Q: Dr. Eppley, I am interested in scalp scar revision. I see you have extensive experience on scars from hair transplantation. Nearly twenty years ago, I had the old hair plugs and have about 1,000 elevated plugs on top of my scalp that look like mosquito bites. I tried to shave my head and get micro pigmentation to conceal them so I could wear my hair short. Unfortunately the bumps are noticeable in the bright light. I would like to have them flattened as much as possible but have received mixed reviews from Doctors. Some recommend laser resurfacing, others say kenalog injections, others say dermabrasion. What would you recommend if there is anything? My goal is to keep my hair buzzed so I would need to improve the 1,000 circular scars in the back of the scalp as well as a strip scar on the sides and back. Any recommendations?
A: When it comes to reducing the raised hair plug areas, it is best to think of it as reduction of a hypertrophic scar…as this is essentially what it is. This requires an aggressive form of skin resurfacing.. This is not an indication for steroid injections. Dermabrasion would be the best approach as it can create the greatest amount of selective reduction of each plug site. Laser resurfacing could also be used but it would have less of an effect and may take longer to heal due to the thermal injury.
Dr. Barry Eppley
Q: Dr. Eppley, I am interested in a form of scalp scar revision I had hair plugs done many years ago which has left me with a lot of ‘bumps’ on my head since I now shave my head. Can these be reduced in any way so that my scalp is more smooth and not so bumpy and irregular?
A: Your scalp issue does represent an unusual form of hair transplant scar revision. Most commonly this issue relates to the donor site scar on the back of the head. But old style large follicular unit plugs can certainly be an issue if one is now shaving their head or wants to. Trying to get good improvement in your scalp situation is not an easy one even though the techniques to do it are not hard per se. Ideally what you should do is a ‘test patch’ of a scalp area with dermabrasion to see how improvement you can get before launching forward on your whole scalp. If a small area done under local anesthesia shows good improvement then you could do your whole scalp under anesthesia. On the one hand this is not the most efficient way to do it but there would be little sense in doing your whole scalp if the amount of improvement would not be worth it. This issue applies to both the donor and recipient areas. It is just hard to predict what the level of improvement would be had with dermabrasion for your hair transplant scar revision so you want gauge the depth of your efforts by testing first.
Dr. Barry Eppley
Q: I have had three hair transplants performed over the past 18 months. While I definitely have more hair, the results of these surgeries do match what I paid to get them. I have a couple of donor scars which when I cut my hair very short, show quite obviously and leave an unsightly scars at the back of my scalp. I would like to reduce the appearance of these as it is otherwise very difficult to be able to buzz my hair short without feeling self conscious about the scars.
A: Scalp donor scars for hair transplants can become wide, particularly when the same donor site is used more than once. This is a function of tension on the scar line which widens and leaves a gap between the sides of the hair-bearing scalp. Any scar widening, or ‘hair gap’, in the scalp is easily seen. Scar revision of hair transplant donor scars can be successful at narrowing their width based on total excision of non-hearing scar/scalp and deep suture support at the galeal level. Any tension on the skin will result in new scar widening. In some cases, I have done a geometric (running w-plasty) scalp scar excision to distribute the tension at the skin level and break up an otherwise straight line scar. Every manuever of tension reduction is important in scalp scar revision, particularly in those from hair transplants in the low occipital horizontal orientation.
Dr. Barry Eppley