Scar revision is a specialty of Dr. Zahid Iqbal. The two most common solutions are advanced surgical scar revision techniques like a so-called geometric broken line repair and a hair-transplant technique to implant hairs into a scar. Although the geometric broken line technique is a successful method of scar repair in hands of a skillful plastic surgeon, not every patient is a candidate for this procedure. Sometimes, excising an old scar may cause another sometimes even wider scar. Consequently, in specific situations transplanting hairs into a scar may be the best solution to scar repair.
A common reason for hair transplant would be the loss of the sideburn, temple, and behind the ear in traditional facelift surgery that robs a woman (and man) of these vital hairs that contribute to both naturalness and youth. Another reason would be due to prior scalp surgeries like skin cancer surgeries of the scalp or brow lifting or brain surgery that lead to scalp hair loss. Hair loss from scars can occur anywhere there is hair, like in the eyebrows, beard, chest, pubis, etc. Of course, hair loss can occur in the back of the head from prior hair-transplant surgery. There are various methods of harvesting hairs in order to undertake scar repair, such as FU-strip, FUE or body hair transplant. In addition, medical tattooing is a non-surgical technique that can help camouflage scars and make them blend better with surrounding hairs. Considering that there are many ways to repair scars, during the consultation, At HairAge, we discuss with you the method or combination of methods that would best suit your specific situation. for example, with a prior hair transplant scar in the back of the head, if the person is prone to scarring in this area, then an FUE method may be ideal to avoid further scarring. If there is no more hair left, then hair maybe taken from the beard area.
Scalp micropigmentation (SMP) can be combined with any method to further improve the result. For facelift scars, oftentimes the traditional FU-strip method may be preferred for the following reasons: 1) could be combined with a larger concurrent hair transplant 2) provides better quality grafts 3) avoids the need for any preparatory scalp shaving. If the scar is contracted, thickened, or misaligned, a formal scar revision involving the excision of skin and repair may be an important initial step before hair transplant into the scar can be undertaken. We are skilled at both the surgical scar revision as well as the subsequent hair transplant. However, it is worth stating here that scalp hair loss typically is not very amenable to excisional methods of repair, i.e., cutting out the scar and closing it oftentimes leads to the same recurrence of the previous scar. Scalp scars are truly unique entities and cannot be compared with facial scars. Usually, the prior scar arose from either poor surgical technique or the anatomical predisposition of the patient to form scars.
Either way, the blood supply to the area is already typically compromised to the point that simply excising the scar will cause a recurrence. Interestingly, more elaborate scar repair techniques used on the face are ill advised in the scalp because they actually cause the scar to worsen. We have observed many patients who have sought a facial plastic surgeon or plastic surgeon to repair a scalp scar only to find that the scar either did not change or instead worsened. Accordingly, hair transplant into the scar and/or SMP are the preferred methods of treatment.
When transplanting into scars, we employ a specialized method for transplantation using micro punching to attain a better outcome. These tiny punches remove a small core of the scar with each punch so as to achieve the following objectives:
- physical reduction of the bald scar
- replacement of unhealthy scar tissue with healthy hair graft tissue
- better access and contact with the underlying healthy blood supply to improve graft growth
- physical relaxation of the scar tissue.
We also believe that the use of bio-enhancement technology like PRP and liposomal ATP are critical in scar repairs to enhance graft survival in areas of otherwise diminished blood supply. He uses these adjunctive measures in all surgical hair transplant cases.
As mentioned, FUE is a viable alternative method in many cases (and at times the preferred method) to improve scars. When transplanting into the scars in the back of the head when the tissue has multiple scars that are further inelastic and tight, FUE is the only acceptable method for hair transplantation. Oftentimes, in these cases, beard hair is the preferred source of donor hair for the following reasons:
1) no scalp shaving is needed (which would expose the scars during the recovery phase 2) the donor hair may already be depleted 3) the donor hair caliber is thin, weak, or unsuitable 4) the beard area supplies typically an abundant, thick, and fast-growing donor hair and heals quickly and imperceptibly in most cases. In rare cases, chest hair may be needed to supplement or be used as an alternative to beard hair but this is less than ideal to the thinner caliber and slower growth pattern of chest hair.
In many cases, the ideal solution for a scar is to use multiple methods to achieve the best result. For example, if the patient undergoes an FUE procedure to repair a scar but has a few areas within the scar that are evident, then SMP is an easy method to further treat the scar. In select cases, some patients may elect only to undergo SMP and forgo surgery. Oftentimes, the best results can be achieved by starting with either FUE or strip hair transplant into a scar followed by SMP. The combined method can look better in more circumstances, as when the hair is wet or cut shorter. A consultation at HairAge can help you decide which method or methods are better for you based on your particular anatomy, type and location of scar, cause of scar, budget, and recovery time, to list only a few of the many variables that guide therapy.