A hair transplant is a surgical procedure that moves hair follicles from a dense donor area of the scalp to a thinning or balding area. Since this process involves making incisions, some form of scarring is an inevitable part of the body’s natural healing response. The visibility and nature of the scar depend heavily on the specific technique used for harvesting the follicles. The appearance of the resulting scar often influences the patient’s choice of procedure.
The Linear Scar of Follicular Unit Transplantation (FUT)
Follicular Unit Transplantation (FUT), sometimes called strip harvesting, involves surgically removing a thin strip of skin from the donor area, typically located at the back of the head. This strip contains the hair follicles, which are then divided into individual units for transplantation. The wound created by the strip removal is closed with sutures or staples.
This closure results in a single, continuous linear scar that runs horizontally across the back of the scalp. The length of this scar can vary depending on the number of grafts needed, while the width is generally narrow, often ranging from 1 to 3 millimeters when the procedure is performed skillfully. However, factors such as the patient’s skin laxity and healing response can cause the scar to widen and become more pronounced.
The limitation of the FUT scar is its visibility if the hair is cut very short. While longer hair easily conceals the linear mark, a short haircut, such as a grade 1 or 2 clipper setting, can expose the scar line. This linear scar restricts styling options for patients who prefer closely cropped hairstyles.
The Punctate Scars of Follicular Unit Extraction (FUE)
The Follicular Unit Extraction (FUE) method extracts individual follicular units directly from the donor area using small, circular punch incisions. This technique avoids the long linear incision associated with FUT. The resulting scars are small, punctate, and dispersed across a wider section of the donor scalp.
These small, circular wounds heal into tiny, white dot scars, typically less than 1 millimeter in diameter. The size of the punch tool used directly influences the scar size, with modern punches often ranging between 0.7mm and 1.0mm. A skilled surgeon will carefully space these micro-extractions to ensure the remaining hair density effectively camouflages the dots.
Because the scars are small and scattered, FUE allows patients to wear their hair shorter than with FUT, often down to a buzz cut, without the scars being readily apparent. However, extracting too many follicles from a single area can cause over-harvesting. This leads to noticeable thinning or a “moth-eaten” appearance in the donor area, making the dispersed scars more visible.
Techniques for Minimizing and Concealing Scars
Surgeons employ techniques that minimize the visibility of both FUT and FUE scars from the outset. For FUT procedures, the trichophytic closure is one of the most effective methods. This technique involves trimming a thin sliver of the epidermis from one edge of the incision before suturing, allowing the edges to overlap. This encourages hair to grow directly through the scar tissue itself.
The surgeon’s skill in FUE is demonstrated through the careful selection of punch size and the even dispersion of extraction sites. Using the smallest possible punch, often 0.8mm or less, reduces the size of the resulting dot scars. Preventing excessive harvesting from any single area ensures that the overall hair density in the donor region remains high enough to conceal the small marks.
For scars that remain noticeable after healing, several post-operative treatments are available for concealment or revision. Scalp Micropigmentation (SMP) is a non-surgical option that involves tattooing tiny dots of pigment into the scar tissue and surrounding scalp to mimic the appearance of short hair follicles. This technique is highly effective for camouflaging both the linear FUT scar and the punctate FUE scars, allowing patients to wear their hair shorter. Other options, such as laser therapy, can be used to improve the texture and color of the scar tissue. Patients must also follow post-operative instructions carefully, including avoiding tension on the scalp and protecting the area from sun exposure, to promote optimal healing and minimize the risk of scar stretching.