Hair transplant (Scars, Types, and Techniques)

We wanted to discuss the cause of Hair transplant scars and Treatment options available to patients. If you were a victim of scarring following cosmetic surgery then you are not alone. Thousands of men are in the same boat as you and often suffer from lack of confidence. The current methods of hair restoration place great importance on patient satisfaction and safety and give them a more natural appearance.

While getting a hair transplant there are generally two methods used: Follicular Unit Transplantation (FUT), and Follicular Unit Extraction (FUE). It is also important for patients to know that both methods carry the risk of scarring. The idea behind hair transplantation surgery is to take from a more abundant part of the scalp and transplant it to an area with less hair growth.

Hair Transplant Before and After

The image below shows a patient aged 47 who was treated using the FUE method, the end result is a very natural appearance

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Follicular Unit Transplantation (FUT) scaring

The FUT method also known as strip harvesting involves the removal of a small strip of tissue from the back of the scalp, they are then divided into smaller parts and transplanted into the required areas. This method distributes hair into groups of follicular units and it sometimes only takes one or two sessions. The selection of the donor areas is important since it prevents complications later on.

Patients need to be screened carefully since some will develop keloids (raised scar tissue) if too much tension is placed on the scar. Most patients will also form scabs in the area approximately 5 days after surgery. Follicular Unit Transplantation is more associated with scaring since it can lead to a reduced amount of hair follicles around the scar.

When should Follicular Unit Transplantation be used?

The FUT method is still used today, mainly linked to the following cases:

  • Males / females with longer hair
  • In older patients over the age of 45
  • Patients with curtly, Frizzy hair
  • As a method to cover scars

Follicular Unit Extraction (FUE) and Scaring

In this method, the need for a donor strip is not eliminated, since the individual follicular units are transplanted. This is more suitable for people who wish to keep their hair short since the scarring is less visible. This method uses a punch graft which only makes holes of 0.6-1mm in diameter, so scaring is hard to see with the naked eye. Even though this is known as the best method to use it does leave what are known as dot-scars in the area.

The image below shows a simple diagram of the FUE process:

  • Hair are harvested at the donor site, usually at the back of the head
  • Individual hair are carefully removed using a punch tool
  • The hairs are harvested and prepared
  • The hairs are transplated using tiny needle sized impressions
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Who Qualifies for Hair transplantation

Hair transplantation is the best long-term solution for baldness in men and women. Those patients aged between 20 and 30 should be carefully assessed before they are considered for hair transplantation, this means they will need a medical history and enough hair loss before they are considered. The color and thickness, and type of hair are also important factors to consider (straight, curly, wavy) since some hair types see better results.

In general, 300 micrografts are needed for a successful new hairline, and their placement is important to create a natural appearance. However, most surgeons who use FUE treatments able to transplant over 3000 grafts in a single day. Keep in mind that FUE is also more expensive than FUT which can cost up to 50 percent more. Currently, around 80 percent of men and women choose the Follicular Unit Extraction method instead of FUT.

Follicular Unit Extraction Advantages

There are a few advantages with regards to scaring that FUE has over FUT:

  • No Linear Scar: Using FUE, you will not have a long scar at the back of the head
  • Ideal when it is used to hide donor scars
  • This is non-invasive surgery
  • Surgery lasts around 6 - 8 hours
  • A fairly short recovery period
  • Most patients are very satisfied with the outcome
  • Any scars are easily camouflaged when hair is 1mm long.
  • Complications like cysts occur in only around 1 percent of patients.

Wide donor strip and Scarring

Some operations will use a wider donor strip (vertically), meaning they don't need to cut as much lengthwise (sideways). However, this puts more tension on the area once it is closed up, and may cause a widened scar. The surgeon should rather opt for a longer sideways cut which will heal at a better rate. If a patient has these types of scars, they should wait around 8 months until the wound has relaxed slightly.

To fix this problem, a new incision is made that is shorter than the old one, this sometimes works but can also result in further damage. A better treatment is to use follicular unit extraction that will place hair directly onto the scar. FUE can also be used to repair a previous transplant that resulted in a linear hairline or a pluggy appearance.

What is a Pluggy Appearance?
This is the sort of patchy appearance you might associate with earlier hair transplantation techniques including the old plug grafts method. The hairs may look doll-like and grouped together in an unnatural way.

During FUT, it is important not to harvest a large donor area since this can lead to more scarring, it is recommended to keep the width less than 10 to 12 mm.

Trichophytic Closure technique

Since many people wear their hair shorter, there has been a large interest in concealing their donor scar. The trichophytic closure is a way of closing the scars created using strip harvesting which can make the scar undetectable. The surgeon makes a cut parallel to the hair follicles, the lower part of the womb is trimmed from the hair follicles which now tend to point in the direction of the cut.

The Trichophytic Closure technique is described below:

  • The donor part of the hair is removed
  • The upper corner of the lower part of the womb is trimmed away
  • The skin below the root is then slighly cut/ incised
  • The womb is closed, and the top edge overlaps the bottom edge
  • This will hopefully allow the hair to grow through the cut area

Scar repair techniques

There are different options for patients, either you cut the scar out which will make linear scar much thinner or alternatively you may benefit from Follicular unit extraction (FUE), which means individual grafts are placed into the scar in order to camouflage the area.

Hair transplant Scar Repair Cost

In Genera, hair transplant scar repair will cost around $2000 per session, some patients will need multiple sessions.


Older Hair transplantation techniques were not as forgiving as today's modern approach. Even though things have improved, scarring is still unavoidable. Nowadays, many patients opt for newer techniques like FUE and Trichophytic closure in order to reduce any complications. It is advisable to do your research and seek out a well-respected doctor, this is one way to increase the chance of a positive outcome.

Follicular unit extraction: hair transplant without linear scar: RUSTON, ROCCO

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