Hi Dr. Rahal, Hope all is well with you. I have a few questions about transplanting FUE into scar tissue.
- Do you perform many FUE procedures into scar tissue?
- Will FUE scars leave white or pink spots, or the donor area be detectable with a very short haircut (1/8 or 1/4 of inch)?
- What FUE graph failure percentage is the norm?
- Do you use Acell and manual punch for the FUE extraction (punch size, 0.8mm?)
- What can be done to increase the FUE density into scar tissue?
I haven’t had a hair transplant and have a good donor area . The scar is from an operation on both sides of the head, about 2 1/2 – inch long each (not too bad, but will show with very short hair). I live in the Washington, DC area.
Dear Mark,
Thank you for writing. I’ll address each of your questions separately.
1. Yes, we perform FUE into scar tissue at Rahal. Concealing scarring with Rahal FUE™ is a simple procedure and takes only 30-60 minutes.
Here is an example of a Rahal patient after FUE into scar tissue… before, immediately post-op and 9 months post-op. The scar is concealed… and the patient is excited that he can wear his hair short again.
2. There are two factors that determine whether or not the Rahal FUE™ extraction points will be cosmetically noticeable. First is the punch size. We routinely use a .8mm punch, as we find this can adequately handle most grafts with ease. Once the extraction points are completely healed, it’s exceedingly difficult to see any evidence of extraction in the form of obvious scarring or discoloration.
Pink dots as you referenced would indicate ongoing healing… and then white dots are when healing has finished and the fibrous scar tissue has settled. With the .8mm punch we find that the final circumference of the extraction point is cosmetically insignificant.
The second factor affecting the cosmetic appearance of the donor zone is the overall pattern of extraction. With the extraction pattern spread out strategically there is no perceptible reduction of donor density, which can be a real issue if not properly executed.
Too many times I have seen patients with FUE from other clinics come to me with donor zones that are patchy because the clinic removed too many grafts in a specific region of the donor zone. This is counter productive to the whole point of FUE, which is to have cosmetically insignificant visual indicators that a procedure has been performed to begin with.
3. You asked about the survival percentages of our Rahal FUE™ (which is a good question). With any clinic performing FUE, there were challenges in the beginning. When I started working with FUE 9 years ago (2005) the survival rates were below that of my “Rahal Mega Session™” survival rates.
However, as time progressed, so did our experience… and today our Rahal FUE™ survival rates are in the high 95% to 98% range (which equals typical FUT survival rates).
At this point the debate about survival rates between FUT and FUT is a moot issue.
The key to getting to this point was not just learning how to use the punch properly. Using FUE punch is a fairly straight forward affair. The challenge was learning how to utilize a punch with the various types of hair and even scalp tissue that presented themselves in our patients.
This is the learning curve that must be overcome before one can consider themselves proficient with Rahal FUE™ and is what allows us to have such high Rahal FUE™ survival rates today.
4. Acell is a product that was very popular online a few years ago but the excitement has someone diminished of late. I am still asked about it from time to time but to be honest , I’m not a fan of Acell. This is mainly because of how it is being marketed by some clinics in the United States with at least one clinic I know of actually stating outright that by applying Acell to Rahal FUE™ donor extraction sites they are seeing in some cases up to 80% regeneration.
To date there is no photo or video documentation to back up these claims.
There may be merit to the use of Acell for basic acceleration of healing post-op… but I find that with the .8mm punch used in our practice there is little use for the ambiguous improvements that may be had through the use of Acell because the donor sites already heal quite well with no external influence.
5. Increasing density into scar tissue via Rahal FUE™ is a fairly simple affair. Many clinics feel that Rahal FUE™ into scar tissue, because of it’s overall lower vascularity compared to healthy skin tissue, cannot support anything more than moderate density at best.
I feel that taking a blanket approach to this issue is shortsighted, as higher densities are indeed possible for some scar formations.
With a proper and strategically safe extraction pattern and a proper sized punch having your hair at ¼ or even 1/8th of an inch in length should allow for a cosmetically acceptable result in the donor zone… but to get a better handle on your case and for you to get a more detailed assessment I recommend you schedule your 100% free consultation today.
That way I can review your case and design your personalized “Hair Loss Treatment Plan™” to address the scars from your operation. You’ll also discover a complete breakdown on cost per graft and recommended treatment options.
Thank you again for your questions.
Sincerely,
Dr. Rahal
P.S. You don’t have to live with visible scaring. There is a permanent solution!