Large FUT Scar Repair - Exploring Available Option

[Houston1]

Background:

• Date of Procedure: 9-18-2020
• Procedure: FUT
• Grafts: 2,500
• Doctor: Dr. Arocha, Houston, Texas
• Age: 35
• Current Preventative Measures: Propecia, Minoxidil, Laser Cap, and Micro Needling

First, I want to say that my goal here is not to bash the doctor. He has been receptive to my concerns and presented some possible solutions. My hope here is to tap into the community for guidance.


Issue:

Unfortunately, the procedure left me with a very wide FUT scar. The scar is largest above the ears, but it is fairly prominent throughout. Prior to surgery, the doctor notified me that scars can be unpredictable, but I was also told that a reasonable expectation is to be able to be able to cut your hair with a guard 3 without the scar showing. Currently, if I cut my hair with anything less than a guard 7, the scar is very visible. Even with longer hair, multiple people have commented on seeing the scar when my hair falls to the side, and this has been a source of frustration and embarrassment.

Objective:

Repair the scar to the extent possible, while also leaving open the door for future procedures. I am planning on getting another procedure (FUT or FUE to further fill in the frontal hairline, temples, and crown). Combining both the scar correction and this second procedure is ideal. The next procedure will likely be 2,000 to 2,500 grafts.


Conversation with the Doctor & Proposed Solutions:

The doctor suggested that my wide scar may be due to the high elasticity of my skin. He also suggested that merely sleeping wrong can result in a widened scar. Further, he pointed out that, though I do not have keloids (thankfully) the scar is slightly thickened.

The doctor proposed the following solutions:

1. FUE Procedure to fill in the scar area, which would require about 300 grafts.
2. Another FUT procedure in hopes of cutting out the scar and using additional staples to help minimize stretching.
3. Combination of an FUT and FUE. The FUT would be near my neck, which has the least amount of stretching and the FUT would be used to fill in the point most prone to stretching, which is above the ear.

Option 1: FUE Procedure

• My concern here is the loss of grafts for future procedures, as well as the fact that so many grafts will be spent just to conceal the scar (300+). I will likely need a third procedure as my hair continues to thin, and so I would like to maximize my available donor area to the extent possible.

Option 2: FUT

• If the procedure successfully cuts out the scar and can result in a smaller linier scar, then that would be ideal (especially considering that 80 grafts would be enough to conceal a small scar). The doctor suggested a special tempur pedic pillow that may help reduce head movement (and thus the chance of scar stretching). The issue is that I have evidence that my skin stretches, and I am also fearful of a keloid (though I do not have a history of this).
• In regard to my prior FUT, I was studying for a major exam for a few months after the surgery. My head was tilted downward while reading, which may have contributed to the scar? This is just a thought regarding one factor that won't come into play on my second procedure.

Option 3: FUT/FUE

• Here, the number of grafts in the wide areas around the ears would be around 100, while the remainder of the scar (near the neck area) would just be excised and more closely monitored. I am open to this option, but the optimist in me wants me to go with the second option (a complete FUT with scar revision) in hopes of attempting to excise the scar and remain extra vigilant.

What do you think?


In your experience, how bad is the scar? Was there something that I or the doctor could have done to avoid this issue?

Is there an option that I am missing? Should I consider another doctor for the procedure? Note: I live in Houston, which makes Dr. Arocha especially appealing (particularly in regard to follow-up visits). That said, I have heard fantastic things about Dr. Konior Hasson & Wong.



This has been a source of stress, and any guidance the community can offer is really appreciated. Thank you, everyone.

 

[Bigmac]

Hi Houston1 and welcome to the forum.
I’m sorry to see your FUT scar has stretched and is difficult to conceal. Looking at your pictures the area you’ve shown is to the right of the occipital bone. Just above ear height.
Does the scar end at this point or does it carry on towards the right and left temples? I’m trying to figure out how long your scar actually is. If you have surgery pictures you could add, this would be helpful. Donor closures are sometimes at a higher risk of stretching above the ears but yours appears to be the back as mentioned above. Did you have staples or sutures for your closure?
Is it possible to measure the width of this part that has stretched the most? It may be too wide to excise out if you don’t have enough laxity in the area. You could run the risk of it stretching straight back, thus putting you right back at square one. Have you had a physical examination by Dr Arocha to assess laxity? Ask him if he used trichophytic closure. I had 2 FUT scar repairs with Shapiro medical group. My scars were not as wide as yours, Dr Ron Shapiro decided that inner dissolvable sutures and outer trichroic closure with sutures was the best option for me. Both turned out well. My scars were greatly reduced, now I only know they are there when my hair is a grade 2 or 3. They are slightly visible with a tell tale slightly thinning look along the scar line, similar to the line left by wearing a tight ball cap.

What to do next.
If you have the scalp laxity you have the option of another FUT. This will allow excising this wide scar tissue out and getting whatever number of grafts for your anticipated second procedure. All going well, you could end up with a nice thin scar.
You could have the section in your picture excised out and opt for FUE to obtain the rest of the grafts for a second procedure.
Me personally, I would not go for a second FUT scar lower down. I would concentrate on repairing the one you have already.

FUE only. This is another viable option. Use a mixture of scalp and beard grafts to conceal the scar. Extract another 2000 or so for the thin area you want to address. Your donor looks to be in good condition. I’d ask the doctor to provide a donor density count, this will help with your decision.

Some people are prone to scar stretching. This is why I think a double layer closure with dissolvable inner sutures and outer trichophytic closure is the best option. It is difficult to say why yours stretched. I don’t think your sleeping position would have been an issue. patients tend to follow the post op instructions regarding this, then after 10 days, have the staples or sutures removed. I slept elevated for 3 or 4 days, after that I was laying on my back. It was a little uncomfortable but manageable.
I don’t think the studying/head position would be an issue. People are advised they can safely resume weight weight training within these timeframes.

Your hair loss regimen seems pretty good. Do you see further hair thinning or do you feel it’s maintaining? If continuing to thin you have options of Dut and oral minoxidil.

I hope that helps.

 

[sl]

Fairly large scar and best to have a consultation and check laxity and if it is best to revise as BM said or go the SMP/FUE to scar route as a less tricky option. If you measure width x length then x 30, the usual density placed into scar tissue, then you get an idea of what is needed with graft numbers. Less is placed as scars are more avascular and you need to make sure of graft survival and go less dense. The scar will always exist but this and SMP can break it up and help camouflage it....All the best .

 

[Houston1]

Thank you everyone for the guidance.

To answer some questions, I had both staples and sutures, and the scar end right above my left and right ears. I will attempt to obtain some photos from a very close haircut (though I do not have surgery photos available).

Dr. Arocha did indicate that I had good elasticity, but he was not really able to explain the stretched scar (besides my possibly sleeping in an odd position, which I had not heard as a risk before).

In terms of additional recession, I am experiencing general thinning in the mid-scalp area and my crown is fairly thin as well. My ideal procedure would be to correct the scar, slightly fill in temples, and address crown/mid-scalp. I realize that this may be a lot to ask, of course.

I have contacted Dr. Konior and Hasson & Wong. Dr. Konior's availability is very limited (I am on the waiting list for 2022 with no indication on when/whether an appointment may be available), and I have yet to receive availability information from Hasson & Wong.

 

[Techno1]

Both clinics you have reached out to are excellent choices. Depending on how quickly you wish to push forward with a repair, perhaps Shapiro, Cooley, Wesley, and Lindsay are worthy of consideration.

 

[Bigmac]

Keep us informed on how you get on.
Good luck with it.

 

[Philw]

I had 300 fue into my bottom scar
No growth at all just feel stubble on scar thats all
Dont have a scar revision cos it will stretch
Best way is to have a small fue and beard hair into scar
Go slowly see how growth is let it heal then have another small one say a yr later and see how u are with it
Then if not happy have smp to finish it off

 

[Kevboy]

If your scalp elasticity is the same across your head why did it stretch in that section only?

 

[Houston1]

If your scalp elasticity is the same across your head why did it stretch in that section only?

I wish I could tell you.


Any thoughts on Dr. Wong for FUT scar repairs? I searched the forum, but I unfortunately found very little on that subject.

 

[Kevboy]

What did Dr Konior say was the best approach?

 

[Houston1]

He actually provided the most detailed response. I understand why he’s so highly regarded. His plan is as follows:

In order to keep the harvested scar as narrow as possible, he suggested that 500 grafts may be obtained within the excised scar mass. In order to accomplish the other goals while minimizing risk for healing of the scar, he recommended that an FUE harvest of 1500 grafts could be performed in combination with the scar revision. This plan would produce approximately 2000 grafts total, which could then be distributed to other areas of concern.

 

[Kevboy]

Sounds like a good plan of action.

 

[Prohairclinic]

A new FUT may or may not stretch again, it is not predictable.

I would personally opt for a low density FUE pass and SMP. This combination is the least risky.

 

[Parasol]

I had 300 grafts placed into my scar, which was also visible at any guard below a 7, and now at a 4 guard (which is the shortest I’ve tried, so potentially even lower), I can’t see it at all.

I know the feeling of being asked about it. I had several people mention mine before it was fixed and it was very embarrassing.

You’ve reached out to some excellent clinics. Just know this is fixable, so how you’re feeling now is only temporary. Hang in there.

 

[Houston1]

I had 300 grafts placed into my scar, which was also visible at any guard below a 7, and now at a 4 guard (which is the shortest I’ve tried, so potentially even lower), I can’t see it at all.

I know the feeling of being asked about it. I had several people mention mine before it was fixed and it was very embarrassing.

You’ve reached out to some excellent clinics. Just know this is fixable, so how you’re feeling now is only temporary. Hang in there.

Thank you for this.