- Reaction score
- 0
Hello,
Thank you very much for reading my thread. I have come to this forum after failing to find the information I am looking for anywhere else online.
I am a 33 year old caucasian male who recently completed an initial consult with a hair transplant surgeon in Southern California. I have relatively mild hair loss in the temple areas as well as frontal scalp (bangs) area and the doctor recommended 1,500 to 2,000 grafts depending on whether I wanted to lower my hairline slightly by a half inch or not.
I thankfully do not have a history of pervasive hair loss in my family, my father is 74 and his hair looks about the same as mine, just some mild hair loss in the temples/front, except his hair is gray now.
As a precaution I started finasteride four months ago to (hopefully) get the DHT permanently under control. So far I can’t tell if it has done anything or not, probably due to my slow rate of hair loss. I certainly have not seen any regrowth from the finasteride, and don’t really expect to for whatever reason.
Where things get complicated is I am a keloid former. I have six (!!!) keloids on my body in areas where they commonly form: Two in my sternum (mid chest) area, one on each of my shoulders and two on my back/shoulder blades.
I understand that the working theory is that keloids tend to form in areas of high muscle tension, which could possibly explain the variance in the rate of occurrence across different areas of the body, for example the shoulders vs scalp, although this theory nothing more than that, a theory. Keloids are still an endlessly confounding topic in modern medicine, and there are many examples that run counter to muscle tension theory.
I went into the hair transplant consultation presenting my keloid history as my overwhelming primary concern, arguably more important than the success of the transplant itself, and explained I would only want to move forward with a transplant after undergoing a small 10-50 test graft session, waiting nine months to observe scar formation patterns, and then making a decision based on those results.
The doctor agreed that was the best course of action, concurred the test graft session is paramount and *if* successful after nine months he recommended FUT strip harvesting due to both my relatively younger age (for donor hair preservation if needed in the future for a second procedure) and the benefit of having a smaller, linear scar in the donor area. He explained the scarring from FUE takes up a surface area roughly 12 times that of the FUT strip scar, due to the fact that the FUE punch hole scars can not be “closed” and reduced in size the way the strip incision is closed. He said “If things were to go south, you would rather have a single long keloid back there which you could grow hair over than to have the entire donor area turn into a field of miniature keloids.” I think I agree with that assessment.
He also warned that a scar free test graft is no guarantee that the hair transplant will be keloid free as well.
I have come to this forum seeking a deeper dive into the statistics of keloid formation in hair transplant surgery. Most information online pertaining to this topic is discussed on the promotional websites of doctors in their FAQ section and always some variation of:
1) “Keloids are very rare in hair transplants. We can do a test graft and see what happens”
2) “Contraindication for hair transplant is a history of keloid formation” (meaning just don’t even try it)
I guess what I’m looking for are actual statistics. Sure maybe they only form in 1% of hair transplant patients, but what percentage of those people actually have a history of keloids in the first place?
A more useful statistic would be the rate of keloid occurrence in hair transplant patients *who have a documented history of keloid formation* - for example “X percent of patients with a history of keloid formation go on to form keloids on their scalp post hair transplant surgery.”
I understand very well that given the mysterious nature of keloid formation it is inherently difficult to predict their occurrence in any single individual. Given the unique complexity of every person’s genetic profile, I’m sure even among fellow keloid formers there is a great deal of variation in occurrence, both in terms of the severity and location of the lesions.
But even taking into account all of that mystery and lack of certainty in terms of outcome, I am surprised there has not been some sort of large meta-analysis done, either in the United States or Europe, to at least *try* and quantify the keloid occurrence rate among hair transplant patients with a history of keloid formation.
It is frankly a bit odd that given the 30+ year history of hair transplant procedures, the topic of keloid scarring is still tantamount to a medical rumor mill, a collection of anecdotal reports from doctors and patients who have seen keloids happen, or maybe they haven’t, it’s just all so incredibly opaque and non-scientific.
So I’m curious if anyone here knows more than I do on this subject. That would be quite easy, since I know almost nothing except what I’ve stated above.
Lastly I would state I can’t seem to find any information on the prevalence of keloid occurrence at the *transplant site* as opposed to the donor area. There are innumerable discussions about scarring in the donor/graft excision area on the back of the head, but almost no discussions (at least that I can find) about the risk for keloid formation where the hairs would ultimately be transplanted into, for example in my case the temple and frontal scalp (bangs) area. I guess I’m wondering how invasive the graft insertion process is compared to the excision process. Obviously in the case of strip harvesting the excision will be an order of magnitude more traumatic than the insertion process, due to the literal excision of a piece of the scalp, but I still don’t understand how invasive the insertion process is. Is a scalpel used to insert the grafts into the temple/forehead regions? Are there any newer, less invasive methods for graft insertion?
I know ultimately for me, like everyone else it will just come down to my own biology and how the test graft heals after nine months, and all of this “research” of mine probably amounts to nothing more than a coping mechanism in a situation where I lack control.
However I thought it would be useful to at least try and create this thread to see if any experienced hair transplant surgeons who have done thousands of cases involving patients **with a documented history of keloid formation** could weigh in with their experiences. Again, the rate of occurrence in patients without a documented history of keloid formation is essentially meaningless for the purpose of this discussion, so while I’m happy that there are thousands of patents out there with positive (non) scarring outcomes, unless they have had a documented history of keloid formation its not really useful information in this context.
Thank you very much for reading this far.
Thank you very much for reading my thread. I have come to this forum after failing to find the information I am looking for anywhere else online.
I am a 33 year old caucasian male who recently completed an initial consult with a hair transplant surgeon in Southern California. I have relatively mild hair loss in the temple areas as well as frontal scalp (bangs) area and the doctor recommended 1,500 to 2,000 grafts depending on whether I wanted to lower my hairline slightly by a half inch or not.
I thankfully do not have a history of pervasive hair loss in my family, my father is 74 and his hair looks about the same as mine, just some mild hair loss in the temples/front, except his hair is gray now.
As a precaution I started finasteride four months ago to (hopefully) get the DHT permanently under control. So far I can’t tell if it has done anything or not, probably due to my slow rate of hair loss. I certainly have not seen any regrowth from the finasteride, and don’t really expect to for whatever reason.
Where things get complicated is I am a keloid former. I have six (!!!) keloids on my body in areas where they commonly form: Two in my sternum (mid chest) area, one on each of my shoulders and two on my back/shoulder blades.
I understand that the working theory is that keloids tend to form in areas of high muscle tension, which could possibly explain the variance in the rate of occurrence across different areas of the body, for example the shoulders vs scalp, although this theory nothing more than that, a theory. Keloids are still an endlessly confounding topic in modern medicine, and there are many examples that run counter to muscle tension theory.
I went into the hair transplant consultation presenting my keloid history as my overwhelming primary concern, arguably more important than the success of the transplant itself, and explained I would only want to move forward with a transplant after undergoing a small 10-50 test graft session, waiting nine months to observe scar formation patterns, and then making a decision based on those results.
The doctor agreed that was the best course of action, concurred the test graft session is paramount and *if* successful after nine months he recommended FUT strip harvesting due to both my relatively younger age (for donor hair preservation if needed in the future for a second procedure) and the benefit of having a smaller, linear scar in the donor area. He explained the scarring from FUE takes up a surface area roughly 12 times that of the FUT strip scar, due to the fact that the FUE punch hole scars can not be “closed” and reduced in size the way the strip incision is closed. He said “If things were to go south, you would rather have a single long keloid back there which you could grow hair over than to have the entire donor area turn into a field of miniature keloids.” I think I agree with that assessment.
He also warned that a scar free test graft is no guarantee that the hair transplant will be keloid free as well.
I have come to this forum seeking a deeper dive into the statistics of keloid formation in hair transplant surgery. Most information online pertaining to this topic is discussed on the promotional websites of doctors in their FAQ section and always some variation of:
1) “Keloids are very rare in hair transplants. We can do a test graft and see what happens”
2) “Contraindication for hair transplant is a history of keloid formation” (meaning just don’t even try it)
I guess what I’m looking for are actual statistics. Sure maybe they only form in 1% of hair transplant patients, but what percentage of those people actually have a history of keloids in the first place?
A more useful statistic would be the rate of keloid occurrence in hair transplant patients *who have a documented history of keloid formation* - for example “X percent of patients with a history of keloid formation go on to form keloids on their scalp post hair transplant surgery.”
I understand very well that given the mysterious nature of keloid formation it is inherently difficult to predict their occurrence in any single individual. Given the unique complexity of every person’s genetic profile, I’m sure even among fellow keloid formers there is a great deal of variation in occurrence, both in terms of the severity and location of the lesions.
But even taking into account all of that mystery and lack of certainty in terms of outcome, I am surprised there has not been some sort of large meta-analysis done, either in the United States or Europe, to at least *try* and quantify the keloid occurrence rate among hair transplant patients with a history of keloid formation.
It is frankly a bit odd that given the 30+ year history of hair transplant procedures, the topic of keloid scarring is still tantamount to a medical rumor mill, a collection of anecdotal reports from doctors and patients who have seen keloids happen, or maybe they haven’t, it’s just all so incredibly opaque and non-scientific.
So I’m curious if anyone here knows more than I do on this subject. That would be quite easy, since I know almost nothing except what I’ve stated above.
Lastly I would state I can’t seem to find any information on the prevalence of keloid occurrence at the *transplant site* as opposed to the donor area. There are innumerable discussions about scarring in the donor/graft excision area on the back of the head, but almost no discussions (at least that I can find) about the risk for keloid formation where the hairs would ultimately be transplanted into, for example in my case the temple and frontal scalp (bangs) area. I guess I’m wondering how invasive the graft insertion process is compared to the excision process. Obviously in the case of strip harvesting the excision will be an order of magnitude more traumatic than the insertion process, due to the literal excision of a piece of the scalp, but I still don’t understand how invasive the insertion process is. Is a scalpel used to insert the grafts into the temple/forehead regions? Are there any newer, less invasive methods for graft insertion?
I know ultimately for me, like everyone else it will just come down to my own biology and how the test graft heals after nine months, and all of this “research” of mine probably amounts to nothing more than a coping mechanism in a situation where I lack control.
However I thought it would be useful to at least try and create this thread to see if any experienced hair transplant surgeons who have done thousands of cases involving patients **with a documented history of keloid formation** could weigh in with their experiences. Again, the rate of occurrence in patients without a documented history of keloid formation is essentially meaningless for the purpose of this discussion, so while I’m happy that there are thousands of patents out there with positive (non) scarring outcomes, unless they have had a documented history of keloid formation its not really useful information in this context.
Thank you very much for reading this far.