HAIR TRANSPLANT FORUM

Hi guys,

I'm hoping I can get some guidance on craniotomy scar issue I am having. I am a 27 year old male, and about 6 months ago I had a craniotomy for the removal of a benign tumor which was discovered shortly before the procedure. The surgery went well and all is good now health wise. However, I now have a 6" long scar that is about 5/16" wide in the back of my head.

I would now like to address how I can improve the aesthetics of the scar, as I prefer to keep my hair short. The good news is with longer hair (shown in the photo), I am able to cover the scar, but I'd really like to wear my hair shorter.

I have visited 2 cranial plastic surgeons and one hair doc in the Bay Area, California. Here is summary of their recommendations on how to improve the scar:

UCSF plastic suregon: Scar Revision and change scar to a zig zag shape.

Stanford plastic surgeon: Standard Scar Revision. Advised against doing a zig zag as it would change hair growth directions and "make it look weird".

Hair Doc: Standard Scar revision and possibly hair transplant on scar if scar needs additional improvement.

Is it true that changing the scar to a zig zag shape would change the hair directional growth? If that is the case, why would the UCSF surgeon recommend that? Do any of you have any recommendations on the best way to improve aesthetics of the scar? My end goal is to not get rid of the scar completely, but to at least improve the aesthetics of it. I'd appreciate some feedback!

You can see the photos here: http://i114.photobucket.com/albums/n246/alexsien/scar-images.jpg

It is common for many surgeons to suggest a zig zag scar to correct a linear scar on the scalp. the premise is that a change in direction will result in a better result. While I've heard this recommendation in the past, a have never seen it produce an acceptable result. Therefore, you should avoid it altogether.

Any removal of donor hair will result in an alteration of hair growth direction. There is a natural flow of hair in the donor area. any sort of excision and removal of tissue will be the equivalent of removing a middle section from a stained glass window. The appearance will no longer be the same and you will see an abrupt change where the top half and the bottom half come together.

I think of the two options you list, the scar revision with grafting is acceptable. Perhaps it would simply be best advised to add hair. I've never seen a scar revision produce a result that is not obvious when you cut your hair short. if you do the scar revision, you will need to graft the scar later on.

you could simply use FUE to add hair. that might be the best solution long term. i'm quite sure that your Plastic Surgeons are not familiar with this method of scalp scar camouflage. It is something new to them.

Hi Dr. Cole,

Thanks for your response! You are absolutely right, both plastic surgeons admitted not knowing *anything* about FUE or hair transplant procedures in general.

How about doing a scar revision, then FUE? With the scar thinner, less hair will be needed for FUE. Of course, there is no guarantee a scar revision will make the scar thinner, so there is an obvious risk.

I'm certainly open to just going with the FUE route as it would be a lot easier for me. Can FUE alone camouflage the area? Approximately how much FUE would be needed for this? I have very thick hair for the record. Please advise.

I have submitted the forhair.com online form for information on doing FUE in the Bay Area, CA.

Thanks again for your response!

i think you can go either way. It certainly is easiest for you to simply try a scar revision first in the Bay area because there are no really good FUE physicians in the Bay area. There are some novice individuals, however. There are some good hair transplant physicians, however. Provided you find a good one, and you do not plan to wear your hair really short, you might be fine going with the scar revision first. i'd make sure they limit the amount of normal hair bearing skin that they remove. This way you will minimally distort the direction of hair growth and waste the least amount of normal hair. Wait at least 6 months to evaluate what you get from the scar revision. For the first 3 months, the scar will be very fine and you will think you are home free. then close to the 3rd month, the scar will begin to widen. If you get lucky, you are done after the scar revision alone though you will not be able to shave your head. if you are not finished, you can start with FUE at that point.

the risks associated with going with the scar revision first are that you will see no improvement, the scar will widen, or that the scar will change from white to pink or red in color. If the color changes from white to pink, you are going to have a new problem to contend with. The other risk is that the scar revision will distort hair growth angles, but if you limit the total width of the excision, i think this risk is very low.

Of course, you can simply put FUE in the scar, but given your location, you might want to start with a scar revision first and see how far you can go with this alone. the other rationale for this is that you might need more than one pass with FUE to get to a point where you can wear your hair really short. That is the only real risk from FUE alone. Multiple trips to a good FUE physicians are something to consider when you are looking into scar treatment with FUE alone.

Let us know how you progress.

You have a little more of a problem than I originally suspected. My staff has just now printed your photos for my review. I did not go to your web address originally that you noted in your post.

Your existing scar is vertical. Vertical scars are not going to heal as fine as horizontal scars. Furthermore, you cannot do a trichophytic closure on them. You can close in two layers with minimal tension and hope for the best, but eventually, you will need to add one or more sessions of FUE. Fortunately, the number of grafts you need is not excessive so the cost should be relatively small. You might even get some help from your insurance company.

the other problem is see is that your scar is already pink. This means that you will probably have a pink scar with the revision should you try this. Fortunately, i hve found that FUE grafts into these scars helps to reduce the pinkness and produce a more natural appearance. Try adding ACELL and PRP to the scar at the time of grafting or revision.

i'd stay away from the W-plasty or a Z-plasty.

it appears from your slightly blurred photos that the scar may extend into the nape of the neck. you might add some fine hairs into this off your leg to help improve this. the photos are not clear so i'm not positive about the scar extension. sorry, i don't have any phone number to call you.

Thanks for your reply Dr. Cole. I sent you a PM with with my number - I'd appreciate it if you or your staff could call me.

"helps to reduce the pinkness and produce a more natural appearance."
Shouldn't be an issue. My hair is never short to the point where my scalp can be seen.

"may extend into the nape of the neck."
That part does not bother me. I think it adds character and a "story" - but the rest looks bad cosmetically.

It looks like FUE is the way to go to resolve this.

cheers,