What Type Of Scar Revision Would Improve My Hair Transplant Scars and Scalp Appearance?
Q: Dr. Eppley, I am interested in scalp scar revision. I had hair transplantation done twenty years ago. However I now shave my head but the recipient area at the front is knobbly and raised where the last line of plugs were placed which is my main concern. There is also a scar running along the top middle of my head an initial scalp reduction which is my second concern and lastly scars on the back of head (donor site) which is much more of a minor concern. So my first priority is to flatten and smooth the recipient area at the front then depending on costs try to break up the linear scar that runs up the middle of my scalp. The donor scars at the back aren’t too much of an issue to me at moment. Do I have to have the old plugs removed (don’t really want to go thru another round of surgery again if it’s at all avoidable) or could I fix this up with dermabrasion/laser/kenalog injection s etc. I would appreciate some advice.
A: When it comes to scar revision of previous hair transplantation recipient sites, there are really fairly limited options. The knobbly appearance is certainly not going to be improved by excising the plugs, that will likely make it worse. There is a substantial surface contour difference between the implanted sites and the native scalp that is not likely to be ever improved by any type of skin resurfacing. Like the face with deep acne scars, laser resurfacing would be a disappointing experience. Dermabrasion may be more effective but at the risk of inducing pigmentation changes. The only procedure that I would remotely consider would be fractional laser resurfacing, as it would be safe, but I doubt particularly effective. The linear scalp reduction may be capable of being improved in appearance by replacing it with a running w-plasty type of scar revision.
Dr. Barry Eppley