I have a huge scar on the back of my head

[CCS]

It was half this wide about 3 weeks ago, it seemed, though I thought at the time that some hair was just in shock. But the edges are very straight and I can easily see in the mirror that it is scar tissue and I have a hat mark. I just realized how big it was when I looked at it last night. It is about 1/3 of an inch wide.

I don't know what went wrong.

Is scar size a gamble every time even if you do well the last time?

Is my scalp tighter this time than last time? Dr Keene said I had plenty of skin.

I started lifting weights a week ago, just two months after surgery. I just sat in front of the computer the first two months. I did not feel tension during weight lifting, but maybe something happened. I was not thinking about it most the time.

Another possibility is I have been sleeping on my belly with my head to one side. Also, when I do sleep on my back, I have a pillow under my head, which props it up 30 degrees. Maybe that stretched the back. I have felt a few minor tensions are very brief sharp pains a few times a week. Maybe I did something wrong.

Last time my scar was only 1 or 2 mm.

Has anyone else had similar experiences? Do I need to have donor hair taken from a different location? I had 4000 grafts taken from the same strip in three procedures. My best results were with the biggest procedure, the second one, which excised a big scar before it.

I think Dr Keene uses tri-closure, since she said she uses internal stiches and cosmetic techniques, and she worked with Dr Shapiro before, who uses tri-closure.

Gilator, do you have any suggestions?

Last night I got really depressed and almost lost my mind when I saw the scar. But then I told myself I'd get it removed somehow, or fill it in with HM. So I'm calmed down now.

 

[DaveOne]

CollegeChem,

A few points:


1.) I've read the scar can stretch as long as 6 months after surgery. I even recall reading a story from a guy who was in the gym a few months after surgery and actually felt the scar stretch. So, it is always a risk. A guy who thinks he is guaranteed a small strip scar is simply misinformed. He might get one, but he might not.

2.) Tricho closure is way overhyped- even Dr. Shapiro has written extensively on this. Here's his writing:



" For scar revisions the use of the trichophytic closure is more variable. It may be effective if the pre-existing scar is thin, there is sufficient laxity remaining, and the entire scar can be excised with limited tension, than it may work well. However if the pre-existing scar is wide and there is decreased laxity than the technique may be less affective for the following reasons. The decreased laxity may make it impossible to remove the entire scar at once. The decreased laxity will increase wound tension and the potential for the new scar to stretch out again. Finally, \the edge of wounds in a scar may have less hair present to grow through which limits the effectiveness of the trichophytic closure.

• The Trichophytic closure is not a magic technique that will automatically create a less visible scar if these other rules are not followed. All three innovators of the technique still emphasize that it is still necessary to use all the rules and methods usually employed to create fine scars. (i.e. limit wound tension, create good skin approximation, properly space sutures or staples, etc). As stated above the trichophytic closure does not limit the width of a scar but instead, primarily masks a scar by letting hair grow through it. Since only a 1 to 2 mm wide zone of epithelium is trimmed away, and this creates only a 1-2 mm width of exposed follicles, the trichophytic incision works best when the scar resulting from the donor incision is 1-2 mm or less. When this occurs the results can be amazing and with the scar being nearly undetectable even with the hair cut short. However if the underlying scar resulting from the donor incision is wider than 1-2 mm, for whatever reason, the benefit is less dramatic. There are a number of reasons why a scar may occasionally end up being wider than expected. This is true no matter what technique is used and no matter who the surgeon is. "

The question you ask about it being a gamble- yes. I've seen recent tricho scars, and while some have been pretty good, others still stretched, and the hair didn't grow through them that well, or at all. The problem is, once you cut into the scalp you f*ck with the laxity, and then it's a real gamble how the revision will turn out. There is just no way to predict. Tricho is most effective on virgin scalps for this reason, but even then they can stretch, and hairs can get transected and not grow through the scar for whatever reason.

I'm really sorry to hear your scar stretched CCS, but I hope your info will help people realize that the risk of scar stretching is always present, and revisions can fail.

 

[CCS]

i still don't understand what the tri-closure is. I don't understand how hairs can growth through a scar. Are there any drawings anywhere that illustrate this?

I did have a very thin scar on my second procedure, but my first and third turned out big. I want to do a 650 fu procedure and a final 400 fu procedure, and I really hope I get lucky on the last one and get a small scar. If not, i guess I'll wait for HM and fill it in then, along with my front.

Can docs tell how lax a scalp is before they cut in?

 

[DaveOne]

I googled it and found a drawing here:



http://www.baldingblog.com/2006/04/07/techniques-to-minimize-donor-area-scarring/



Scroll down on the page and you'll see the pics. Basically, one edge of the strip wound is beveled or angled in such a way that hair will grow through the area, thus camouflaging the scar tissue. When it works, it looks pretty decent, but it's usually the most effective on virgin scalps, and on guys who don't scar as badly. But those guys would probably have a thin scar anyway, so go figure... the lucky get luckier!

If you're going to do more work, why would you get more strip scars? For that small an amount of hair, you should look into FUE.

 

[CCS]

The FUE costs more, and the Doctor has a bigger insentive to cut corners because it is time consuming, and I just think that every time a Doctor punches out a FU, there is a chance of slicing the follicles next to it. A strip procedure only risks the hairs on the edge of a big strip, which is a small percent that might not even die. The FU risks probably 5 follicles around each removed one.

Also, it makes since not to switch methods. I'd rather have one line or many specs, but not both.

I'll do the FU only if my scalp is just not lax enough. Or I might wait for HM, if that every comes. Yeah, it might not come. But $6 per FU is a bit pricey for me in college. $4.40 is more managable, unless I see a good reason otherwise.

Thanks for the link.

 

[CCS]

wow. that is clever. I thought of the tunneling one myself. I wonder what Dr Keene uses.

 

[DaveOne]

"A strip procedure only risks the hairs on the edge of a big strip, which is a small percent that might not even die. The FU risks probably 5 follicles around each removed one."

A strip can cause shockloss around the strip, and that margin can increase as your scalp laxity gets worse, and your scar tissue runs the risk of widening each time you do it.

As far as FUE risking 5 follicles around the graft, that's not true (unless the Doctor is a hack), or it's a popular myth. Maybe 4 years ago, during the early stages of FUE that was the case. But now, fue surgeons (the good ones anyway) score the area around the follicle, and then "pluck" the graft out with a blunt-edged tool, and the scarring is much less extensive than people assume, and there is no damage to surrounding follicles. 1000 grafts removed from the back of your scalp will not even make a dent in terms of being noticeaby thinner, assuming the Doctor knows what he is doing and spreads the extractions over a wide area.

Here's a video of an extraction of a few follicles (link is on the page..video is quick time):

http://www.hairsite4.com/dc/dcboard...ic_id=14984&mesg_id=14984&listing_type=search

No offense to strip docs, since they have no incentive to change their technique (at least not yet), but an hair transplant Doctor who does strip all day is not going to be aware of the most cutting edge techniques in FUE extraction.

If I could go back in time, I'd do a one-time megasession of strip to get 4k-6k grafts, and then an FUe session of 2-3k grafts if I still needed it. Then body hair as a filler. Getting multiple strips is bad news IMO.