, scarring


We received some Scalp MicroPigmentation (SMP) questions:

1) The results pictures on the website all seem to show everyone with shaved heads. Should I expect the ability to cut my hair that short after the procedure and not have the scar visible? or are those atypical, “best case” scenarios? I know there will always be some irregularity but the pictures show it being very difficult to discern. This isn’t a make it/break it question. I’d be happy to cut my hair down to 1/8″ without the scar visible. I just want to make sure my expectations are in line with reality.

2) Must I shave my head for the procedure itself?

3) If I do have my head shaved and I expose the SMP’d scar to the sun, will it fade?

4) Is the SMP permanent? Permanent as in, I do this once (the 3 sessions) and it lasts for 50+ years? Or is there an expected life span for the SMP?

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1. The photos on the SMP website show most people shaved, because that is what makes the scar blend in with the stubble of hair and the flat pigment of SMP underneath your skin.

Keep in mind, if you get SMP for a scar, it is not hair and that there will be a “step” in the hair where there is a scar. SMP will only make the scalp darker so you wont notice the white line. If you keep your hair 1/8 inch long you may see the step of where the hair starts and ends. Most patients shave or buzz their hair around the scar with an electric shaver set at zero guard or they keep their hair long enough to cover the invisible scar. Everyone is different in their degree of how they hide the scar, but you must remember that you will always still have a scar. SMP only helps hide it to most casual observers. No matter how good we get your SMP, you will always notice the scar in certain lighting and certain angles… and you will notice it more because you know how to look for it.

2. You don’t have to shave, but if you are ever going to shave later it will help us blend it in better. We work with longer hair all the time (this is not an issue). It is when we finish the job with long hair and later you decide to shave it, you will notice some areas that don’t look perfectly blended in. So if you are ever going to shave it, we recommend you have SMP done with the area shaved, because that is how we get it almost perfect. If you are never going to shave, then it is not an issue.

3. SMP will fade with or without sun. UV light makes it fade a bit more, but it won’t erase. If you ever need a touch-up in the future because you think it has faded too much, the fee is $300.

4. SMP is permanent just like a tattoo is permanent, though you may want a touch-up in the years to come. In our experience over the last 4+ years, most people do not return for touch-ups. When we follow up with our SMP clients, we find that most say it has not faded to a degree to warrant a touch-up.

We’ve answered many more SMP questions on our FAQ.

Tags: scalp micropigmentation, smp, pigment, hairloss, hair loss, scarring


When I was little I had an operation which resulted in a huge scar on my head. I cover it with my hair and am forced to keep it long enough to conceal it. Unfortunately for me I have hair loss in my family. Im 22 now with no signs of hair loss. I am scared to death that I will have my scar showing for everyone to see. Any suggestions?

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Without knowing more details about your scalp scar (where it is on the head, how wide it is, how long it is, etc), it’s tough to offer any suggestions. If you have no hair loss at this point, that’s a good thing. Cross your fingers that you don’t have genetic male pattern baldness down the line, as it can skip generations. If you start noticing signs of hair loss, then you should see a doctor to get a treatment plan together. Until that happens, there’s no preventive treatment to use.

As for the possibility that your scar could show in the future, you could see a hair transplant doctor for options on how to disguise it (if it becomes noticeable).

Tags: surgical scar, scalp scar, hairloss, hair loss, hair transplant


Dr Rassman,have you heard of Dr Carlos Wesley’s Pilofocus no scar procedure? I watched the video it looks pretty amazing. I am curious what you think.

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This was presented at this past October’s ISHRS meeting. Essentially, the procedure gets the hair from under the scalp with an endoscope. Although he was short on details, I would imagine that the scalp is lifted up with a gas (carbon dioxide) and then the hair follicles are plucked from below. If it looks/sounds too good to be true, then it is. We have no pictures or scientific material to base the claims that this is a valid procedure and I would imagine it would be very difficult and time consuming. A lot of work for very few hairs.

There is no such thing as scar-less surgery in the real world. Since I started offering Scalp MicroPigmentation (SMP), I have treated many Follicular Unit Extraction (FUE) patients who thought (and were told by their doctor) that their FUE surgery is “scar-less”. Even FUE produces some tiny scarring.

Tags: pilofocus, hair transplant, surgery, hair replacement, scarring


Hello doctor. My question is an honest one and one that hasn’t been asked before.

I had a hair transplant 2 and a half months ago but I still have a lot of pain above the linear scar (when I press it) and also the sensitivity on the top of my head in terrible and is constant. It’s like my hair is being pulled. My surgeon said in 17 years he has no idea what is causing it and never had this problem before. There is also a gap of about 10mm where the scar is and said he said to me he can do a scar reduction in a year. I am so sorry I had this procedure done as the pain is not letting up.

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It sounds like you may have a scar entrapment (nerves squeezed by scar) or damage to the occipital nerves in the scarred area. I have had patients report symptoms like what you’re describing when they had a nerve entrapment. Sometimes, a scar will form around the occipital nerves just from the strip surgery, or the nerves could be mechanically damaged, or even partially or completely cut.

Doctors who will examine you will look for something we call a Tenels’s sign, which simply produces some of the symptoms as the doctor taps the area above the nerve. Surgery is a last resort to fix the problem if it is just induced by the scar. If the nerve is cut completely, a surgery most likely wouldn’t help.

Tags: nerve damage, scarring, hair transplant, surgery, hairloss, hair loss


Dr. Rassman,

I had many strip procedures in the early 1990’s that left my hair looking very “pluggy”. People would immediately look and my forehead at first meeting and continue to stare as though I was not even present. I wore a baseball cap everyday to cover up my hair everyday for 9 years (all the way through college, graduate, and PHD school). Luckily, I took a chance and made an appointment with you. You completely changed my life and helped rebuild my self-esteem.

After many corrective surgeries and reaching an amazing result due to you experience and craftsmanship, I have one last question regarding “reducing donor scar left from the strip harvesting.” Are there any other new options out there that could eliminate the donor scar through Trichophytic closures coupled with FUE, laser surgery, or tissue expansion that would allow me to shave my head if needed?

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Thank you for the kind words and I’m glad I was able to help.

With respect to the donor scar, there are scar revision surgeries and even Scalp MicroPigmentation (SMP) to disguise the scar. I don’t know that you’ll be able to completely eliminate the scarring, but masking it or revising it would possibly be doable. With that said, everybody’s situation and needs are different, and I cannot give you a detailed personal consultation over the Internet without an examination.

Please call my office at (800) NEW-HAIR or (310) 553-9113 and we can set up an appointment to discuss your options.

Tags: hair transplant, repair, scarring


16 months ago i had a hair transplant using the strip method which has left me a scar on the back of my head. if i was to have another transplant with the trichophytic closure procedure, would this problem of the scar not be so visible if i were to cut my hair shorter?

i would appreciate some advice just so i can be sorted out. kind regards

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A second strip surgery in a person who had a sizable scar after the first surgery can produce an even larger scar the second time, but this is not always the case. There are times that a second surgery can reduce the scar from the first surgery. Considering the size of the scar, it might be excised and then closed with a trichophytic closure; however, the scar may return nevertheless.

One of the new and innovative ways to treat a hair transplant scar is with Scalp MicroPigmentation (SMP). See examples here.

Tags: hair transplant, scar, scarring, hairloss, hair loss, smp


If I am prone to forming keloids is it still possible to safely undergo hair transplant surgery w/out forming additional keloids? And have you ever done a hair transplant on someone who has a history of keloids?

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Many patients undergo hair transplantation despite a history of keloids, and most of them do well. Keloids can appear on the frontal hairline, but that is relatively rare. Keloid scarring is more likely to form on the donor scar, but the surrounding hairs will cover it so that it’s generally not a problem.

Tags: keloids, scarring, scar, hair transplant, surgery


I was wondering if there is anything that can be done with raised scars on the top of the scalp from hair transplant plugs? I read there is a possibility of cortisone injections? What about just making the top of the head more dense with SMP?

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Everyone is different, so there’s no exact solution I can provide without seeing you and getting a better understanding of your individual case. Special cortisone injections may help, but that depends upon what we are treating. If the elevations are due to the mass displacement of the old plugs in atrophic skin, then the cortisone shots might not help.

Hair transplants around the plugs (especially in the frontal hairline) does wonders for camouflaging them, correcting the abnormal hairline — and then even Scalp MicroPigmentation (SMP), when properly used in the right places, might help further.

I would have to see you to determine what can be done appropriately. Out of curiosity, how long ago was your hair transplant that you got the old plugs done?

Tags: hair transplant, hair plugs



I had a hair transplant 5 years ago. Some months after the procedure, I noticed some persistent pain and sensibility in my scalp, mainly in the scar and areas near it (example: where the eyeglasses touch my head). But it did not heal. The areas near the scar are extremely sensitive. I need eyeglasses to work but its impossible to use them (my astigmatism is incompatible with contact lenses), so my situation is very hard.

Some surgeons said that its necessary to remove the scar, because I could have some neuromas. The scar is very homogeneous, it is not wide, and the HT was made by a very experienced surgeon. He said that this never happened to his patients and has no idea of what happened with me.

I went to some pain specialists (psychiatrists) that told me to take amitriptilin (50mg/day) and pregabalin (Lyrica, 225mg/day). None of them had any effect. Other things I already tried are: laser therapies, topical capsaicin and local injections of corticoids. No results.

Now, the surgeons think that the only thing to do is to a surgery to completely remove the scar, like a new strip (very very thin) for hair transplant, without transplanting follicles. Do you think it is a good idea or the situation can become even worse?

I already did lots of search and some web sites and surgeons comment that it is possible (very rare) to have persistent pain after years of HT, but I never found suggestions of how to treat it.

Thank you.

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You have risk no matter what you decide. Have you had injections of steroids into the painful part of the scar? I would need to evaluate you before giving you a recommendation. I’ve written before about nerve damage from a hair transplant in some past posts that might have some value to you:

Tags: hair transplant, pain, nerve, surgery


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