Q: Dr. Eppley, I have a bad scar across the back of my head from two previous hair transplants. After the first procedure the scar looked pretty good and was narrow. But after the second time it has gotten wider and more noticeble and I can not wear my hair very short anymore. What is the nest way to improve this scar? Cab it just be cut out again and will it look better? Or should I just have hair transplants put into the scar? nd if hair transplant are done how would the grafts be taken and wouldn’t that just make another scar or risk making this on wider.
A: When it comes to hair transplant scalp scars, there are three approaches to consider. The first, as you have mentioned, is to simply re-excise the scar and reclose it. (scar revision) Whether this would make a successful improvement depends on how loose or lax your scalp now is. Given that you have had two hair transplants with the strip method, it is likely your scalp has lost much of its elasticity or natural stretch. Wide scalp undermining would need to be done from above but how successful that would be at reducing tension on the scar revision closure is unpredictable. Another scar revision approach would be to first do a few weeks of scalp tissue expansion. Going through the scar scar in a first stage, a small tissue expander is placed above the scar and expanded every few days for a few weeks. Then the scar revision is done and it could then be assured that there would be no tension on the wound closure and a very fine line scar achieved. The third approach would be hair transplantation. But this would not be done using a strip method. Rather a follicular unit extraction (FUE) method would be done using the Neograft system. This method harvests the hair (follicular units) by using 1mm punches spaced out over the occipital and temporal donor area. These small extraction sites heal imperceptibly and the hairs are then transplanted into the scar.
Whether a scar revision or hair transplantation approach is best for your strip scar would depend on how much laxity your scalp has (or doesn’t have), the width and location of the scar and what your hair donor site look like.
Dr. Barry Eppley
Q: Dr. Eppley, what is the difference between a stage one and two skull augmentation? What is the most you can expand? And how does the expanding procedure work? (ie what is used? Is it painful? How long does it take? Do I need to stay inIndianapolis during this time? Is it noticeable? Etc) I want to assume that I will expand a lot and I want to expand on the back and top of the head.
A: In ‘extreme’ or significant skull augmentation, it requires the initial use of a tissue expander to gain the necessary amount of scalp expansion for coverage over the volume of cranioplasty material. The first stage is the insertion of the scalp tissue expander which is similar to a balloon. It is inserted in a one hour procedure and is placed flat. (unexpanded) It is inflated on a weekly basis over the next 3 to 6 weeks based on how fast one wants to expand and other issues such as their geographic location. Depending upon the amount of expansion needed and one’s hair style, the tissue expander changes may be slightly or very obvious. Scalp tissue expansion is associated with minimal discomfort. The second stage where the cranioplasty material is applied to the skull can occur anywhere from 3 weeks to 3 months after expansion is started based on their schedule and the amount of expansion needed.
Dr. Barry Eppley