Once upon a time, male pattern hair loss was a direct path to baldness. But these days, people going bald have never had so many options. There are topical treatments, oral drugs, laser therapy caps, nutraceutical supplements, and tons of other choices.
Unfortunately, some people use minoxidil, finasteride, and just about every other non-invasive hair loss treatment they can try, but are unable to get good results. And if hair loss is allowed to progress, the treatment options that can prevent balding become increasingly limited. It’s usually at this point that people start considering hair transplants.
Hair transplants are an expensive but extremely successful way of counteracting androgenic alopecia. One of the biggest downsides to them is that they can cause scarring, which can make people self-conscious and unhappy with the procedure’s results.
Hair transplants and scarring
Right now, there are two main types of hair transplants that are commonly performed on people with androgenic alopecia: FUE and FUT. Those names stand for Follicular Unit Excision (or Follicular Unit Extraction) and Follicular Unit Transplantation.
What is FUT?
FUT hair transplants have been around for decades. In this procedure, a surgeon extracts a piece of skin from the back (and sometimes sides) of the head, then closes the wound. They then extract hair follicles from the strip of skin. Each of these follicular units is then transplanted into the balding area of the scalp.
What is FUE?
FUE is a newer, less invasive version of FUT. Instead of extracting a piece of skin, FUE transplants involve the removal of healthy follicular units. These follicular units are then transplanted into the balding area of the scalp.
Since FUE involves the individual extraction of follicular units, it’s much more time-consuming. This procedure also tends to be more expensive.
Do hair transplants leave a scar?
It’s probably unsurprising to hear that removing a strip of skin can cause scarring. A long, linear FUT hair transplant scar is just about guaranteed for individuals receiving this procedure. That being said, the extent and severity of the scarring can vary quite a lot.
FUE is quite popular as an alternative to FUT as it’s considered to be a hair transplant without a scar. But this is really just a misconception. Every follicular unit extracted and transplanted will also form a scar.
A study in the Journal of Cutaneous and Aesthetic Surgery says that you’re essentially just choosing between one big scar and thousands of tiny scars. And despite its reputation as a ‘scarless’ procedure, FUE causes a greater overall area of scarring compared to FUT.
In FUE, the hair transplant scars are just less obvious — and may not be very visible. The resulting marks are small, diffused, and in some cases, discolored. According to a study in the Journal of Maxillofacial and Oral Surgery, these hypopigmented scars tend to be tiny round marks that are 1.5 to 1.6 millimeters in diameter. They’re particularly likely to occur to people who have darker skin types and more melanin in their skin.
How long do hair transplants take to heal?
Hair transplant recovery is fairly fast and straightforward, and most people can go back to work after just a few days. However, the wounds themselves take a while to heal. People need to be particularly careful for the first two weeks after the procedure.
The UK’s National Health Service says that stitches can usually be removed after about a week and a half to two weeks. But this doesn’t mean that the transplant wounds are completely healed at this point. According to a study in the Journal of Cutaneous and Aesthetic Surgery, it can take between weeks and months for scars — especially large FUT scars — to fully heal.
If you’re hoping to hide your scarring, this can take quite some time. New hair only starts to grow in after about 6 months. It can take a whole year or as long as 18 months to see substantial hair growth and the full result of the transplant.
Is hair transplant scarring obvious?
The FUT hair transplant scar is extremely obvious. The scar usually forms a long line along the back of the person’s head. Regardless of how thin or thick it is, it is usually distinctly recognizable as a FUT donor scar.
If you want to completely hide a FUT scar, you’d have to grow your hair out and style it in ways that completely cover the scar. This is fairly challenging and also requires substantial hair density — something that’s not often possible for people with substantial hair loss.
A FUT scar is very different from the average FUE scar: The former is large, linear, and obvious, while the latter involves a number of dispersed tiny circles or bleached-out marks. Compared to FUT scarring, FUE scarring is practically subtle. However, it can still be noticeable — especially if a person likes buzz cuts or other short, cropped haircuts, has very thin hair, or if their hair transplant procedure was unsuccessful.
You also have to consider that scarring can be hugely different from patient to patient. People who suffer from post-surgical complications, like infections and excessive inflammation, or who develop cysts or ingrown hairs are more likely to end up with very obvious scarring.
Can you remove a hair transplant scar?
In an ideal world, it would be possible to simply get hair transplant scar removal. And for some people, it may certainly be possible to have the size or severity of a scar reduced.
At the moment, it’s definitely possible to improve hair transplant scarring, but it’s unlikely that you’ll be able to remove scars entirely. People attempting FUT scar repair have three options to choose from: scar revision, laser treatments, or another transplant.
FUT scar revision
Scar revision is essentially a type of corrective surgery. The procedure involves removing the existing scar and closing the wound again. The hope is to end up with a less prominent scar. This option might be reasonable for someone who had surgical complications or a post-procedure infection.
However, scar revision is not suitable for everyone. For instance, in order for the procedure to have any chance of success, the person needs to have enough extra skin on their scalp.
While your doctor might certainly offer hair transplant scar revision as an option, it’s not most people’s first choice. According to a study in the Hair Transplant Forum International journal, the results can be quite unpredictable.
If you previously had a FUT transplant and didn’t have any major complications or infections following your procedure, it’s unlikely that scar revision will improve the appearance of your scar. Realistically, opening up the skin again will just create another scar — one that could be worse than the first.
Hair transplant scar removal using lasers
Scar tissue, regardless of where it is on the body, is notoriously difficult to fix. However, you do have one particularly good option if you’re looking for non-invasive hair transplant scar repair: lasers.
You may have already heard of using lasers for scar removal. Fractional lasers have been reported to help people with other types of scarring, like burn scars. These same lasers are now being used to help reduce scarring after surgeries.
According to the book Hair Transplantation, fractional lasers can be used to help with FUT scar repair. These lasers can help improve the scar’s texture and appearance. Unfortunately, at the moment, there are no studies showing that this procedure can remove such scarring completely.
FUE after FUT
Another possible hair transplant scar treatment is actually just another hair transplant. It might sound strange, but you can essentially use FUE to fix your FUT scar. The goal is to transplant hair in and on the area affected by the scarring. As the hair grows out, it covers the scar naturally.
The trouble is that it can be hard to transplant hair into scarred tissue. While it depends on the cause and how severe the scarring is, scarred skin is generally thought to reduce the survival of transplanted follicles and the procedure’s success.
However, there are additional treatments you can obtain to improve your chances of a successful transplant. According to a study in the Aesthetic Surgery Journal, fractional lasers and microfat injections have helped people with burn-induced alopecia. Performing these procedures beforehand helps improve the success of hair transplantation afterward.
If your scar is quite severe, it might be sensible to start with laser treatments and then go on to perform the FUT scar cover-up with FUE afterward. Consult your surgeon and discuss the options they think would work best for you.
FUE after FUT with body hair
We’ve obviously been talking about scarring, and have mentioned that FUE has the potential to cause scarring too. Why would we recommend a procedure that can cause more scalp scarring?
The answer is simple: FUE to repair FUT scars doesn’t need to use the hair follicles from your head. Instead, you can get FUE using facial or body hair. And while scarring and pigmentation issues are still possible when extracting hairs from other regions, this issue seems to be less of a cosmetic problem in these areas.
Putting body or facial hair on your head might sound a bit absurd, but this procedure is becoming increasingly popular. A study in the Journal of Plastic, Reconstructive, and Aesthetic Surgery reported the successful use of FUE (using beard hair) to hide the FUT scars of over 60 people. Particularly large scars might use a combination of both facial and scalp hair follicles.
Scalp micropigmentation: A hair transplant scar tattoo
If scar revision, laser treatments, and FUE don’t appeal to you, there is one other option: micropigmentation. Scalp micropigmentation is essentially a temporary tattoo. It’s not going to wash off in a few weeks, though. Instead, it’s likely to last between 5 and 10 years.
Since it’s a semi-permanent tattoo, scalp micropigmentation could be considered to be a hair transplant scar concealer. It’s almost like permanent make up. And the best part is that it works well for both FUT and FUE scars.
Getting scalp micropigmentation is similar to getting a regular tattoo. You book an appointment, and when you go in, an aesthetician or cosmetologist applies colored pigments to your scalp based on your hair color (or the hypopigmentation you’re trying to counteract). According to Hair and Scalp Treatments: A Practical Guide, the pigment is only deposited into the upper layers of your skin.
A study in the Journal of Clinical and Aesthetic Dermatology says that people getting this procedure usually have tiny circular dots tattooed onto their scalp. These round marks are meant to resemble closely shorn hairs or hair follicles.
Many people who get scalp micropigmentation are very happy with this procedure. However, this procedure is in no way a corrective treatment. It won’t do anything to heal your scar or repair the tissue in any way. However, if your concerns are mainly cosmetic, this procedure is an ideal way to mask scarring over the long term.
How do you fix FUT scars?
Fixing FUT scars is challenging. You have three main options: scar revision, laser treatments, and FUE transplants. Although you might have heard of old-school solutions like scar revision, this is now considered to be an unreliable treatment and is no longer the most recommended option.
Laser treatments can help improve scars, but they can’t fully hide them or make hair regrow from those areas. Out of all these options, FUE is the only one that has the potential to hide scarring.
Depending on your hair density and other factors, your clinician might even recommend you use FUE to transplant body or facial hair onto your head. An additional FUE transplant is the only way to get hair to grow from the damaged tissue and permanently hide the scar.
But if you’re done with surgeries, the best option might be a cosmetic one. Scalp micropigmentation, a temporary hair tattoo, is a great choice for people who like wearing their hair short but find themselves feeling self-conscious about their FUT scarring.
Scalp micropigmentation can help people dealing with FUE scarring, too. This hair transplant scar cover up is one of the few ways to deal with the skin discoloration that’s caused by FUE.