FUE hair transplant, what is the likelihood of scarring?

Question

I have very pale skin, with auburn hair. Right now I am in mid 20's and fairly balding along everywhere on the top. I expect to be completely bald on the top when I am in my mid 30's. 1) Given pale skin and auburn hair, what is the chance of scarring (in case I decide to shave my head for a film role)? 2) If you are completely bald on the top but have thick hair on the sides and back, will it look decent or is that too much hair to replace?

Jae Pak, MD · Answer

All cuts on the skin will leave a scar.  FUE will leave a scar in the form of round "dots".   The color of your skin or hair color cannot predict how good or bad your scar may be.  If you shave your head, you will definitely see the FUE scars no matter how well you heal.

Sean Behnam, MD · Answer

There are 2 procedures and each definitely produce scars. There is no such procedure that is scarless. It is important that you know that you may go completely bald in the next 5-6 years. This is extremely important as it is sets realistic expectations of what to expect. Typically you can cut your hair shorter with the Follicular Unit Extraction (FUE) procedure. For my FUE procedures, I use a 0.9mm punch. I also use a product called Acell which is growth factors derived from pig bladder. There are some case studies that demonstrate it promotes better wound healing. I use it in almost all my cases. Although this reduces the scarring, nevertheless, there is still scarring there. I have also developed a wrapping technique with Acell and Vaseline that actually promotes faster wound healing. I think the best thing to do is to see multiple doctors. I hope this helps. 
With regards to the scarring in the recipient area which is the area where the grafts are being transplanted into, this is rare but does depend on the instrument that is used. I use one times needles that are extremely sharp for every 50 sites that I create. This is very important because since the needles are very sharp, it does not actually create scarring. After every 50 sites, it becomes slight dull. This way I am able to minimize scarring in the recipient area.

Allan J. Parungao, MD · Answer

Do your online research and then have multiple in-person consultations with hair transplant surgeons.  In cases such as yours, FUE may be the answer.  Alternatively, you may find out after these appointments that shaving your head and scalp micropigmentation (SMP) is the answer.  Are you agreeable to multiple procedures? How about lifetime maintenance/enhancement with oral finasteride &/or topical minoxidil &/or PRP?   There are so many individual issues to cover with each and every patient that you had better get well-informed before the first graft is taken.  If you so desire, my group has an office in mid-Wilshire that can answer all of these questions and more.  Best of luck to you.

Joseph L. Williams, MD · Answer

Unfortunately, it is not possible to cut the skin with
either FUT or FUE & result in NO scar. Anyone who tells you that a hair
restoration procedure is a scar-less procedure is misrepresenting the facts.

Your skin color &/or hair color are factors significant
in illusion of coverage due to limiting the contrast of the hair over the skin,
but has very little to do with scar formation with a hair restoration
procedure.

The lack of a linear scar (line of scar) can be eliminated
with FUE, but mathematically, there is a great deal more scar from FUE since
the punched out skin must be completely filled with scar tissue. This additional
volume of scarring occurs due to the circular patterns caused by the punch. If
a small enough punch is utilized such as 0.7-0.8 mm then short hair can usually
camouflage it. Rarely, in my opinion, can a patient shave his scalp without
seeing scarring, just not a line of scar.

The second question is difficult to answer without photos.
However, shorter hair on sides & back often look much better after the
first procedure due to drawing less attention to the difference in volume which
is more obvious due to the length.

Baubac Hayatdavoudi, MD · Answer

If you have a thick donor region on the sides and back of your head, then there should be enough donor grafts to be able to restore the top where it looks great! A great first step would be an online consultation. Often you can submit photos to top hair restoration surgeons for a complimentary evaluation and assessment. This should help lead you in the right direction. Having multiple consultations with different doctors will let you know your best options.

Sara Wasserbauer, MD - Account Suspended · Answer

You will have scars from any surgery, regardless of your skin/hair coloring.  Anyone who says otherwise is lying.  Your choice between a linear surgery and an FUE is simply what form that scar will take - will it be a fine line (usually 1-2mm) or several thousand tiny ~1mm dots.  
For FUE, choose a surgeon based on their ability to "grade" the sides and back and "feather" in the edges so that it doesn't end in a straight line (which can look just as obvious as a "bad" strip surgery).  Make sure your FUE surgeon actually performs the surgery him or herself!!!  For a traditional surgery, choose a surgeon with a long history of attention to scars and make sure they do a "trichophytic incision" on BOTH the upper and lower edges of the incision. SMP can camouflage poor healing really well in either case if you have a less than optimal outcome.
You will likely get more total hair growing in the long run with the traditional "linear" surgery which would be best if you have a completely bald head on top, and an FUE surgery can be used to get hair from untouched areas of the scalp that a traditional surgery would not typically get grafts from.  For OPTIMAL results, you might also consider a HYBRID surgery using both techniques simultaneously.  tough 10 days of post-op, but amazing results at 1 year!
Good Luck!

William Rassman, MD (retired) · Answer

Scarring in the recipient area is not common. Great care must be taken by the doctor not to produce deformities of the recipient skin. To do this, we trim down the grafts leaving very little skin on the grafts that are placed. Few doctors do this with FUE.

As you will see as you read about us, Dr. Pak and I are the patent holder inventor of two core technologies of the hair transplant robot, submitting two patents in 2003 and getting them issued in 2006. The manufacture of the robot took 4 years to build the ARTAS robot starting in 2006 after the company acquired a license from me.  I am also the modern day inventor of the FUE procedure, doing these FUE procedures longer than anyone in North America, dating back to 1996. I published the first article on FUE in 2002 and then the rest is history. The reason I invented the robot was because too many doctors failed to perform FUE successfully, which is somewhat the case today. The ARTAS leveled the playing field as far as doing the extractions for FUE. I hold now 17 US patents on various hair technologies and publish in medical journals and medical textbooks extensively. If you should come to one of our open house events, you can look directly on the hairlines of many patients who have had it done to see that there are no scars evident in the recipient area.

FUE hair transplant, what is the likelihood of scarring?

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