- Friday.April 05. 2019
Patients’ preference for shorter hairstyles leads to increased concern in minimising and concealing the donor scar. At our clinics, hair restoration surgeries are performed by skilled and experienced hair transplant surgeons, Dr Jennifer Martinick and Dr Sara Kotai. Our doctors keep incisions and closures precise to allow for the most seamless healing possible.
With modern hair transplantation using FUT (Follicular Unit Transplantation) or strip harvesting, the donor wound is closed meticulously to minimise the scar formation. On top of this, our doctors use a specialised suturing technique that allows hair to grow through the scar line. This yielded the most aesthetically acceptable scar appearance.
Actor-presenter Paul Gerrard narrates, “Six months after the procedure, the scar at the donor site was barely visible, I was absolutely thrilled. And now, two and a half years later, I’m struggling to find it.”
“Visibly, it looks really good and the sensation has become increasingly relaxed over time. And now, you wouldn’t even know that I’ve had the procedure,” says Paul.
Using FUT enhanced by the Martinick Technique™ has helped achieve an outstanding result. Paul’s donor area healed beautifully. The old scar is very well hidden, so it’s just a really fine white line along the back of his head.
Dr Sara says, “To get the best scars, you need the least tension on the stitches. So we always use a double layer closure. You’ve got stitches underneath which is doing most of the work. And then you’ve got these superficial stitches on the surface.
“It’s what we call double trichophytic closure; a technique where when we bring the two edges together, the hairs will grow through the scar tissue to make it disappear.”
The final running suture is completed, with care taken to avoid deep ‘bites’ of the scalp that have the potential to damage underlying follicles. The stitches are neatly laid at regular depth and spacing, hence, hair can grow through the scar to assist in hiding the donor scar.
This important detail is worth emphasizing to maximise the results with the trichophytic wound closure. The resulting scar then is difficult to find, allowing the patient to wear his hair short in the donor region.
FUT scarring explained
FUT is a surgical technique that needs high standards, expertise, and adherence to proper closure techniques. Recently, there has been an influx of doctors of all specialties into this field, who may not have the necessary surgical skill.
Although the thin linear scar is easily concealed, there are patients who have scars that have widened. Donor site complications may also cause varying degrees of unwanted scar formation.
In addition, there are patients who have several scars from multiple procedures. The cause of such disfiguring scars often relates to poor planning and poor surgical decisions, such as taking too much tissue, thus making closure difficult. It can also relate to the patient’s unpredictable healing tendencies.
Dr Martinick says, “Some people will have worse than usual scars despite doing all the right things and utilising an excellent technique. There is a high incident of poor scarring amongst young men possibly because they are more physical. There is also a higher incident amongst Asians in general possibly due to the type of skin.”
Is the scarring less in FUE?
Follicular Unit Extraction, now called ‘excision’ (FUE) has been marketed as a technique that does not involve cutting and is therefore promoted as ‘scarless’. The primary motivation for choosing FUE is that a linear scar is avoided. Although a linear scar is not created with FUE, circular scars are formed. Hence, it is not proper to use the terms ‘scarless’ or ‘no scar’. The accumulated excision scarring of FUE is greater than the area of linear scaring in FUT.
With each succeeding session, the scarring in FUE is increasing. For example, if the first FUE session is 2500 grafts, there will be 2500 tiny round scars. Adding a second session of 2000 grafts, there will be a total of 4500 scars. The scarring and distortion of the donor scalp from FUE make subsequent FUE sessions more difficult.
In contrast, with FUT, the first scar is completely removed in the subsequent procedure. Even though the scar may be longer in the next session, regardless of the number of procedures, the patient is left with only one scar.
If a patient becomes extensively bald (i.e. the donor fringe becomes very narrow), the line of FUT will generally still remain hidden, whereas the dots of FUE will be seen above or below the fringe of hair.
Dr Martinick says, “FUE is sometimes recommended to patients with insufficient donor hair for strip harvesting techniques and with a history of significant scarring.”
“However, I only make this recommendation when the patient is fully educated on its risks and limitations.”
“If the patient wishes to proceed I may agree to do a small procedure of 300 to 500 follicles. Ultimately, I will only recommend treatment if I consider it to be in the patient’s best interests,” says Dr Martinick.