The Latest Techniques in Scar Grafting and Repair –1yr Pics

Jessica

The Latest Techniques in Scar Grafting and Repair – 1 year results

One of the most popular procedures is scar grafting. Donor damage can be caused by plug surgeries, widened strip scars, lifts, flaps, out dated hair transplant methods, etc. We offer scar revisions and scar grafting as options for repair. Revisions involve removal of the scar tissue and re-closure the area in the hopes that it will heal properly this time. Additional hair may also be harvested at this time for the recipient areas. If the goal is to revise the scar first and then graft it, it is best to wait 6 months to one year after revision before attempting to graft.

Scar grafting helps to improve the appearance of the scar. Follicular units obtained from the scalp, body, and/or plug redistribution are harvested and placed into the scar. This helps in several ways. First and most obviously, when hair grows in the scar it helps to cover the scar. Also, when healthy tissues are transplanted to “dead”, shiny, smooth, white scar tissue, it helps to break up the appearance of the scar tissues and establish more circulation and pigment to the area. Some scars have a red or pinkish color to them that doesn’t seem to go away. This can also be improved with scar grafting.

Scar grafting has had varied success in the past. IHTI has some interesting perspectives on the approach to scar grafting that has led to an increase in scar grafting results across the board. We have found that dense packing scars with as many grafts as will fit does not always provide a high yield; it can sometimes be as low as 70%. The yield is significantly increased when lowering the density that is placed. For example, we have found that body hairs grow best in the scar or normal tissue when using anagen phase hairs at a density of 20-30 grafts/cm2.

Dense packing can also cause the scar to be pinkish or red for the next 6 months to 1 year in some patients. It can also add volume to the scar and cause it to be temporarily raised a little. This is because the scar tissue does not have the elasticity that skin tissue has. Fortunately, FIT grafts have very little adipose on them so they contribute much less tissue volume than strip grafts. This reduces the risk of volumetric expansion or ridging in normal skin and in scars.

Transplanting lower densities may cause the patient to break their procedure into steps. There are some great advantages to treating the scar in two or three sessions rather than all at once. Circulation is not as good in scar tissue. When you transplant a follicular unit into scar tissue, it will establish circulation to the area, introducing blood flow to the scar tissue. When the scar grafting is broken into several sessions adding low density, the first pass helps to prepare the environment to accept new growth. The second pass will be transplanted into much healthier tissue, thanks to the first pass.

Here is an example. This patient had plugs redistributed. His pictures, results, and details can be viewed here: Plug Redistribution Results. The hairs obtained from the plug removal were divided into smaller units and transplanted to the scar. There is a before and after picture of the left side of the scar, which was successfully grafted with one pass. There are also a few pictures of the right side of the scar, which was grafted in two passes.

In the magnified pictures, you can see the scar before any repair, one month after the first pass, and one year after the first pass. Notice that before any grafting, the scar tissue looks white and dead. After the first procedure, the scar tissue changes to be more rosy-colored as circulation is established within the tissues. Grafting also adds melanin pigment to the scar tissue from the transplanted follicles and skin. Notice that the areas of new circulation are concentrated in the area of newly placed grafts. In the result picture, there is more hair growing in the scar area, but also notice that the tissue itself looks healthier.

With these techniques, Dr. Cole can diminish the variations in scar grafting success rates and improve yield. Through his research and experience, we as an industry are learning more and more about how to increase the overall effectiveness of repair efforts.
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