A female patient after a face-lift with a scar behind her ear.
Nine months after a single session of transplanting to correct the scar shown in Fig. 21a.
The same patient with a scar running along the temporal hairline and absence of sideburn hair after a face-lift. (A common hallmark of face-lifts.)
The same patient six months after a transplant to the scar and the sideburn area. Scarred areas can be successfully transplanted whether they are caused by cosmetic surgery, trauma, or some skin diseases.
The above photo shows an intra-operative photo of a patient who had an unacceptable donor area scar in his left temple. A small punch has been used like a cookie cutter to punch out individual FU in the donor area, instead of excising a donor strip and dissecting it microscopically. The lower photo shows the results of the session without any visible scarring at the site of the FU extractions and with the FU that were transplanted into the scar completely concealing it six months after surgery. (In fact some of the FU were also used in areas of MPB at the same time.) The Follicular Unit Extraction (FUE) in this individual was done by another surgeon to whom I referred the patient.
This patient underwent FUE and was left with quite noticeable scars at the site of each of the extractions, as well as multiple purulent cysts. The noticeable scarring is the result of a combination of a larger than ideal sized punch having been used, the grafts having been taken too close together given the size of the punch and perhaps the healing characteristics of the patient. The cysts are the result of some transected FU having been driven underneath the skin at the time the extraction was being carried out. The photo should remind patients that FUE can be done well or badly just as any other form of surgery.
The donor strip has been excised and the wound sutured. The hair has been combed upward so that we can see the sutured wound. When hair is combed over the sutures, it easily, and immediately after the operation, completely camouflages the donor site.
The same wound shown in Fig. 24a, six months after the procedure. The vast majority of donor areas scars will be only 0.1 mm to 1.5 mm wide even after multiple sessions.
As seen above, the donor scar of some patients will be a little wider than that shown in Fig. 24b.
This photo was taken at the same time as that shown in Fig. 24c but the hair has been combed as normally worn. More than 95% of our patients have scars similar to that shown in Fig. 24b & c and can wear their hair as short as that shown above without the scar being noticeable. The other approximately 5% have an inherent tendency to heal with wider than average scars. However, because there is only one scar no matter how many sessions are carried out, and it runs through the densest rim hair, even these wider scars should be completely camouflaged by surrounding hair that is cut to a reasonable length.
A patient with a relatively limited donor area, before transplanting. He had quite sparse hair in the lower part of his "permanent rim" and therefore had an extremely narrow potential donor area.
Before and after two sessions of relatively low density FUT because the area to be treated was so large and the donor area resources relatively small.
A frontal view before and after two sessions, one to the frontal area and one just behind it.
The donor area after three sessions of transplanting had been carried out with the hair combed as normally worn in the upper photo. In the lower photo, the only scar present after the three sessions.
A close-up of the scar after three sessions.
A patient one day after his first transplant in 1995. The black crayon marks denote areas that we intended to excise with alopecia reductions at a later date.
The same patient several months after his fifth transplant (and two alopecia reductions). The scene in the above photo really represents the results of hair growing after four sessions as the fifth session was only beginning to grow at the time this photo was taken.
The patient's donor area showing a relatively narrow zone of reasonably dense hair and quite sparse hair in the lower part of the "permanent rim" hair that was unsuitable for donor harvesting.
The only scar that was present after five transplant sessions. The hair has been clipped so as to reveal it more clearly. Figs. 26c and 26d were photos taken just prior to a sixth session.
Another quite old photo done years ago (when sessions were smaller) just prior to a seventh strip being removed from the same area. The hair has been clipped in order to facilitate the harvesting of the next strip. Note that most of the scar is still quite narrow despite the preceding six sessions. It is a little wider to the right probably because of a higher closing tension at that site than in the majority of the length of the strip. It is commonly said that although a good scar can be obtained after a single or perhaps second strip harvest that the scars tend to get wider with each subsequent harvest. Figures 24 through 27 are intended to show that this is not necessarily so. The width of the donor scar is dependent on many factors and the number of sessions is only one of them; closing wound tension is more important by far.
A patient seen approximately 15 years ago for correction of pluggy-looking hair transplanting carried out in another office. The hair in the grafts has been cut short just prior to the surgery.
An intra-operative photo showing that portions of each of the larger grafts had been excised. At the same time as that was done, a combination of micrografting and micro-slit grafting was carried out in the same area.
Nine months after the photo shown in Fig. 28b showing a far more natural distribution of hair because of the combination approach of excising portions of old grafts and adding new smaller ones.
This 56-year-old gentleman had undergone hair transplanting 15 years prior to seeing me in 2002. He had fine-textured, reddish-to-blonde colored hair. The transplanted area was moderately pluggy-looking and would have appeared much worse had his hair not been so fine and relatively light-colored. The density in the transplanted area was also relatively low. In addition to the preceding, his MPB was obviously extending further laterally and he had lost all of the hair behind the transplanted zone. He was basically left with a pluggy-looking, unsatisfactory isolated frontal forelock, as is shown in the photo. I designed lateral "humps" for completion of the frontal-third of the area of MPB and a new hairline zone in front of the old one. The black crayon line delineates these objectives.
A patient who had been in a car accident and had severe scarring alopecia in the temple area.
A patient before repair of transplanting done in another office. The areas to be treated are outlined in black grease pencil.
The same patient shown in Fig. 30a, 10 months after his first frontal repair session (1973 FU).
The same patient shown in Figs. 30a and b, 11 months after his second repair session (1361 FU), the latter behind the first one.
A photo of a back view, taken at the same time as the photo in 30c.
Many patients who come for repair of older-type transplanting have alternating rows of scars and hair in their donor area as shown in this schematic drawing with H denoting the hair-bearing sections and S the scar-bearing sections. A strip is excised that contains two rows of scar and one row of hair as shown in the drawing and the wound is sutured closed. One ends up with one scar instead of two. The single scar is in addition, far narrower than both of the two that have been excised. One also ends up with two rows of hair-bearing skin adjacent to each other. The result of this sort of repair harvesting is that a) one obtains additional hair from the hair-bearing section that was excised as part of the strip, and b) the donor area looks thicker rather than sparser despite the removal of additional hair because one is left with one finer scar instead of two, and just as importantly, there are two rows of hair adjacent to each other now.
A clinical photo of a patient who demonstrates old methods of harvesting prior to repair.
After a strip that has been excised that contains two rows of scar and one row of hair as demonstrated in the schematic drawing in Fig. 31a. Obviously, the donor area looks better after this harvest despite the removal of additional hair.
A scar from an infection in the donor area during a preceding hair transplant done elsewhere. Many people believe that such scars cannot be improved upon by additional strip harvesting. This is not necessarily true.
The same patient immediately after excision of the strip from the area shown in Fig. 32a. In such cases, it is particularly important a) to not close the wound with any tension whatsoever and b) that one border of the new incision should run through intact hair-bearing skin, thus supplying a better blood supply to the new wound.
Six months after the photo in Fig. 32b showing that the scar has not become wider with the passage of time. The hair adjacent to the remainder of the scar has been clipped short just prior to another strip being removed in order to further improve the scarring.
A patient who had been in a car accident and had severe scarring alopecia in the temple area.
The same patient nine months after a single session of grafting into the temple area. Hair transplanting into scar-bearing tissue can produce substantial improvements. See also Fig. 21.