A Complete Guide to Hair Transplantation Scarring

Anxiety is a completely natural and reasonable response to the prospect of undergoing any surgical procedure. For this reason it’s not surprising for our patients considering hair transplant surgery to occasionally express their concerns about the possibility of scarring.  Hair restoration surgery is after all an elective form of treatment undergone for aesthetic purposes; therefore it stands to reason that excessive scarring would somewhat defeat the purpose of such a procedure. Firstly, it is important to understand that no surgery known to modern medicine carries a 0% risk of scarification. In fact, various medical oversight bodies have issued official statements condemning those who advertise any sort of surgical procedure as ‘scar free.’ However, despite these natural caveats, hair transplants remain (with good reason) an immensely popular form of treatment the effects of which, on an individual’s general wellbeing, far supersede the merely aesthetic. And we confidently assert that our clinic’s surgeries leave scarring so fine that it is practically imperceptible unless under a microscope.

To help alleviate any anxiety you may have, let’s take a closer look at hair transplants and scarring.

Scar tissue forms as part of the body’s natural healing response and, in a surgical context, is proportional to the extent and depth of the incision. Any damage to the skin can result in scarring; even a paper cut can leave subdermal scar tissue. During a commonly used technique for hair restoration surgery there are two areas of the scalp on which small incisions are made; donor area, from which the hair transplant grafts are harvested, and the recipient area where the same hairs are transplanted.

The small slits made upon the bald part of the scalp (the recipient area) are made with minimally invasive surgical implements and, if done correctly by a skilled professional, should result in no visible scarring. Subdermal scarring will not be visible. Visible scarring may result in certain cases if, for example, large implements are used or if a practitioner attempts to squeeze an injudiciously large amount of grafted hairs into the skin of the scalp. Again, while it would be disingenuous to suggest that there any procedure is 100% scar free, as there will always be some changes below the skin, under normal circumstances you should expect the skin of your scalp’s recipient area to look more or less the same as before the procedure; except, of course, that it will now be covered by a beautiful new growth of hair!

Very minor scarring in the donor area is, however, unavoidable with any currently known medical procedure. Any practitioner who suggests otherwise is, quite frankly, lying. The hair grafts must be removed by means of judiciously placed surgical incisions and a cut, by its very nature, will inevitably leave some form of scarring. The good news for you, however, is that such scarring as is expected to occur during the harvesting of hair follicles is minimal. The incisions made by highly trained professions on the donor area using the highest quality surgical implements are difficult to see once recovery is complete and will also be hidden below hair. To better understand scalp scarring in the donor area we need to discuss the two different methods for harvesting hair follicles; Follicular Unit Transplantation, also known as FUT and Follicular Unit Excision, or FUE.

Follicular Unit Extraction (FUE) – In FUE individual hair follicles are removed from a donor area of the scalp and are transplanted to the area in need. No stitches or sutures are required for this minimally invasive procedure. Tiny implements, some of them measuring less than 1mm, are used to carefully excise individual hair follicles, small forceps are then used to free the graft. The small holes left behind from the cutting and removal of the grafts fill with scar tissue, leaving small dot-like scars wherever a graft has been extracted. When performed correctly, FUE scarring is almost impossible to discern.

Correctly is, however, the operative word – to minimize visible scarring the number of extractions must be small. In an inappropriately performed FUE procedure thousands of these small dot-like scars will be noticeable which, along with visible thinning of the donor region from overharvesting, is not an ideal aesthetic situation. The appearance of scar tissue varies somewhat with skin tone. As scar tissue is often lighter in color compared to one’s natural skin tones, patients with darker skin may have more apparent scarring from FUE because of a greater degree of contrast. In either case though, the scars are difficult to notice even on those who prefer very short hairstyles; if they so choose, our FUE patients should easily be able go down to a #2 (1/4th of an inch) on the clippers while retaining excellent scar coverage.

Follicular Unit Transplantation (FUT) – In FUT a strip of scalp tissue is removed from the donor area. The scalp tissue is then separated into individual grafts for the needed areas of the scalp. The resulting FUT scar is also a very fine, straight line in the donor region. Typically less than 1mm in width although patients with certain physiological characteristics may develop a scar up to 2mm in width. Both 1mm and 2mm scars are considered to be within the normal range of healing. Your small scar will be hidden by any reasonable length of hair growth. Hair grows above, below and through the scar. Hair growth through the scar is facilitated by a special closure technique; other techniques also exist that ensure, for example, that you will only ever have one scar even if multiple harvestings are required. In all typical cases the scar heals so well as to be indistinguishable even on those who prefer to wear their hair in very short styles. We have observed that even patients with hair buzzed down to as short as 3/8ths of an inch using the #3 guard on a set of barber clippers still have sufficient hair to render the scar barely discernible. The small linear incision scar resulting from FUT provides our practitioners with the greatest number of available grafts. The harvesting process causes no stress to the grafts themselves and, moreover, no further damage or scarring in the donor region. This guarantees that, if required, more donor hairs will be available for future surgeries.

Now let’s talk about subdermal scarring. Scarring beneath the surface of the skin occurs with both the FUE and FUT procedures. Owing to the nature of these procedures and also to the body’s natural scarification process,the subdermal scar is almost always going to be bigger than the visible surface scar. This is not an issue with FUT as the 1mm-2mm scar typically has only an additional 2-3 mm of  scar tissue below the surface. Thus hair follicles within millimeters of the FUT scar are totally untouched and ready for future harvesting.

On the other hand, FUE scars may form too close together if the procedure is not performed correctly. As we mentioned above, FUE cuts made too close together are to be avoided. Such overharvesting may result in an overlapping network of web-like  scar tissue (sub-dermal fibrosis) compromising the health of surrounding hair follicles and rendering further harvesting problematic. The small surface scars from a properly performed FUE procedure are, again, difficult to appreciate even on those with quite short hair.

While most patients are left with minimal, well hidden scarring (and a fully restored head of hair), the technique of Scalp Micropigmentation (SMP) can be performed to further minimize scarring if necessary. SMP is quite similar to standard tattooing, although it utilizes natural pigments in place of ink. SMP involves tattooing small dots which look like shortly buzzed hairs onto the scalp which help to darken, camouflage, and break up the appearance of scar tissue thus allowing patients who wear shorter hair to effectively hide any trace of visible scarring.

For more information about FUE and FUT or to discuss any anxieties or concerns you may have regarding scarring and hair transplant procedures, be sure to contact our hair restoration surgery center today. While hair transplant surgery does cause scarring it is almost imperceptible if done by a very skilled practitioner. At Modena Hair Institute we always strive to provide our patients with the highest standard of custom hair restoration treatment available, directly tailored to their individual needs. Our specialists are eagerly awaiting your visit or digital consultation. Contact us today!

Dr. Amir Yazdan, MD, is an internationally renowned hair transplant surgeon, expert guest on Dr. Phil and The Doctors, creator of the GroMD hair restoration product line, ISHRS member, accredited member of the IAHRS and a visceral advocate for patient care. Learn more about Dr. Yazdan or read rave reviews from his patients.