Is Excision Or Hair Transplants Better For The Treatment Of My Scalp Scar?

Q: Dr. Eppley, I have found your website to be very helpful.  I was wondering if I could please make an inquiry on an important personal matter. My son is now 5 years old. He had a laceration in his scalp when he was 3, and the stitches were made by an emergency room doctor (not plastic surgeon). Attached please find several pictures of my son’s scar. Would a scar revision or hair transplant be viable options for us to consider for him? Any thoughts which you may have would be truly valued and appreciated!

A:  Your question about scars is the scalp is a common one. What makes scalp scars noticeable is the lack of any hair. Even slight scar widening in the scalp is noticeable because of the lack of hair. The question then becomes how best to get the scar area covered with hair. While hair transplants would seem like a logical approach, they are a secondary choice for most scalp scars. Hair transplants take very poorly into scar tissue so their success rate is very low. In extremely small scars, a strip hair transplant rather than single follicular units would be more successful because the poorly vascularized scar tissue is being removed. But the far simpler approach is to recruit normal scalp and hair tissue from around the scar. In other words, scar excision and scalp advancement and closure. The scalp can be mobilized significantly and most linear scalp scars should be approached in this way. Your son’s scar is a good example of where scar revision by excision would work well.

Dr. Barry Eppley

Indianapolis, Indiana