March/April 2005 Volume 15, Number 2

Hair Repair: Donor Scar Repair

Steven C. Chang, MD Newport Beach, California

History

A 53-year-old Caucasian was referred with a history of numerous surgeries starting 20 years ago that left him with wide, cosmetically unacceptable donor scars. A scar revision had been done seven months prior in an attempt to improve the appearance. No improvement was seen after scar revision. His main complaint is that he has to use upper parietal hair to cover up the scars on the posterior occipital donor area. On windy days, the scar is very noticeable. His physician retired and referred him to my clinic. This case was first presented in a previous issue of the Forum (Vol. 14, No. 4, July/August 2004, page 143).

Exam

The donor scar measures 24cm long by 4cm wide (Figure 1). There is only sparse hair growing within the scar.

There is almost no donor hair available from the traditional donor area. After close examination, I found there is still a little bit of donor hair available at both upper parietal areas.

The maximum donor from one side that I can remove is 8cm long by 0.4cm wide. Another side is 7.5cm long by 0.4cm wide. Total donor area available is 6.2cm². And the total scar area is 96cm² (24cm long by 4cm wide).

Treatment

A previous scar revision had failed, and it was decided that more attempts to excise the scar would not be successful. If the whole scar area is grafted, the improvement will be minimal. This increase in density is not going to help much at all. Therefore, the scar area in each temple, measuring 5 cm long by 4 cm wide, was not treated. A decision was made to transplant only the occipital area and the transplanted area was reduced to 14cm long by 4cm wide (56cm²).

From 6.2cm² of excised donor area, 320 double follicular unit grafts were produced. The occipital scar was grafted at higher density at the top of the scar to give more hair to shingle downwards.

Follow Up

Seven months later, the patient returned for the follow up visit. He was completely satisfied with the posterior hair coverage (Figure 2). This case demonstrates that focusing a relatively small number of grafts into a cosmetically critical area can have a significant impact.