Scar repair on the scalp can be performed with a number of different methods. Generally scars can be re-excised and closed with a technique called trichophytic closure which allows hair to grow through the scar masking it. Other times the FUE technique can be used to extract hair follicles from other regions and transplant those follicles into the scar. It's best to meet with a qualified hair restoration surgeon that can examine your scars, your scalp, and discuss with you the best option.
In most cases, hair transplant to scars or patchy bald areas may not completely cover the scar and you must understand you may need a second follow up surgery for desired coverage. Of course this may vary based on how you wear your hair and how long you keep your hair.
In your particular case, the doctor may want to "test" the grafted area to make sure a transplanted hair will take and grow.
The method of harvesting the hair is between you and the surgeon. There is no right or wrong / better or worse.
Scar revision (base on your photo and your history of skin grafting) is not advisable.
Finally Scalp MicroPigmentation (SMP) is also an option for addressing the scar (with or without a hair transplant).
There are few experts who can treat such abnormalities and one is Dr. Sheldon Kabaker in Oakland who is a real expert in these types of wounds. I would write to him.
I would prefer to perform FUE hair transplantation using NeoGraft if the scar can @take@ the graft. Scars come in different forms. If the scarred scalp feels mobile then there is likely enough tissue to hold a follicle. With some resections, the subcutaneous tissue is removed leaving a paucity of good tissue for grafting. If not, tissue expansion is an option but its a 2 stage procedure and you will have a head deformity for a couple months. An evaluation by a board certified plastic surgeon would be helpful.
There are many ways to treat a scalp scar including:
- Removal of scar and closure with trichophytic closure. That allows us to minimize the visibility of scalp scar by bringing new hair into it
- The other option is to harvest hair from other areas through FUE procedure and implant into the scar. Scar visibility is usually due to the contrast of the scarred area and the neighboring areas with full density.
- The last option is SMP or Scalp Micropigmentation that can put dermal pigments into the scar and minimize the contrast of it with other areas and improve its visibility.
Hair transplants for scars
Surgical scalp scars, including those from skin grafts, can be suitable for hair transplant surgery to restore hair cover. The scar needs to be mature which can sometimes take a year or more, and there needs to be enough tissue between the scar and the skull. It might take several procedures to build up the density of the hair coverage.
Scalp expansion for 6-8 weeks followed by a flap reconstruction could give you complete coverage. I've done these procedures since the early 1980's. No two cases have been alike. Hair direction is often a key issue, especially in the temples.
The only way to remove this scar and replace it with normal hair is the use of the tissue expansion technique which we developed many years ago and described in our medical textbook on hair replacement surgery. Hair transplants will not provide good growth in scarred tissue like this.
this is very tricky because if you don't get it right you end up worst than what you already have. The area where the scar is located is a interesting spot, because if you look closely at the hairs growing around the edge of the scar , the hair grows in different directions. Therefore if you just consider scar removal or combination of scalp expansion with scar removal the end result is where the edges come together the hairs follow different directions and therefore it will look very unnatural. Your best bet is to do a small scar revision and extract some hair to do hair transplant and make the incisions by following the direction of your own existing hair for the transplantation. If you don't want to remove the scar, you can then do a small session of up to 50 grafts in that area wait
and see if it takes then do a large session.
Treatment of large scalp scar.
The best treatment for this is something we pioneered 35 years ago. It is call Tissue Expansion to creat enough skin with hair so as to be able to totally remove the scar and replace it with normal scalp. Hair transplants do not grow well in scar and I would avoid that.