Q: Dr. Eppley, four years ago I had a hair transplant procedure done. The procedure left me with a wide, deep and very visible scar in the back of my head. I want to do anything that is possible to reduce the scar. Can you please help?
A: The traditional method of hair transplantation uses the strip method from the back of the head for the donor hairs. One of the problems with this donor site is that it can leave a large scar due to its horizontal orientation, which exposes it to the downward pulling forces of the lower scalp and neck skin. This can result in a wide scalp scar if not closed properly or if this donor site is used more than once, which is frequent. If a man at some point decides to give up on hair coverage on top and wants to shave his head or have a close-cropped haircut, this scar can become an aesthetic liability. This is why the contemporary approach of FUE, follicular unit extraction (Neograft), is better because it does not leave a single long scar for the posterior scalp harvest.
When it comes to improving the wide horizontal scalp scar from a hair transplant, there are two approaches. A traditional scalp scar revision can be performed which means that the entire scar is removed and re-closed, making it a much finer and more narrow scar. The other approach is to use an FUE technique. The scar is contracted by the punch excision of scar tissue and hair transplants are inserted. Both have their merits and I would need to see pictures of the scar to determine which may be best. If there is significant scalp laxity, then scar revision is a good choice. If the posterior scalp is very tight, then the FUE approach may be better.
Dr. Barry Eppley