Hair Restoration Procedures to Repair Scars from Previous Surgery

As patient awareness hair transplantation techniques grows, repair poorly planned poorly executed procedures increasingly it restoration hair wt surgery. repairs performed excision re-implantation / camouflage. Follicular unit transplants ud restore aspects procedure. Using techniques drilling linear excision allows surgeon relocate poorly planted grafts appropriate. key elements camouflage include creating deep zone follicular units, fishing yr address grafts forward weighting grafts enhance appearance fullness. special situations, removal grafts wt re-implantation accomplished using lasers electrolysis. Scarring visible injury poorly executed hair transplant procedure. Unacceptable linear scar removal re-resection considered scarring wl localized aesthetic benefit removal offset lower density surrounding hair. Be importance surrounding camouflage, success reducing size existing scar depends choice scar, actual surgical technique repair. surgical techniques tend produce poor donor scars. Understanding techniques contribute wound healing understanding compensation achieved. mt common ps are: * Deep * donor incisions donor strips worldwide * Suture bites * Poor wound edge approximation * * contour incisions incisions donor incisions placed low * deep donor incisions placed hh donor fascia acts structural support wound healing. Wn ts support violated, risk hg broad scar greatly increased. le amounts tumescent anesthesia infiltrated directly io subcutaneous fat rise dermis increasing distance base follicles fascia. probably bt kp wound superficial. Wh oy method collecting strip conditions service, outer edges donor strip cut shallow, easily deepen wh single blade strip lifted fm scalp. using multiple-blade knife, standard tool mini-micrografting superficially cut strips impossible live deeply, oe removed fm dissection scalp extremely problematic. Be this, surgeon tendency cut deeply wh multiple-blade knife ts increases risk cutting fascia. Oe fascia reduced, partially cure delete subcutaneous space. Eliminating natural surgical plane makes difficult judge depth subsequent splits. repair, wh it surgeon he gr control or depth wound. Ts achieved using single-edged knife allows eh edge wound treated separately. single sheet ao beneficial wn marked devoid hair angle incision, nd follow angle follicle. case, incision perpendicular allow edge edge contact avoid thin, friable upper edge fixed angle knives. harvest superficial tension wound, layered closure rarely necessary, position sutures deeper affecting hair suturing fascia, remained intact. contrast, wh fascia repair bn violated. meticulous layered closure, including fascia it te significant wound tension scar tissue sutured wound strength recovered slowly normal hair bearing scalp. undermine harvest planned virgin scalp, conservative repair procedure ss ny undermine. Gl weakening de superior direction care stay fascia scar tissue follicular damage avoided. Neutralization inferior direction neck flexion transmitted wound edges, increasing potential stretching. Wn require closure layers, interrupted sutures facilitate safer controlled approach deeper tissues. Polyglactin 910 (3-0 coated Vicryl) braided absorbable suture tt tensile strength handling properties excellent material deep sutures. Recently, he using synthetic monofilament Poliglecaprone 25 (3-0 Monocryl) closure depth. suture advantage causing ls inflammation, but, monofilament, tends cut tissue easily little harder tie. Wide strips donor-In era mega-session, taking wide swath donors bn common pm hair transplantation surgery. wide belt unnecessary stress closure donor leads extended scar. Hair loss associated wh type closure offset advantages session. larger sessions appropriate, scalp gd mobility, surgeon sd consider incision instead broader. Harvesting strip width suitable donors, minimal tension wound closure mt tg surgeon minimize scarring fm donors. wide initial incision bn identified cause widened scar, bt wait lt months scar chance mature regain original laxity. Returning division, advisable strip lt 3-6mm narrower tn previous one. Wn tight closure cause, gy attempt remove entire width scar, ts invariably leads recurrence worsening scar. heal, division, extended wh spiky hair. situations, wn adequate laxity present, removing entire width scar beneficial. Wn approaching hair bearing areas, healing ss improved. question wr additional security suture wound edge dryer tt outweighs potential loss hair suture if determined case. general, surgeon sd try remove entire length scar age, incision create tension closure. Excision repair extended fr previous split, sd counter side, suturing se create tension other. repair successful, remaining scar removed lr meeting. creative repair defects caused closure stress, called "Deep Plane Fixation" recently proposed Seery. technique, "the channels fm forces surface tension tissues risk, deeper tissues dissipated harmlessly." procedure performed ft suturing deep dermis wound edge deep tissue fascia lower edge wound. upper dermis epidermal components wound edges sutured together, end, wt tension. Suture wh tidbits suturing le bites wh significant at scalp hair incorporated io sutures. Especially running stitch, post-op edema tension aa donors tend compromise blood supply tissue trapped result permanent hair loss. Furthermore, tension wound, mechanical pressure sutures cause hair loss. repair procedure, useful horizontal mattress sutures reduce wound tension. Bites, near edges wound closure recommended surface. skin suture, Poliglecaprone 25 (5-0 Monocryl) excellent low tissue reactivity relatively slow loss tensile strength (2-3 weeks). Metal staples useful sutures left periods time. However, clamps he disadvantage allowing perfect wound edge apposition causing postoperative discomfort sutures. advantage commodities destructive hair follicles continuous suture minor importance, wn closure means entire scalp scarred. Poor wound edge approximation, perfectly resist wound edges donor incision key factor preventing scar stretching. incision me harvesting strip follow angle hair, edge necessarily acute obtuse others. Suture techniques tt io account dt angles wound edges wl able kp edges color lead lack contact skin-dermis spread wound. Placing Beware suturing sl bites bt wound edges attached, on time consuming process. faster metal clips allow at control sh suturing result scarring, especially te tension wound. wrong suture material poor suturing technique identified cause wide scar, remedied meticulous closure using appropriate sutures. Contour incisions incisions follow natural contour curve skull tend heal scarring tn te follow him. Wn planning split, he split follow natural curvature skull, regardless linearity original split wr excision completely covers division age. Special care mt re-excision sl mastoid area. helps me division closely area. mt cases, focus sd reducing size original scar changing direction, completely eliminated. donor incisions placed low various factors contribute donor scar widened, me problematic regard reparation incision lower posterior scalp. Se surgeons believe hair scalp source fine hair, however, ts hair permanent crop result scarring unacceptable location. unlikely event hair follicular units 1 sufficiently sensitive (as ft edge temples, leading edge female hairline) fine hair generated removing terminal hair bulb harvested mid-permanent. discussed "limitations", mt convenient position donor scar middle permanently. mt people, level external occipital protuberance midline superior nuchal crest, moves laterally. trapezius muscle, mt superficial muscle neck area, originates fm superior nuchal line nuchal ligament. incisions line neck te affected muscle movement directly bw he tendency stretch. Ts exacerbated deep scar donors destroys subcutaneous layer muscle movement neck me directly transmitted overlying skin. bn advocated tt donor scars treated wide re-excision relation undermine aggressive possibly tissue expansion. However, conservative re-excision scar wider occipital scalp carries significant risk healing scar en more. scars sd removed and, additional transplants performed, hair harvested fm incision mid-permanent, leaving tn zone hair separating lower incisions. Instead trying hard eliminate scar, appearance consistently improved addition sl amounts hair area, mh risk. donor incisions placed wn donor incision high, bt left untreated unless scar le poor surgical technique identified cause. Often, surgeon misjudgment placing wound poor job closing. case, te reasonable possibility tt scar improved wh techniques. scars, try reduce improve appearance, trying remove scar completely. temptation add hair io scar resisted, progressive baldness hair isolate bearing scar cosmetic problems, demanding additional hair. exception hair vertical scar, scalp reduction fell permanent donor strip. Implantation hair localized donor scar cosmetically bothersome, excision practical, easily accessible donor hair or areas, beneficial pe hair directly io scar donors increased. follicular units hairs useful purpose placed acute angle. sl hair usually soften appearance scar. Spending mh hair purposes unnecessary wasteful. appears grafts grow hypertrophic scar, manage te scars intra-lesional corticosteroids, 5-fluorouracil silicone gel sheeting, trying add hair. Conclusion: "science" surgery hair restoration involves ability mimic nature possible, carefully matching newly transplanted hair patient's original hair tr distribution growth pattern. te principles bn violated, standardized approach lr sufficient restore normal appearance person. wh dramatic cosmetic defects, severely limited supply donors, exasperated patient, surgeon attempting repair facing nr challenges fm fd wn operating virgin scalp. corrective surgery, judicious grafts critical priority setting surgical technique itself. repair work, routine, symmetrical placement grafts on insufficient meet goals patient. surgeon fd transform harsh walls hair hair smooth lines amounts hair camouflage larger areas. surgeon able ey bit hair harvestable donor site hair en reuse previously transplanted grafts. results, requires creative resources follicles. "art repair.