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Hair Transplantation to Conceal Scars

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Hair Transplantation to Conceal Scars

Male Hair Restoration

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!

Why is Ethnicity an Important Consideration for a Hair Transplant?

Women's Hair Tansplants,

Performing a hair transplant that achieves the look of natural, healthy hair growth is – or should be – the goal of every hair restoration surgeon. Therefore, a skilled, experienced surgeon knows that there is no cookie-cutter, one-technique-fits-all approach. However, you might be surprised to learn that in addition to the numerous factors a conscientious surgeon such as Dr. Marco Barusco – founder and Chief Medical Officer of Tempus Hair Restoration – considers, the ethnicity of the patient is highly important in determining the “game plan” for the placement of hair, as well as for the implantation technique.

A native of Brazil, Dr. Barusco has been privileged to perform hair restoration surgery on patients of all ethnicities, crediting his adopted home of Florida with being a popular destination for people of every racial heritage throughout the world. Some of the information in this article is based on Dr. Barusco’s video – “Is Ethnicity Important When it Comes to Hair Transplantation?” – that Dr. Barusco produced for his YouTube channel, Hair Loss Medical Advice.

“There is a lot of mixture of races here, and so I come across every type of ethnic hair that there is: Asian, African-American and Caucasian,” says Dr. Barusco. “They each require a slightly different approach.”

Common Ethnic Considerations for Planning a Successful Hair Transplant Procedure

According to the International Society of Hair Restoration Surgery (ISHRS), there are common factors for a surgeon to consider when planning for a successful outcome:

  • Head shape – For example, a “long” head shape and a “round” head shape require different approaches to placement of transplanted hair.
  • Hair characteristics – For example, hair color, hair caliber (diameter) and hair shape (straight, wavy, curly, frizzled, etc.) all influence the appearance of transplanted hair.
  • Hair density – Differences in the numbers of hairs per square centimeter of scalp – for example, about 200 hairs per square centimeter in East Asians versus about 130 hairs per square centimeter in Caucasians – influence the surgeon’s decision on where, how and how many follicles to implant in the recipient sites.
  • Skin thickness – Thickness and other genetically programmed features of skin influence technique for setting donor hair into the transplantation site, and may predispose a patient to postoperative formation of the type of scarring called keloids. African-Americans are particularly susceptible to forming keloids in response to skin injury, which must be taken into account before surgery. Dr. Barusco’s YouTube video – “What is Keloid Scarring?” – addresses this issue in detail. People of Asian background are also more prone to keloid scarring than Caucasians, although to a lesser extent than African-Americans.
  • Cultural preferences – Ethnicity may influence a patient’s preferences regarding where a transplanted hairline should be placed, and how much “baldness” is acceptable.

Characteristics of Asian Hair to Consider in Hair Transplantation

In covering the characteristics of Asian hair, the ISHRS makes the distinction of people of East Asian origin (Chinese, Japanese and Korean). Noting that East Asian hair is similar in most respects to Caucasian hair, there are differences that can influence the transplant procedure.

Characteristics include the following:

  • East Asians have thicker individual hairs than Caucasians, but fewer hairs per square centimeter of scalp (lower hair density). However, the thickness of hair follicles creates the impression of greater hair density. For this reason, a larger donor area must be harvested to obtain the number of hairs necessary for a transplant.
  • The characteristic shape of the East Asian head is somewhat more rounded than the longer, more narrow head typical of Caucasians. Therefore, hair placement must be adapted accordingly to achieve a natural-looking hairline and growth pattern.

Characteristics of African-American Hair to Consider in Hair Transplantation

The curling and twisting of African-heritage hair provides the appearance of good scalp density, which is an advantage in hair transplants. Hair may emerge at a variety of angles from the scalp, which can make the harvesting of donor hair more challenging. Both the follicles and hairs have a degree of curvature in relation to the scalp that must be accommodated when harvesting. However, its curliness allows coverage of scalp areas with fewer number of follicles needed to achieve an aesthetically pleasing “full” coverage – thereby reducing the number of follicles needed for transplantation.

In his article for the ISHRS, William D. Yates, MD, writes that African-American hair transplantation involves unique factors which must be considered in the pre-op, operative and post-operative stages to ensure the best outcome. Because developing keloid scarring may be a possibility, the surgeon should ask if a prospective patient has a history of such scarring, or any other scarring scalp disorders. A conscientious surgeon will also monitor for scarring post-op, as well as watch for ingrown hairs, which can occur two to three months after surgery, when the hair begins to grow.

Characteristics of Caucasian Hair to Consider in Hair Transplantation

Caucasian hair is generally straight or wavy and is the thinnest of the three main types of hair, while its cross-section is relatively elliptic. It grows diagonally to the scalp, and has the highest density of the three ethnic profiles.

People of multi-ethnic backgrounds may have hair that better fits one particular profile – which, of course, the surgeon needs to take into consideration when planning a hair transplantation procedure.

Cultural Preferences to Consider

In addition to the technical aspects of harvesting and implanting different types of hair, a conscientious surgeon will also be aware of how the patient’s culture affects their self-image and expectations. For example, Dr. Yates writes that his male African-American patients prefer less temporal recession in the design – that is, a less-pronounced “M” shape that characterizes the mature male hairline.

Dr. Barusco sees similar preferences in his own practice. “Some ethnic groups are much more in tune with what their hairlines are, so they want a lower, more aggressive hairline; others don’t.”

What This Means to You – Choose Your Hair Restoration Surgeon Wisely

If you’ve decided to have a hair transplant procedure, be sure the surgeon you choose has experience with patients of your ethnic group, and has achieved good results. Our website’s Before & After Gallery provides examples of Dr. Barusco’s outstanding work in creating the look of healthy, natural hair growth for patients of all ethnicities. In addition, ask any surgeon you schedule a consultation with about their experience in performing hair transplant procedures on members of your group. This article should give you a basis for questions to help you determine the surgeon’s degree of knowledge and expertise.

The consultation also is the time to tell the surgeon about your own aesthetic preferences and expectations of the results you want. The surgeon may assume you want coverage in a particular area, when you actually want to see growth on a different area of your scalp. If the surgeon has a vision that differs from yours, there may be a reason – but it is the surgeon’s responsibility to explain their reason so that you understand and can make your decision based upon this information. Our blog post – “Why Do Some Hair Transplants Fail?” – covers such reasons as poor doctor-patient communication and poor technical execution of the transplant procedure – among many others – for unsatisfying results.

Ultimately, choose your surgeon based on experience, results and integrity. 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!