Scar Repair

Dr. Darling has made scar repair one of his specialties. The two most common and advanced forms of scar revision are geometric broken line repair and a hair transplant technique that covers the scar with implanted hair.  The geometric broken line technique is a successful method of scar repair in the hands of a skilled plastic surgeon, but there are some scenarios where the method is not the best option for the patient, such as when excising an older scar the method can potentially cause an even wider scar. In these scenarios, transplanting hairs into the scar may be the best solution for repairing the scar.

Hair loss from scars can occur anywhere there is hair, such as eyebrows, beard, chest, pubis, sideburns,as well as even behind the ear. At times, scalp related surgeries such as removing skin cancer from the scalp, brow lifting, or brain surgery lead to more than just a scar but also leaves hair loss on the scalp. There are few different methods of harvesting hairs in order to undertake scar repairs such as the FU-strip, FUE or body hair transplant. In addition to these methods, medical tattooing is a non-surgical technique that can be pursued to help blend in the new surrounding hairs to help camouflage the scar more.

There are many ways to repair scars, which is why Dr. Darling takes the time to narrow down and discuss with you the method or combination of methods that are the best solution for your situation. For example, a patient with a scar from a prior hair transplant may benefit from pursuing the FUE method to avoid further scarring. If there is no more hair left on the back sides of a scalp, then the beard area can become an option for borrowing hair. Combining scalp micropigmentation (SMP) with most methods can also further improve results.

For facelift scars, the FU-strip method tends to be the preferred option. This method is usually more convenient for clients because it lacks the need for any preparatory scalp shaving. Beyond that, the FU-strip method can easily be combined with a larger concurrent hair transplant and also provides much higher quality grafts. At times, a formal scar revision involving the excision of the skin may be needed as an initial step before hair transplant into the scar can be pursued. This initial step is sometimes necessary to properly prep the scar for having hair transplanted into it. Dr. Darling is skilled in carrying out surgical scar revision then providing a subsequent hair transplant.

Scalp scars are much different from facial scars. At times, with scalp hair loss and scarring, excisional methods of repair that cut out the scar and close it often leads to a similar scar developing in place of the previous scar. In most cases, the prior scar arose from either an anatomical predisposition of the patient to form scars or poor surgical technique. In both scenarios, the blood supply to the area is already damaged to the point that attempting to excise the scar would just cause a recurrence of the issue. The elaborate scare repair techniques commonly used on the face tend to cause the scar to worsen when applied to the scalp. Dr. Darling has ran into many patients that sought out a facial plastic surgeon to repair a scalp scar only to see no changes or even found that it worsened. For this reason, hair transplant into the scar and/or SMO are the preferred methods of treatment rather than the techniques better suited for the face.

Dr. Darling uses a specialized method for transplantation that involves micro-punching in order to attain a better outcome. Tiny punches are made to remove a small core of the scar in order to physically reduce the bald scar and to replace the unhealthy scar tissue with healthy hair graft tissue. These tiny punches also provide better access and contract with the hidden healthy blood supply in order to improve graft growth. Micro punching also provides physical relaxation of the scar tissue.

Dr. Darling believes that it is critical during scar repairs to use bioenhancement technology like PRP, ACell, and liposomal ATP for enhancing graft survival in areas that have a lack of blood supply. Dr. Darling takes these appropriate technological measures in all surgical hair transplant cases. PRP helps improve blood supply and graft vascular ingrowth, while ACell helps soften and remodel the scar tissue. Then ATP is basically the equivalent of providing “CPR” for the grafts to help improve graft survival. As mentioned earlier, FUE is a practical alternative method in many cases (and at times the preferred method) to improve scars. When dealing with the back of the head and tissue with multiple scars that are tight, FUE is the only acceptable method for hair transplantation. In these scenarios, the preferred source of donor hair is beard hair due to the lack of scalp shaving needed, the donor hair may already be thin or lacking, and the beard area provides a more abundant, thick, and fast growing donor hair that usually heals quickly and without too many issues. If beard hair is not the best option, there are rare cases where chest hair may be used for donor’s hair, but it must be warned that chest hair takes longer to recover after making a donation for a hair transplant. Finding the appropriate method or methods is based on a long list of variables such as the anatomy, type and location of scar, cause of scar, budget, and recovery time. Identifying these variables during a consultation with Dr. Darling and his team is the next best step to finding which method or methods is the right one for you.