Hair Restoration surgery is evolving rapidly and we are consistently refining our approach on a regular basis to improve the quality of transplanted hair while at the same time minimizing the possibility of complications. Double edged trichophytic closure is a new approach to donor wound closure that has been put into practice by Dr. Mohebi and US Hair Restoration.

Double edged or two sided trichotomy can help to minimize complications of trichophytic closure (based on the width of epithelium that is being removed and inability of some the hair follicles or oil glands to find their way out to the skin surface). This practice of double edged closure helps us to minimize the width of the top skin layer (epithelium) that is removed from each edge of the donor wound. By making these changes, double edged trichophytic closure allows hair to grow into the wound from both edges and thus minimize the contrast between a patient’s scar (with no hair) and surrounding scalp (with 100% hair density).

By employing the double edged trichophytic closure in our pratice, we constantly have results of less detectable donor scars. In addition to less detectable scarring, we are also able to minimize the risk of folliculitis or ingrown hairs in the donor area, which are the two of the most common complications of traditional trichotomy.

Hair transplant surgery is designed to restore hair in men and women depending on the condition. For most, this is done in the event of male or female patterned hair loss. Others may use this procedure for other areas of the body that may have once had hair like the eyebrows and others to place hair like facial hair or where they may see fit. The only remaining issue is the scar that remains in the donor area after a hair transplant procedure.

Can this be avoided? Is there any way to remove or conceal an existing scar?

Depending on the procedure, the scar can either be avoided or minimized. Follicular unit extraction (FUE) is an advanced hair transplant procedure where hair graft units are selectively extracted and refined without leaving a linear scar in the donor area. This technique has also been used to transplant hair into an existing hair transplant scar. This is one technique used to conceal a donor area scar but it does not remove it. The objective is to conceal the scar as much as possible.

For those patients looking into hair transplant surgery, follicular unit transplantation (FUT) is the golden standard in hair restoration. There are ways to minimize the scar’s appearance. In most cases, a hair transplant surgeon can use single or dual trichophytic closure to minimize the visibility of the scar in the donor area. This technique allows hair to grow in through the scar creating an illusion and concealing the scar. Patients whom have had a hair transplant procedure can undergo scar revision and have the existing scar excised and reclosed using this technique if it has not already been done.

As stated, the objective is to minimize the visibility of the donor scar. If the patient is undergoing hair transplant surgery through FUT, you must bear in mind that a scar will still be present. It has been noted that Botox can also be used to avoid additional stretching of the scar further preventing visibility. This should be taken care of right after a hair transplant procedure. These options should be discussed with your hair transplant surgeon to assure that you are getting exactly what you want out of your hair transplant procedure.

Q:

To Dr. Mohebi:

17 days have passed since my hair restoration procedure at your office in the San Fernando Valley.  As I remember, I had an FUT procedure with bi-lateral trichophytic closure performed for about 650 grafts to reinforce my front hairline. I want to make sure to say first off that I’m extremely grateful for the time you took to answer the questions I had in a well-informed and honest manner. Also, I’d like to say I had a wonderfully positive experience and was treated kindly by everyone at your office. It was a much different experience than the first time I had a hair transplant with someone else.

Included are five photographs (recently taken) of my grafts about fourteen days after the surgery. I got rid of the scabs on the grafts and donor area. I noticed the hair grafts are now growing, and a few have fell off the scalp. I have a few inquiries.

• One snapshot reveals, at the pinnacle of the front hairline, a red circle and the particular area looks bald and bare. Do you remember planting any grafts in this part of my head. I expected this part to have hair growing on it because the front tip sticks out.
• The donor area feels sensitive and it’s still painful but also numb in other parts. I’m wondering if this is what usually happens after a fortnight.
• The back of my head (donor area) feels stretched and makes it hard for me to look at my shoes or look down when urinating. It’s a bit painful. I don’t think I had this issue after my first hair transplant. Or maybe the pain wasn’t as prolonged as it is now. Maybe it’s because the bi-lateral trichophytic closure is on another scarline? When do you think the pain in my donor site will go away?

Thanks again for the well-done procedure. I look forward to hearing back from you.

A:

It warms my heart that you enjoyed your visit with us when getting your hair transplant. You underwent a donor scar revision procedure to enhance the look of your donor linear scar on the back of your head with a two sided tricophytic closure to ensure hair growth into the scar for the highest invisibility. About your questions, I’ve written below my responses to them in chronological order.

• Intentionally, we made the frontal area irregular so it wouldn’t appear to look linear and reconstructed. After the hair transplant, you ought to have lost a good number of grafts. The way your hair looks now and is not the way it will look eventually. I’d advise you to wait at least another six or seven months so all your hair will have grown out. It will look much better.
• As part of the healing process, a bit of inflammation is normal and will appear about two weeks after a hair transplant procedure. But, if the inflammation doesn’t eventually go away or if it becomes more inflamed, come to my office immediately.
• You may feel more pain and stretching on the back of your head because you’ve had previous surgeries. There wouldn’t be as much pain in the donor site if you hadn’t ever had a hair transplant. Try not to look down too much or in a herky-jerk manner for the following eight weeks after surgery because there’s a risk of stretching out the donor scar. On the second month, if there’s still pain, visit me and we’ll take a look at it. In the meantime, if there are other questions you may have about hair growth or other inquiries regarding your hair transplant, call and make an appointment to see me.
  I’m eager to meet with you again in later visits.