Scarring and Its Impact on the Future Appearance of the Patient

Each time a person has a surgery of any type, a scar is produced. Scars are dynamic and they change over time more than most people realize. In the first month after any wound is formed (surgically produced or otherwise), microscopic, temporary changes occur in and around the wound area, which form a latticework of materials, which strengthen the healing scar. Further healing occurs over the months that follow. Healing places a firm, almost cement like, dense scar tissue in and around the healing wound. When this occurs in the donor area, this hard tissue extends to the hair follicles in and around the wound. In future surgeries, this cement like material impacts the yield of hair in the donor area if the same area is harvested again. Re-harvesting the same area is important to keep visible scaring to a minimum. Many doctors try to bypass this problem by harvesting a clean, non-scarred area for each subsequent surgery. When many surgeries are done, these poor unfortunate individuals have a stepladder type appearance of the back of the scalp as the multiple scars dominate the harvested area.

Over a six-month period, the scarring distorts the hair shafts in the adjacent skin below the surface for a distance of at least 1/8 inch on either side of the surgical donor site. This distortion occurs because scars tend to contract, and when they contract, they create a force, which tugs on the microscopic structures around the scar. If different donor sites are chosen for each hair transplant procedure, the total area for distortion of the hair follicles becomes quite extensive and cumulative. Such distortions become a significant factor in the surgeon's ability to maximize the donor hair supply for more extensive hair transplant reconstructions.

The more scarring present, the more distortion of the local anatomy and the less hair that can be moved. Surgeons who per-form multiple procedures with a small number of grafts can reduce the available donor hair by a factor of 30% or more if they elect to place the incision in a new, fresh, untouched part of the donor scalp.

Surgeons who use the now out dated open donor method of harvesting grafts produce significant visual scarring. In addition, this scarring can reduce the available donor hair by a factor of over 50%. Despite this, the open donor method of harvesting grafts is still used today. It is this author's opinion that the open donor method of harvesting grafts falls below the standards of today's acceptable medical practice.

Scar Improvement

Often, hair transplant specialists are confronted with patients whose donor area has been severely scarred by an older harvesting method (open donor technique) or by improper harvesting techniques, or from too many surgeries, or more rarely in a per-son who heals with a poor cosmetic scar for reasons intrinsic to their body's healing properties. In a very rare patient, the scars may become visibly wide if they have inherited a defective healing process (may be seen in 1:10, 000 patients). Frequently when scars occur, they can be surgically improved. Only on rare occasions can all of the visible scar tissue be removed.

The ability to modify obvious scarring may be attempted at the same time as an actual transplant procedure. The correction of scars may require, however, a more focused session. Hairlines

Proper selection of donor sites and graft sizes addresses the supply part of the balding problem. Design of the hairline and sitting of the recipient sites are equally crucial to a successful out-come. Some doctors do the same standard hairline on every patient, and this practice is less than ideal. Natural hairlines vary from one individual to another as much as facial features do. The hair transplant specialist must be aware of the spectrum of racial and ethnic variations that normally occur. All natural hairlines are not completely asymmetrical; therefore one should not attempt to obtain a perfectly balanced hairline for it is distinctly not natural looking. Movie stars frequently want balanced, symmetrical, very heavy hairlines and if they do not have it naturally (rare) then the make-up artists create it. Look at a male hairline in the -macho-men depicted in film and see what we mean. The lesson here is that you should not attempt to achieve the hairline shown by your favorite male movie star.

Men of European extraction often have receded corners or a slightly pointed hairline;. Men from the Middle East and Asia often have wide, flat hairlines with a wider, gentler curve. Men of African extraction have hairlines that vary from one that is similar to that of Europe to as very straight, flat hairline.

The design and placement of the hairline is crucial because nothing can completely erase the signs that something was created. Although transplants are permanent, there should be no visible scars with follicular grafts. The patient must have an active voice in all decisions; concerning the placement and design of the hairline. These decisions, once acted upon, will be permanent and irreversible