It is important to remember that all surgical procedures result in some degree of scarring, and that also includes hair transplant surgery.
While this is undeniably true, in the case of CIT or FUE hair transplantation, the scarring is very minimal and appears as white dots in some individuals. These dots are not visible to the naked eye when hair grows in the donor area unless it is shaved down to guard 0-1.
Strip procedure, on the other hand, can result in ear to ear scars that can be 2-3 inches wide. The strip scars can be very visible even with longer hair.
Many patients are now asking the ultimate question: How can I avoid hair transplant scars?
Hair Transplant Scar
One of the tell-tale signs of having undergone hair restoration surgery is a linear scar across the back of your head. Hair transplant scars result from a method of hair transplantation known as FUT, or strip surgery. Hair transplant scars from this type of surgery are unpredictable in nature.
Some lucky strip hair transplant patients will have only a slight, paper-thin scar. Others will develop thick, protruding scars of half an inch in width or more. The problem is that it is very difficult to determine how individual patients will heal and whether their scars will stretch in time.
Avoiding a Hair Transplant Scar
The only way to avoid having a linear strip scar is to elect not to have strip surgery. One alternative method to strip is FUE or follicular unit extraction. This method involves the excision of individual follicular units, one at a time.
FUE does not result in a hair transplant scar because the doctor is not removing a large portion of tissue, nor is there a need for sutures. Without the linear scar left by strip surgery, FUE hair restoration surgery allows patients to restore their hairline, or add density where needed, without having to keep their hair long to conceal the donor area scar.
Why CIT® Produces Even Less Scarring Than Standard FUE
Not all FUE is created equal. Dr. Cole’s Cole Isolation Technique (CIT®) takes scarring reduction a step further.
The key difference? Minimum depth invasion.
Standard FUE punches go deeper into the scalp than necessary. CIT® uses a controlled depth approach that only penetrates as far as needed to extract the follicle. Less tissue trauma means less scarring.
The result is tiny extraction sites that heal faster and leave virtually no visible marks. Even patients who shave their heads short rarely notice any scarring from CIT® extractions.
There’s another benefit too. The minimum depth approach leaves stem cell remnants in the donor area. This allows approximately 30-40% of extraction sites to regenerate at least one hair follicle. You’re not just avoiding scars. You’re preserving donor capacity for future procedures.
Strip Procedures and Scarring
During a strip procedure, the physician excises a ‘strip’ of tissue from the back and sides of the patient’s head. While surgical technicians begin dividing the tissue into individual follicular units, the physician closes the wound using sutures.
In an ideal situation, the wound heals well, and the scar is virtually undetectable underneath existing hair. However, in most situations, the scar will be quite visible and may even stretch over time. Having a hair transplant strip scar prevents patients from being able to wear their hair short or shaven without exposing the scar.
Other Drawbacks of Strip Procedures
In addition to the hair transplant scar that is left following a strip procedure, strip hair transplantation has a number of other drawbacks.
Strip procedures are more invasive in nature than FUE, and the patient, therefore, requires additional healing and recovery time. Strip procedures also permanently distort hair growth angles, where the tissue and hair is removed, drawing even more attention to the linear scar.
Yet another concern with strip procedures is that surgical technicians, and not the hair restoration surgeon, are often responsible for dissecting the strip into individual follicular units. This can contribute to fewer hairs per graft and even result in graft transection.
Factors That Affect Hair Transplant Scarring
Why do some patients heal with barely visible scars while others develop prominent ones? Several factors come into play.
Genetics and Skin Type
Your genetics play a major role in how you scar. Some people are simply prone to thicker, more visible scars. If you’ve had surgery before, look at how those scars healed. That’s a good indicator of what to expect.
Darker skin tones may develop hyperpigmented (darker) or hypopigmented (lighter) scarring more readily. Keloid-prone individuals, more common in certain ethnic backgrounds, face higher risks of raised, thickened scars.
Scalp Laxity and Tension
For FUT procedures, scalp tightness matters enormously. A tight scalp means more tension on the wound closure. More tension means a wider scar.
Surgeons can test scalp laxity during consultation. If your scalp is tight, FUE becomes the obvious choice.
Surgeon Skill and Technique
This one’s straightforward. An experienced surgeon using proper technique will produce less scarring than an inexperienced one.
For FUT, the closure technique matters. Trichophytic closure, where one wound edge slightly overlaps the other, allows hair to grow through the scar line and camouflage it.
For FUE, proper punch size selection and extraction spacing prevent the “moth-eaten” appearance that comes from overharvesting.
Post-Operative Care
How you care for your scalp after surgery directly impacts scarring. Following aftercare instructions isn’t optional. It’s essential.
We’ll cover this in detail in the prevention section below.
How to Minimize Scarring After Your Transplant
You can’t control your genetics. But you can control your behavior before and after surgery.
Before Surgery
Stop smoking at least one to two weeks before your procedure. Nicotine constricts blood vessels and reduces oxygen delivery to healing tissue. This directly impacts scar formation.
Avoid blood thinners, including aspirin, ibuprofen, vitamin E, and fish oil for at least a week before surgery. Excessive bleeding during the procedure can compromise healing.
Stay hydrated and eat well. Your body needs resources to heal properly.
After Surgery
Follow your surgeon’s aftercare instructions precisely. This isn’t the time to improvise.
Keep the surgical area clean to prevent infection. Infection is one of the leading causes of excessive scarring.
Avoid direct sun exposure on the donor area for several months. UV damage can darken scars and make them more visible.
Don’t pick at scabs. Let them fall off naturally. Premature scab removal can damage healing tissue and worsen scarring.
Avoid strenuous exercise for at least a week. Increased blood pressure and sweating can compromise healing wounds.
If you smoke, stay off cigarettes for at least two weeks after surgery. The healing phase is when nicotine does the most damage.
Camouflaging Hair Transplant Scars
If you already have a hair transplant scar, there are a few options available to help you conceal your scar. The best working scar treatment is FUE hair transplant scar repair.
The first and easiest way is to simply leave the hair surrounding your scar long enough to conceal it. However, many men, particularly as their hair loss progresses, get tired of this and simply want to buzz or shave their heads.
Another option involves the use of cosmetics, such as DermMatch, which can help disguise the scar. Unfortunately, this is only a temporary solution.
A more permanent option to consider is surgical scar revision. This involves “re-doing” the scar by excising it and suturing the wound again. Although this will occasionally result in a less noticeable scar, revisions often do not work.
A better surgical option involves grafting permanent hair into the scar. This can be done via the FUE method and may require more than one ‘pass’ to achieve desired hair restoration results since yield tends to be lower in scar tissue versus virgin scalp.
Advanced Scar Treatment Options
Beyond the basics, several advanced treatments can significantly improve the appearance of hair transplant scars.
Scalp Micropigmentation (SMP)
SMP is essentially a specialized tattoo technique that deposits pigment into the scalp to mimic the appearance of hair follicles.
For FUE scars (the small white dots), SMP can reduce the contrast between the scar and surrounding skin. A few sessions typically produce excellent camouflage.
For FUT linear scars, SMP gradually builds up layers of pigmentation to blend the scar with surrounding hair. It won’t eliminate a raised scar, but it can make it far less noticeable.
The best part? SMP works even if you want to wear your hair very short. It creates the illusion of density where there is none.
Many patients achieve optimal results by combining FUE scar repair with SMP. The transplanted hair provides real coverage, while SMP fills in any remaining gaps.
Laser Scar Treatment
Laser therapy targets scar tissue to improve texture, reduce redness, and stimulate collagen production.
Fractional CO2 lasers and pulse dye lasers are commonly used for hair transplant scars. They work by creating controlled micro-injuries that trigger the body’s healing response.
Laser treatment is particularly effective for:
- Reducing redness in newer scars
- Smoothing irregular scar texture
- Improving the overall appearance of both FUT and FUE scars
Multiple sessions are typically required. Results develop gradually as the skin remodels over several months.
PRP and Growth Factor Treatments
Platelet-rich plasma (PRP) and other growth factor treatments can improve healing and reduce scar formation.
When applied during or shortly after surgery, these treatments promote faster tissue regeneration. The growth factors encourage healthy collagen formation rather than excessive scar tissue.
At ForHair, we use cytokine-rich plasma (CRP), which delivers five to eight times the concentration of growth factors compared to standard PRP. This can make a significant difference in healing outcomes.
For existing scars, PRP injections may help soften and improve the texture of scar tissue over time.
Cortisone Injections
For raised, thickened scars (hypertrophic scars or keloids), cortisone injections can help flatten the tissue.
The steroid reduces inflammation and breaks down excess collagen in the scar. Multiple injections over several months may be needed.
This treatment is often combined with other approaches for best results.
Treating Donor Scars with FUE
When performing FUE we often run into individuals who do not desire additional strip scars or the risk of a wider scar. Sometimes they have a limited donor supply. Sometimes, they have a very tight donor area.
If these individuals desire larger sessions, we face a problem. If we want a large session, we must shave a larger surface area. This may risk exposure to the donor scars.
Working Around Existing Scars
Patients do not want to take this chance oftentimes. In other instances, they are willing to suffer the embarrassment of exposing their linear donor scar for a short time to maximize their potential coverage from a single procedure.
We have found that leaving the hair long allows us to obtain as many as 1500 grafts in a single procedure without shaving the entire donor area.
When the hair is of an average length, we can typically obtain between 800 and 1200 grafts without shaving or exposing the donor region.
If there is significant scarring in the donor region, we are sometimes more limited in the number of grafts we can obtain without shaving the donor region.
The Hair Prosthesis Solution
Sometimes individuals want a larger number of grafts, but they do not want their scars exposed. To deal with this problem, we devised a new method of concealing the donor strip scars after shaving the donor region.
One patient was told by a well known and well-respected strip physician that he could obtain up to 600 grafts only from a subsequent strip harvest. He did not want to risk a wider scar or additional scars. Therefore, he opted for the Cole technique of FUE.
We did our best to avoid shaving the donor region, but his follicular density was markedly reduced due to the multiple strip surgeries in the past. He wanted to maximize his results from this procedure.
The Procedure and Results
We devised a temporary hair prosthesis for the donor region and applied it to his donor scar. We shaved the surrounding areas and performed our procedure to remove individual follicular groups.
He had numerous lovely 2 and 3 hair groups. We extracted and placed approximately 1900 to 2000 grafts in total. This is well over what he could have obtained from the strip alone.
We left the hair immediately above the scar slightly longer, but combed it upward so you can see how well our hair prosthesis covers the strip scar.
The hair surrounding the extraction sites in the shaved donor area will grow quickly. After one week, I advised him to cut his hair one even length so that it blends better with the area that we did not shave.
This, along with the hair prosthesis, should help to conceal his scar. After the incision sites heal, which should take about one week, the worst-case scenario is he will look like a guy who got a bad hair cut rather than a guy who had a strip incision.
Using Beard and Body Hair for Scar Repair
When scalp donor supply is limited due to previous surgeries or extensive scarring, alternative donor sources become valuable.
Beard hair is often the preferred choice for scar repair. It’s thick, grows quickly, and the extraction sites on the face heal with virtually no visible scarring.
There’s another advantage too. Using beard hair means no scalp shaving is required. This keeps existing scars concealed during the recovery phase.
In rare cases, chest hair may supplement beard hair, though it’s less ideal due to its thinner caliber and slower growth pattern.
Frequently Asked Questions About Hair Transplant Scars
Do all hair transplants leave scars?
Yes, all surgical procedures leave some degree of scarring. However, the type and visibility of scars varies dramatically between techniques. FUT (strip) surgery leaves a linear scar that can be quite noticeable. FUE leaves tiny dot scars that are typically invisible unless the head is shaved very short. Advanced techniques like CIT® minimize scarring even further through minimum depth extraction, leaving no visible scarring to the naked eye.
Can hair transplant scars be completely removed?
Complete removal is rarely possible, but significant improvement is achievable. Combining treatments like FUE grafting into the scar with scalp hair and/or beard hair, and scalp micropigmentation, can make scars virtually undetectable. The best approach depends on the type, size, and location of your scar.
Can I wear my hair short after a hair transplant?
With FUE or CIT®, most patients can wear their hair short without visible scarring. The tiny extraction sites are difficult to detect even at very short lengths. With FUT, you’ll likely need to keep hair at least a few centimeters long to cover the linear scar, unless you undergo scar repair treatment.
Is scalp micropigmentation a good option for hair transplant scars?
SMP is an excellent option, especially when combined with FUE scar repair. It’s non-surgical, relatively affordable, and produces immediate visual improvement. SMP works well for both FUE dot scars and FUT linear scars. Results typically last 3-5 years before requiring touch-ups.
