Post-Surgical Scars in Hair Restoration Surgery

Anytime surgery is performed or skin is wounded a scar results. Scars are the body’s attempt at healing. Scars result from any surgical procedure, whether it is an FUE or Strip Harvest. Certain individual characteristics, such as increased scalp laxity, predispose to wider scar formation. However, scars can be minimized by the practice of maintaining the tension on the skin surface to a minimum. Minimal linear scar resulting from traditional strip harvest. Note that it is less than .5 mm, faintly visible and of course covered by hair. “Bird shot” pattern of diffuse FUE scars. Note that some of the FUE punctate scars are about 1mm. Of course these scars are also covered by hair, hence usually not visible unless the hair is trimmed very short.

FUEs are performed employing a small punch either 1 or .75 mm to score the follicle, the wound is very small, but it is left to heal without primary closing, hence it does so by secondary intention which means that a small scar will result. In FUEs there are numerous punctate scars producing a “bird shot” pattern of diffuse punctate scars.

Traditional Strip Harvest should produce a linear scar, however, it should only be faintly visible if the principle of minimizing surface tension is adhered to. In addition, the use of tricophytic closure renders the faintly visible scar invisible by having the hair grow through the scar. State of the art strip harvesting employs use of a two layer closing, the deep layer serves to minimize surface tension. The superficial layer gently brings the surface margins together, allowing the healing of the wound with minimal tension. The third step, is the beveling of the lower wound edge, this causes the hair to grow through the scar.

Typical invisible scar resulting from a strip harvest in a hair restoration ultra mega session.

[caption id="attachment_494" align="alignnone" width="577"] Another example of an invisible strip harvest scar resulting from a tricophytic closure of a strip donor harvest in a mega mega session.[/caption]

[caption id="attachment_495" align="alignnone" width="577"] It takes the wound about 6 months to mature. Weight lifting before the wound has matured can widen scars because of the increase in skin surface tension from the weight lifting.[/caption]

[caption id="attachment_496" align="alignnone" width="577"] Very fine scar less than 1mm resulting from a 2 -layer closure of a strip harvest in an ultra mega session. Note small point bleeds due to suture removal just before photo.[/caption]

[caption id="attachment_497" align="alignnone" width="577"]
Photo showing widening of the prior fine scar, taken after a few months of heavy weight lifting. The scar is now 2-3 mm wide.[/caption]

In conclusion, minimally noticeable scars can be achieved in modem hair restoration surgery no matter which method of harvesting is employed. The critical sine qua non of minimizing post-surgical scars is the principle of keeping the tension vectors on the wound as small as possible. The great results in minimizing scars can be further enhanced by the tricophytic closure so the resulting scar is usually nearly invisible.