You may have seen advertisements in magazines, Facebook, Instagram and various other websites that talk about hair transplant surgery being “scarless”. Is this true? Can hair transplant surgery be a scarless procedure?
Hair transplant surgery is, in reality, a real surgery which means that in order to harvest the follicles that are necessary to restore some semblance of your old luscious locks, new hair has to be taken from somewhere else on your body. No, you cannot have donor hair donated by your best friend. That would be nice, but your body would reject the follicles just as if he were donating a kidney. And we won’t start to talk about the anti-rejection medications you’d have to take for life, either, as that is another subject completely. Since the hair that needs to be harvested must be removed in a surgical fashion, that means that your skin is going to have to be cut.
Let’s look at the two basic forms of surgical hair restoration in 2019. There is FUT, otherwise known as “strip” surgery and the second form of hair transplant surgery is FUE or “follicular unit excision”. Both are cutting edge surgical procedures that can provide a phenomenal cosmetic improvement for the right candidate. FUT is the older of the two procedures and FUE is the procedure that is more popular and for one simple reason.
With strip surgery, a “strip” of hair bearing scalp tissue is surgically excised in order to gain access to the hair follicles needed for the procedure. The result in the donor zone is a long thin scar that may be seen with haircuts that are too short. If properly done, many patients can still wear short hairstyles without a visible line scar being noticed by the casual observer. The patient should follow post op instructions to limit movement for a period of time to allow healing.
With FUE, there is no strip removed and instead, each follicle is removed with a tiny round surgical punch. This means that there is no linear scar and patients are usually free to cut their hair as short as they wish without a major cosmetic hit to their donor area as long as the total follicular units are limited. But does this mean that there are NO scars at all? There is no magic formula since the more that is removed from the donor area, the more likely that a scar will become visible, even with FUE. Therefore, there is a limit on what can be removed in each procedure such as using larger punches or removing two neighboring follicular units in the same procedure to prevent empty voids.
There are scars with FUE but the scars are, on their own, much less visible with very short haircuts than one continuous linear scar that is naturally expected from a strip hair transplant surgery. If the donor hair is kept long, neither scar is typically visible. The size of an FUE scar is directly related to both the size of the FUE punch used by the surgeon as well as the healing characteristics of the patient having the FUE surgery. When combined in order to get enough hair to make a cosmetic improvement, the number of tiny scars from an FUE hair transplant surgery can be visible, but in a manner that is different than that from strip surgery.
The downside of FUE is the total amount of follicular units that can be removed from the donor area compared to FUT. Therefore, both techniques can be combined, in the same or different procedures in more advanced cases of baldness and avoiding the limitations intrinsic to each technique.
With FUE, donor scars are spread out and are random. In fact, follicle for follicle, FUE will actually leave MORE scarring in the donor area than a strip surgery that is harvesting the same number of follicles. This is because the number of donor scars that are the result of follicular unit excision are directly related to the number of follicles removed. One follicle, one scar. With FUT, there is no such relationship as the tissue that would develop the excision scar from an FUE surgery is removed along with the follicle in the overall strip tissue. The scar line from FUT may get longer with larger surgeries, but it is still one line of scar tissue that has a smaller overall surface area than a similar sized FUE surgery. Then why is FUE so much more difficult to detect with shorter haircuts? As humans, our eyes are drawn to patterns and the randomness of FUE excisions is far more difficult to see than a single, thin line that is right in the middle of the back of your head.
The allure of FUE is strong when considering a hair transplant, and the idea of FUE being a scarless procedure is simply incorrect, but when performed correctly by a qualified surgeon, FUE can be a fantastic procedure that has very little evidence of having ever been performed. When it is not performed properly, regarding the pattern of excisions, the result can look worse than any FUT procedure that has gone wrong.
Without proper donor management in place, a reckless hair transplant clinic can remove too much hair in one area of the donor zone, or even worse, create a zone of excisions that significantly reduces the donor density when compared to area of the scalp where no excisions have been performed. This can mean that a very visible pattern can be seen by everyone around you and that you don’t have enough donor hair for future procedures. Even if the scars are not as visible as a linear scar from FUT, the resulting donor destruction can, and has, created problems that cannot be fixed. This is why it is super important to find a qualified hair restoration doctor that understands the importance of properly managing the donor area in relation to the recipient area on your scalp.