Scalp Scar Revision
Q: Dr. Eppley, I am seeking a scalp scar revision. I had a hair transplant done five years ago which was supposed to leave me with a “pencil thin” scalp scar. What I ended up with is a far cry from such an optimistic prediction. So now I’m looking for best scar revision option, maybe combined with tissue expansion and w-plasty/ geometric broken line closure. I just want to laser my hairs out and be bald. I know scar will not disappear but i want just to improve it as much as possible. Do you think based on my attached picture that the scar can be reduced to an acceptable level on my scalp? Thanks.
A: In looking at your pictures, you have a modestly wide occipital scalp scar harvest site. Your assumption is correct in that only a scalp scar revision has any chance of making a lessening in its appearance. Only by cutting out the scar and getting back to unscarred scalp that contains hair follicles can make that improvement. Given the pattern of the scar a running w-plasty/modified geometric closure would be the preferred type of skin closure. The key to a scalp scar revision’s success is how much tension is on the closure. It doesn’t matter if the best interdigitating skin closure is done, if the tissues are tight some recurrent scar widening will occur. While there is no question that a scalp tissue expander is always going to be of great benefit, you obviously would not like to take it that far if it can be avoided. Since it has been five years and I assume that you had only one harvest procedure, there is a good chance enough scalp laxity is present to avoid tissue expansion. If you have had two strip harvests and the back of your head feels very tight then scalp expansion may be needed for more assured success.
Dr. Barry Eppley