Whether caused by injury or surgery, scars on the head leave a constant reminder of either a trauma that the individual is trying to emotionally move on from, or a procedure intended to improve one’s appearance – but left unwanted evidence. In both cases, a hair transplant designed to conceal such scars can provide a major step to restoring the self-confidence needed to make the recipient feel like a whole, healthy person again, or the last mile to complete the aesthetic goal of a brow lift or facelift.
Dr. Marco Barusco – Founder and Chief Medical Officer of Tempus Hair Restoration – has extensive experience in performing hair transplants to cover scalp scars of every type. Although each patient has their own story about the journey that led them to his practice, the particular problem that scars on the scalp pose is fundamental.
Why Doesn’t Hair Grow on Scars?
Hair typically doesn’t grow on its own in scar tissue because it lacks the dermal structures to support hair growth, as exist in normal skin. Regular readers of our blog may be familiar with our blog post – “An Up-close Look at Hair Grafts” – which describes a hair follicle and its related structure.
A follicular unit is a cylinder of skin and hair that encompasses the hair follicle, the sebaceous gland (which secretes sebum – a lubricating oily matter – into the hair follicles to lubricate the skin and hair), the arrector pili muscle (a microscopic band of muscle tissue which connects a hair follicle to the dermis), and the papilla – or bulb – of the hair, which is an important stem cell reservoir.
In undamaged skin, blood vessels under the follicles help them grow and regenerate. But when skin is damaged, a scar consisting of thick fibrous tissue forms, which doesn’t allow hair follicles to grow back. Because scar tissue tends to be thicker than undamaged skin, scars on and around the scalp are conspicuous. Scars caused by injury are also irregularly shaped, while those from surgical procedures show the path of the sutures.
Surgical scars on most locations of the body can be concealed under clothing, but scalp scarring has nowhere to hide. Depending upon the location and/or size of the scar – as well as the amount of hair one has – it typically isn’t possible to grow hair long enough to comb or style over the scar. Even so, no matter how carefully styled one’s hair may be, wind and the numerous movements you make throughout the day are likely to shift its position, falling away from the scar to leave it visible.
What are the Challenges of Hair Transplants to Conceal Scalp Scars?
This type of hair restoration surgery involves implanting hair grafts into the scar tissue itself. Because the original hair follicles are gone, the surgeon must determine the correct angle and direction in which to place the individual grafts to fill in the areas of lost hair. Also, the thick, stiff nature of scar tissue makes precise placement of hair grafts more challenging.
Another major challenge is ensuring the hair grafts have an adequate blood supply. They must take root, so to speak, and connect with surrounding capillaries before hair can start to grow. Scar tissue is prone to poor blood supply, so it’s more difficult for transplanted follicles to get the nutrients necessary for healthy hair growth. If the blood supply is inadequate, the transplanted hair follicles will die or be unable to function adequately.
Hair Transplants to Conceal Scars from Trauma and Neurosurgery
As the International Society of Hair Restoration Surgery (ISHRS) notes, the head is particularly vulnerable to injury. Major causes of head/scalp trauma are motor vehicle accidents, childhood accidents, sports injuries, industrial accidents and physical violence. Neurosurgery performed to treat brain injury will result in additional scaring.
Regardless of the severity of such injuries, performing restorative surgery requires the highest level of experience, medical knowledge, strategic planning, skill and sense of aesthetics. In this field, Dr. Barusco is renowned for the complex procedure he performed for “K.J.” – a man whose near-fatal motorcycle accident resulted in multiple skull surgeries. A few years after making a remarkable recovery, K.J. decided he was ready to make the most of his second chance at life, without the scars that he felt self-conscious about. His inspiring story is the subject of our blog post – “See Me, Not My Scar – Restoring Hair to a Head Trauma Patient Other Doctors Turned Away” – which we invite you to read in its entirety. K.J. also provided this testimonial video, which can be seen on Dr. Barusco’s YouTube channel, Hair Loss Medical Advice.
“(The patient’s) case was difficult, and posed a higher risk of serious complications due to the surgeries he had for his head trauma,” said Dr. Barusco. “Particularly the reconstruction of his skull with a synthetic material, which was placed under the area to be transplanted. This made the procedure of transplanting hair more challenging and risky. Most other doctors don’t have the experience or the facilities to perform this procedure under sterile conditions, and with the pre- and post-operative preparations that were needed to do it safely.”
Dr. Barusco chose the Follicular Unit Transplantation (FUT) procedure on K.J., which he determined would achieve the best result. “Due to his various scalp scars, the safe area for donor hair harvesting was limited to the back and right areas of his scalp. An FUT was recommended in order to move more hair in one procedure.”
Although Dr. Barusco decided that the FUT was the appropriate procedure for K.J., the Follicular Unit Excision (FUE) may also be used. Typically done as a shaved procedure (where the donor area is shaven), Dr. Barusco created an improved technique known as the “no-shave” procedure. This technique allows clients to have the benefits of an FUE procedure without having the downtime of waiting for the hairs of the donor site to grow in. Advantages include complete concealment of harvested donor sites immediately, and a quicker return to normal activities, as no suture removal is required.
In addition, Dr. Barusco created a pre- and post-operative protocol designed to increase safety in these types of procedures. This protocol was published in a scientific journal and in a medical textbook, and today is used by many doctors in the field.
Hair Transplants to Conceal Cosmetic Surgery Scars
Ironically, the surgical procedures that many seek to achieve a more youthful appearance – such as facelifts and brow (forehead) lifts – result in scarring along the hairline, and sometimes complete loss of hair in some areas, such as the sideburns. Depending upon the experience and skill of the surgeon, cosmetic surgery scars may be discrete and not readily visible, or more obvious.
In his YouTube video – “Hair Transplants Into Scars from Plastic Surgery” – Dr. Barusco makes the following observations:
“Many patients come to me because they’ve had a cosmetic procedure – like a facelift or forehead lift – or skin cancer or an accident or burns, and now the scars are hard to hide. So a lot of times the incisions from a facelift are going to go either in front of the hairline. They start around the temples, depending if you have a lower lift, they’re going to be tucked in usually behind the ear. So this can affect your hairline around the ears – sometimes behind the ears … It depends on what you need and what your doctor is going to do for you. Sometimes, the doctor will make an incision in front of the hairline – sometimes behind the hairline – and it wraps around the ears. So when you go for your consultation for your facelift, ask your physician to tell you which technique he or she is going to use, because that can affect your hair in different ways.”
Visible scarring, hairline distortion and sideburn distortion are complications that occasionally follow facelift and brow lift surgery. Camouflage is possible whether these facelift and brow lift scars are located around the ears, in front of the hairline or within the hairline. Grafts are implanted directly into and around the scar so as to create a seamless transition between the facial skin and the scarred area. Our blog post – “Hair Transplants to Conceal Facelift Scars – What You May Not Know” – explains this topic in greater detail.
A hairline that is higher or farther back than desirable – as well as the loss of sideburns – can also be repaired. Again, meticulous care is taken to match the angle and direction of the hair in the reconstruction zones so as to produce a completely natural-appearing result. Dr. Barusco’s YouTube video – “Hair Transplantation to Cover Facelift and Eyebrow Lift Scars” – provides case studies and before-and-after photos of patients for whom he performed such restorations.
While we always emphasize the importance of making sure the surgeon you choose for your hair restoration has the experience, qualifications and skill to provide the best possible result, it is even more essential to do so when your goal is to conceal scalp scarring. This is not a procedure to be performed by a surgeon whose practice depends upon one or two types of procedures performed in a rather standard manner for all patients. As with our determined patient K.J., those living with scars want their appearance restored to the point where they can feel comfortable and confident facing the world – either as a fully integrated healthy individual, or as a younger, more refreshed version of themselves!
Keep in mind that the success of any hair transplant procedure ultimately depends upon the experience, skill and integrity of the surgeon. Dr. Barusco’s long list of accomplishments, his notable artistic ability and his successful surgical team make Tempus Hair Restoration a renowned practice. Contact us to schedule your free virtual consultation. Dr. Barusco conducts every consultation himself, giving you the opportunity to learn your options in the comfort of your home – or any location, on any internet-enabled device.
Dr. Barusco conducts consultations in English, Spanish and Portuguese. For your greater convenience, Tempus Hair Restoration offers a two-night complimentary hotel stay to out-of-town clients who travel 100 miles or more to our Port Orange, Florida, surgical center. No matter how far the distance, we welcome the opportunity to help you on your hair restoration journey!