HAIR TRANSPLANT FORUM

Attached are photos of a donor area with a 3-4 cm wide strip scar running through it. The severity of scarring was due to a connective tissue disorder and multiple ill-advised strip harvests, performed at other clinics.

The patient requested Dr. Cole graft into the scar in order to help conceal the prior surgical intervention. Nearly half the surface area in the donor region is hairless scar tissue, and the scarcity of transplantable scalp hair is apparent. Body hair was therefore the only donor resource option.

The treatment strategy in this case is a tricky one. The surface area of the scar tissue is large and consequently requires massive amounts of BHT to achieve a semblance of coverage. We have noted however that BHT tends to grow optimally using anagen hairs grafted at a density of 24-30 grafts/cm2. We also have noted that lower densities tend to provide the greatest chance for survival in scar tissue. Therefore multiple session of BHT will be necessary in order to treat the area.

One of the larger unknowns with this type of repair is how the BHT will react to scarring of this extent. We have seen in a variety of patients that BHT from particular body areas will respond better than BHT from other areas. This reality seemed to suggest that the first course of treatment should be test patches into the scar utilizing different types of BHT. During the patient’s initial September surgery, thigh, shoulder, leg and chest BHT were grafted in discrete areas in order to monitor in the rate of growth.

Today, less than three months post op, we have noted that while the thigh, shoulder, and chest BHT remain largely resting (in accordance with the usual HT time lines) the leg hair has experienced particularly rapid growth. The leg was grafted over the occipital protuberance and this early growth can be viewed in the comparison photos below.

We are encouraged by this low density grafting approach into scar tissue. One question that arises is how to keep grafted density consistent? In our initial density studies, a transparent sheet with square centimeter density grids were placed on the scalp and the incisions were cut through the sheet. If you observe the second photo you will notice that the square centimeter density grids are placed throughout the scar. These grids were created with stamps indicating 24 or 30 marks/cm2 to ensure the grafted densities would remain within this range.

Please note that, while leg hair grew the fastest in this patient, leg hair is not always the fastest growing BHT source.

Hi,

How many grafts would this guy probably need to get the best yield of growth into this strip scar?

Gamecock,

We are grafting body hair into the scar at lower density to increase the changes of high yield. This means multiple passes are required. I suspect that 2500+ will be needed over time to treat this scar. This will not give the scar area the same density as the surrounding area, but it should enable a shorter hair cut and camouflage. The main problem with scars this large is that patients need to have hair styles they would not ordinarily choose. While they may be able to comb over the area in ideal conditions, they will have troubles when the wind blows or when the hair is wet. This will limit one's lifestyle.

A scar registers to the eye as such because it is a bald area where we expect to see hair. That is why it is crucial to get a good yield in the area so the image of the scar is broken up.