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All Scarring related posts

 

I had a session of about 1600 graphs about 4 years ago. I have thin hair, and it had receded to about a grade 5 baldness. Because my hair is thin, and maybe because I didn’t get enough graphs, I’ve never really gotten the thickness or coverage that I was hoping for, and I am now considering having the transplants removed entirely. Have you had much success with laser removal of transplants? How much scarring is typically visible? I am concerned about having a bald head with little holes all over it.

Thanks

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Your question comes right after I met a fellow in my office today who asked about the same subject, removing his transplants completely and going back to his normal balding state. You are correct to worry about the deforming issues if the grafts were anything but today’s modern follicular unit grafts with skin trimmed down when they were transplants. There are many things that an examination will show a good doctor and they include (1) the presence of cobblestonning of the skin along with other surgical scars in the recipient and donor area, (2) the number of grafts we are talking about removing and what type of grafts that was transplanted, (3) The distribution of the grafts, etc…. With that information, it would be easier to discuss this approach, but generally removing the grafts involve removing both the hair and the skin, each producing its challenges. The patient I just saw was more specific in his questions, so I am going to reference my letter to him reflecting the visit he and I had. This particular patient did not want another hair transplant, even though it is the only good option for him to become normal looking.

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A recent post I made about large sessions has lead to another good question:

What about multiple smaller transplant sessions… are they better?

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In the hands of experienced doctors who understand large session hair transplant surgery and the nuances in performing them, the larger sessions are better than multiple smaller sessions. Each and every time the donor area is harvested, scarring to the deep structures are the inevitable result. I am not talking about visible scarring at the skin level, but deep invisible scarring below the skin. This scarring increases with each subsequent procedure. Fewer procedures produce less deep scarring.

Simply, I will answer your question with another question: Why have two surgeries if you can do it just once?

 

Have there been many advances to the visible scarring problem that is talked so much about?

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This is an interesting question, most appropriately directed to me. A small number of patients do develop noticeable scars (less than 5% of first time patients). This is more intrinsic to the healing properties of the patient themselves, but the techniques used by the surgeon have not generally been able to address the unique needs of the small number of patients with a scarring problem. Now there is a new closure process that allows the surgeon to better address the scarring risk in this 5% of patients that have a scar widening tendency. We are using this new technique in virtually all patients. We have actively solicited patients who have widened scars as a new business activity and have been repairing scars from patients who come from around the world.

 

Do most people have visible scars from a traditional hair transplant?

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The answer is that every person that receives a cut to the skin gets a visible scar. The more appropriate question should be: How often are scars large enough to be seen in social conditions? Most people who have donor hair taken with a traditional incision get a scar that is about 1-2 mm wide. A scar of this width can only been seen by combing back the hair and closely observing the scar with good lighting. Fully 95% of patients fall into this category. These scars should never be detected when the hair is at least 1/4 inch in length (this may not apply to a coarse, straight haired individual). If a person shaves his head, a pencil line scar will be evident in virtually everyone.

 

An African American woman writes…

I am interested in the restoration process to my temples. Having black skin I am concerned with forming keloid scars in the visible frontal and back area. Does this happen? I noticed pictures of African Americans however they may be some of the lucky ones who don’t form big scars. Can you give me some more information on this?

There also didn’t seem to be any info on other possible pitfalls to take into consideration?

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Thank you for your email. If you are a known keloid former, then a test of the scalp may be the safest way to determine if you would form a keloid. Such a test might be performed with a very small incision in the area where the hair would come from and a few needle ‘pokes’ in the area where the transplants were to be placed. If you have no history of Keloids, and have had scars in the past that did not produce Keloids, then it would be reasonable to assume that you would not form a Keloid in a hair transplant area.

As a black woman interested in hair transplants, please make sure that you are evaluated by a good, ethical and competent doctor. With regard to Keloids of the scalp in association with a hair transplant, they are very, very rare even in black skinned people.

 

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