Hair transplant for scalp scars

 Originally Published on Feller Medical

A number of reasons for scalp scarring include accidental trauma, previous surgery, burns or previous failed attempts at hair transplantation. Hair transplantation is a useful tool where hair loss is a direct result of a scalp scar.

Understanding Scalp Scars and Their Impact on Hair Growth

The formation of a scar is a consequence of the injury, a replacement of normal skin with fibrous tissue. Fibrous tissue formation is a useful mechanism for replacing skin from an injury; however, fibrous tissue in the skin (the scar) interferes with the normal growth of hair follicles. The fibrous scar represents a disruption of the skin surface architecture that, ultimately, results in a loss of hair follicles within the area of scarred skin.

Common causes of scalp scars include:

Traumatic Injuries: Accidents or lacerations to the scalp can result in scarring.

Surgery scars: Some operations (such as neurosurgeries, especially interventions on the peripheral nervous system, or older hair-transplant procedures done using older techniques) often cause visible scars.

Burns: Thermal or chemical burns can destroy skin and hair follicles.

Disease processes: lupus or lichen planopilaris, an iron deficiency-based or skin-rash-inducing disease, could cause some scarring alopecia (permanent loss of hair follicles).

Hair Transplantation: A Solution for Scalp Scars

A hair transplant is a form of surgery that involves transplanting hair follicles from a donor to a recipient location. Hair transplant procedures have been practiced for decades, and today it has become a minimally invasive surgery that commonly elicits predictable outcomes.

Although the insertion of hair transplants into scalp scars are usually more complex surgeries, it is still an option to discuss with your hair transplant doctor of choice.

There are two main techniques involved:

Follicular Unit Transplantation (FUT) — A Strip of viable hair is removed from the head, dissected into follicular units, and implanted.

Follicular Unit Extraction (FUE): Individual follicular units are extracted from the donor area by means of punch tools and implanted into the recipient area.

Challenges of Transplanting Hair into Scar Tissue

Scar tissue differs from normal scalp skin in several ways:

Loss of vascularity: Scars contain fewer blood vessels, and so transplanted hair follicles could have less chance of survival.

Thickened Collagen Deposits: The thickened collagen in scars impedes ‘normal’ hair growth.

Despite these limitations, surgical technique and postoperative care have been refined to the point that follicular unit transplantation into scarred areas is possible and much more successful.

Preoperative Assessment and Planning

A thorough evaluation is crucial for a successful hair transplant in scar tissue:

They are gauged only after they are complete or near-complete, and good contour will consist of a line insofar as it coincides with a line on which the scar itself exists.

Assessing the scar involves analyzing several features: how much the scar is discolored as opposed to matching the color of the adjacent skin; how the scar’s texture fails — if it does — to be completely indistinguishable from the neighboring region; how large the scar is in relation to what is considered ideal; to what extent contour is accurate — that is, how much the scar’s shape matches that of the normal skin that surrounds it — or, vice versa, how much the scar ‘falls short’; what the scar’s overall appearance looks like; and, finally, how vascular it is.

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