Scars are an inevitable by-product of hair transplant surgery. Often referred to as hair restoration, even modern surgical procedures cannot prevent visible scars from forming. Here, we explore camouflage and concealment methods to reduce their visibility.
Hair transplant scars are a source of significant anxiety for millions of men, and also a significant number of women, who have had hair restoration surgery at some point in their lives.
Even with modern hair transplant techniques, the issue is that no physician can prevent the continuation of hair loss after surgery. As time progresses and more hair is lost, many people opt for further procedures to mitigate against ongoing thinning of their hair. This leads to more significant scarring and of course there is less hair available to cover the scars.
Eventually, many men reach a point where they would simply prefer to shave their head. This is problematic after hair restoration because scars become much more obvious with no hair to conceal them, leaving the patient in a catch-22 situation where their hair looks bad because of how much density has been lost, but they can’t do anything about it.
Even if the patient keeps their hair, they often find they have to style it a certain way or use temporary concealer products to make it appear thicker and to hide the scars. Hardly an ideal long term solution.
There are four different kinds of scars that patients carry, depending on the nature of the surgical method used:
Each of these scar types presents different challenges from a camouflage point of view, and the nature of how they are concealed is quite different.
To what degree the scars can be hidden depends on a number of factors. The color of the tissue in comparison to the surrounding skin, the scar texture, the extent to which it has healed, its size, width, position, whether it is flat, indented or raised, the shape of the head, the amount of hair surrounding the area and not least the skill of any practitioner chosen to remedy the situation, all play a part.
As you probably realize, research is important to ensure you choose the right option for you, and if necessary, the right practitioner to help you.
The easiest and cheapest method, however also the least effective, many people use concealers such as Toppik, DermMatch or Nanogen to make their hair appear thicker, subsequently hiding scars under the hair.
A pointillism method of tattooing, scalp micropigmentation is the most common option for concealing scars of all types.
Typically used to hide FUT scars, this surgical process requires the grafting of hair units into the scar using the FUE method.
A method for historic or bad FUT scars, the scar tissue is surgically removed and the wound is sealed using modern suture techniques.
As laser techniques improve, some clients are turning to Fraxel or Vbeam laser techniques to make their scars less visible.
Follicular Unit Extraction, or FUE, is the most modern and least invasive type of hair restoration surgery. The procedure itself involves the use of a punch tool to extract individual hair grafts from the donor site, usually the back of the head, combined with a slit technique to implant the grafts into the recipient site, usually at the frontal hairline moving back towards the crown.
Scars from FUE surgery are characterized by small round ‘dot’ scars. They are usually numerous and cover a large area, but as they are generally separated from surrounding scars, remaining hair coverage usually provides better cover than with other hair transplant methods.
Due to their small size and relative ease of concealment, the most common camouflage methods are scalp micropigmentation and temporary concealers.
Follicular Unit Transplantation (FUT) was widely used from the 1990’s onwards, and is still commonly used today. Often referred to as the strip method or sometimes Follicular Unit Strip Surgery (FUSS), FUT surgery costs less per graft than FUE and generally has higher long term retention rates after healing.
The major downside of FUT is that the procedure creates more significant scars that are often harder to conceal. Seen as a line at the back of the head, sometimes extending from ear to ear, although recipients of multiple FUT procedures will sometimes have donor sites at the sides of the back of the head. Cheaper FUT procedures with less experienced or high volume physicians often result in worse scarring as less care is taken on the incision and the closure.
Concealment methods vary depending on the nature of the scar. Revision surgery is becoming more common, and often the scar is removed anyway if the recipient has further hair transplant surgery later on. Sometimes patients will have FUE into the scar or choose scalp micropigmentation to conceal it. Fraxel and Vbeam can also be useful in some cases.
Before the introduction of modern hair transplant techniques, more primitive methods were used. Many examples of bad hair transplants from years ago are published online, often resembling a dolls hair appearance where instead of separating each graft before implantation, the hair has been transplanted into the scalp in large clusters.
The resulting scars in the donor site from this type of surgery can be significant, and are usually referred to as plug scars. Furthermore, excess trauma or improper implantation technique in the recipient site can cause another problem known as cobblestone scarring.
Recipients of surgery that resulted in plug scars are typically older men who had their procedure a long time ago. Often this led to a lifetime of anxiety, leading many to seek modern solutions to fix the problem.
Realistically the only viable options are temporary concealers, fraxel laser or scalp micropigmentation. Of course some people turn to hair systems, but this option comes with its own set of drawbacks.
A scalp reduction procedure is not for the feint of heart. A gruesome process, scalp reduction surgery involves the removal of skin from the scalp, after which the remaining skin is pulled into place and secured with sutures until it has healed.
This enables the patient to do the following:
Thankfully scalp reductions are less common than they used to be, although there is still a use case for the procedure in certain circumstances.
Unsurprisingly scarring is significant and can be a challenge to hide. The methods used are generally the same as for FUT scars and include Fraxel or Vbeam laser, scalp micropigmentation, FUE into the scar and temporary concealers. Scar revision surgery may be less suitable as the skin is often tight after a scalp reduction and cannot accommodate the further stretching required to revise the scar.
Concealer products are sold under many brand names such as Toppik, DermMatch, Caboki, Nanogen and Cuvva. Whilst they all claim to offer the best results, whether they are shaken into the hair or brushed on with an applicator, they ultimately all do the same job and are basically made of keratin fibers or a powder similar to makeup.
Concealers can be very effective and provide relief to many millions of people, not just for scar cover-ups but also to disguise hair loss in general.
Unfortunately they are not without their drawbacks. Temporary concealers are expensive to use long term, and are not entirely fixed to the hair. This means that exposure to wind, rain or swimming pools, or being brushed by clothes, hands or pillows is a huge problem. Concealer users often experience constant anxiety while using them. They can also look fake, particularly if the hair is thin and a lot of product has been used.
It is important to note than concealers only work if there is enough remaining hair to cling to. If you are completely bald, concealers are not a viable option.
A pointillism-based tattooing method, scalp micropigmentation has been around for decades but was really innovated and rolled out internationally from 2009 onwards.
Scalp micropigmentation is a hair loss solution available through thousands of specialist clinics, however it is increasingly used for scar camouflage too. In fact, SMP has become the world’s most common solution for scar recipients.
It is important to note that a high level of artistry, as well as specialist knowledge of the process, is required to deliver effective results. We do not recommend visiting a tattoo parlor for this procedure, in fact many hair transplant surgeons also produce sub-par results in this area. We recommend seeking a specialist SMP clinic and conducting thorough research before choosing this method.
This is a commonly-used option offered by most reputable hair transplant surgeons. it is arguably the most effective for those who wish to keep their hair at a certain length, however it does have a few drawbacks to consider.
Scar tissue is not as robust as healthy skin, therefore the retention rate of transplanted hair can be low. Clearly this method also requires further surgery so more scars are created, however as this is a FUE method used to implant hair into a FUT or scalp reduction scar, overall scarring is usually reduced.
As this is a specialist area, we recommend seeking the assistance of a reputable hair physician. Many patients return to their original surgeon, and if you are happy with their work, this is usually a good starting point. The important issue here is to manage expectations, and ensure the scar has healed sufficiently to maximise post-procedure hair retention.
When FUT scars do not heal optimally, it is often because the surgeon did not take sufficient care or was not skilled or experienced enough to make the incision and closure as clean and trauma-free as possible. In these cases, it is sometimes possible to surgically remove the scar and start again.
Obviously if the scar tissue is removed, the recipient will be left with a new scar and they are betting on this scar being better handled than their original. Hair transplant surgery has come a long way in recent years, so it can make sense to take advantage of modern techniques and skilled surgeons who can address this problem for you.
Sometimes scars are revised by default. For example if you had a FUT procedure and want to improve the scar, you could opt for further FUT surgery and have the physician remove the old scar as part of the strip they remove to harvest donor hair. This means less donor hair yield from the procedure, but it does give the surgeon the opportunity to do a better job with the incision and sutures this time and hopefully produce a cleaner, less noticeable scar.
This is a relatively new area for hair transplant patients. Certain types of laser were developed to reduce skin imperfections, for example Fraxel is commonly used to reduce fine lines, wrinkles, acne scars and sun damage, whilst Vbeam is used to treat dilated blood vessels, commonly referred to as rosacea.
Both these lasers offer potential benefits for hair transplant patients, although most clinics you visit will not have experience of applying their laser devices in this way.
Fraxel laser is useful for smoothing the skin. For patients with raised or indented FUT, plug or cobblestone scars, this can be really beneficial although it takes several sessions to see any real results.
If you are caucasian and have pink scar tissue, Vbeam lasers can be used to normalize the color of your scar. This can help significantly when trying to hide the scar, particularly if scalp micropigmentation is the chosen camouflage method.
