Is a second hair transplant more challenging due to scar tissue in the recipient area? (Photo)

Question

I had a FUE transplant 5 years ago, with no satisfying result. A lot of grafts did not take, with low density as a result. I thinking about a second hair transplant with a more reputable clinic to add density to my hairline. Is a second hair transplant more challenging due to scar tissue (not visible by the eye in my case) in the recipient area? Is there bigger chance a lot of grafts will fail, this time caused by scar tissue from the previous transplant? Photo from my recipient 5 years ago.

Manu Gujrati, MD · Answer

Hi - I'm sorry to hear your experience 5 years ago was not as great as it should have been. When grafts to not take, it is often a sign of poor surgical technique. For healthy patients, there should be almost 100% growth of the grafts if the proper care is taken during surgery. 
In your case, it would be best seen by exam in the clinic whether there was also a problem in the donor area where the grafts were taken. If the extraction of the FUE was done properly, the remaining hairs in the donor area should still be strong and healthy. These can still be harvested and if the skin in the front of the scalp (the recipient area) healed well after surgery, at this point it should be more than healthy enough for another surgery with proper techniques and graft survival should not be a problem.
Your exam should include the surgeon's expert opinion if there are signs of any skin conditions however that could have lead to the problem in the first surgery. Patients who have auto-immune problems, history of itchy or infected scalp, tightness of the scalp skin, or other traumas/scars could have something else going on that would lead to problems with the grafts being able to take and grow properly. 
Wishing you all the best of luck and always happy to help.

Robert Dorin, DO · Answer

Hello Rutger24.There should be no additional risk in having a second or multiple hair restoration treatments attributed to “ scaring ” in the recipient region provided you do not have an undiagnosed medical condition affecting the integrity of your scalp and hair in the first place. If you do not have any medical conditions such as an autoimmune condition causing cicatricial alopecia ( scaring alopecia) and or you do not have a form of diffuse alopecia affecting the health of your donor hair, the transplant should be successful if it was executed with fidelity.Multiple hair transplants in and of themself are not a cause of scaring that would inhibit good growth in the recipient region .

Matt Tahsini, MD · Answer

Hello and thank you for your question. I know this must be very frustrating and disappointing but the good news is it can be fixed. You can get a second transplant IF your donor area is sufficient. I suggest an in person consultation to discuss your concerns and options. Choose a reputable doctor wisely as to minimize further issues. Best wishes.
Dr. T

Kulakarn Amonpattana, MD · Answer

When doing the second surgery, what we concerns are1. The donor capacity that has left2. The previous scar at both donor and recipient site3. Previous hairline design, if it is not realistic.In your situation, the previous session took out not very large number. We presume that you should have enough donor to donate more. And if the recipient site is fully healed now, you can consider the second procedure. However, talk with experience surgeon that is capable for the redo procedure. The second surgery can be challenge.

Jeff Donovan, MD, PhD · Answer

Second transplants done by a reputable clinic are likely to work very well. These are something that an experienced clinic does often. Sure there is some scar tissue in the scalp, but no - it does not have huge impact for most. The photos here show a relatively low density post op recipient area so it may be that the area was seeded at low density from the beginning. If truly there are grafts that did not take you should have a dermatologist review if there are scalp issues that  are causing problems before going for a second transplant.  Those issues are not common of course but I urge everyone to rule out scalp issues (ie lichen planopilaris and other immune based diseases) anytime density is less than expected.

Ilhan Serdaroglu, MD · Answer

Actually  we  do revision surgeries  to our  patients  to  increase  the  densty  who  has been operated a couple  of  years  before with  no  prblem  and  succesfull  result.   A second hair transplant  is not more challenging due to scar tissue .. There will  be   no bigger chance of failed survival of  the implanted grafts, this time caused by scar tissue from the previous transplant.

Neil Verma, HBSc, MD, FCFP - Account Suspended · Answer

A second hair transplant procedure can be done after the first. We would take into consideration the location of the first surgery to decide where to take the second strip.

William Rassman, MD (retired) · Answer

Many men get more than one FUE because either the balding area was not fully covered or the density placed was not adequate to cover the balding area

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