Getting a hair transplant on scar tissue is possible.

But a hair transplant on a scar is done differently from a typical hair transplant, because the skin and tissues of a scar are different from regular skin and tissue.

Let’s get into how hair transplants on scars work, what to expect from the results, and what you need to know when recovering.

Hair doesn’t naturally grow in scar tissue because there aren’t any hair follicles in a scar.

Hair follicles are capsules underneath the skin that hold and regrow hair. Blood vessels under follicles help them grow and regenerate. But when a scar forms on damaged skin, hair follicles don’t grow back. This is because scars are made of thick fibrous tissue called collagen that forms to protect the skin underneath.

This doesn’t leave any room for hair follicles, blood vessels, or even nerves in some cases. It’s not like regular skin at all, so scar tissue can’t accept a typical hair transplant where hair is inserted into existing follicles.

In order to transplant hair onto a scar, a surgeon will graft hairs that are still contained in their follicles into the scar. This lets the hair to begin taking root and growing again once they make contact with blood vessels.

Hair follicles will usually start growing hair back after the area’s healed and the follicles are fully grafted into the skin, receiving blood flow from nearby blood vessels.

Hair transplants on scar tissue also require close aftercare to make sure they implant successfully. You may also need multiple procedures because of the initial lack of blood flow to the area.

Scar tissue is also often thickened or raised. A doctor may recommend injecting the area around your scar with corticosteroids to flatten the scar surface and make the area look more natural.

There are two main types of hair transplants that a surgeon may recommend to transplant hair into your scar tissue.

Here’s how each procedure is done.

Follicular unit transplantation (FUT)

  1. Your surgeon uses a scalpel to take a 6- to 10-inch piece of skin from your scalp or other nearby skin (depending on the size of your scar).
  2. They close the area back up with stitches.
  3. Your surgeon splits the skin into tiny pieces called grafts, some of which may only contain one hair and its follicle.
  4. Using a scalpel or needle, your surgeon creates openings in your scar tissue where follicles will be inserted.
  5. Your surgeon puts the grafts into the openings in the scar.
  6. They wrap up the surgery by bandaging the area with cotton and gauze.

Follicular unit extraction (FUE)

  1. Your surgeon shaves an area on your head or near your scar.
  2. They extract a series of follicles from the skin, leaving behind tiny visible marks.
  3. Your surgeon creates openings in your scar tissue and inserts the follicles into the openings.
  4. They bandage your scar tissue with cotton and gauze.

Most transplant procedures take about one to two hours. You’ll usually be able to go home the same day as your hair transplant. A bigger transplant may take several different appointments over a few days.

Your surgeon will take off bandages once the area has begun healing after the surgery. They may also use a triamcinolone injection around the area of the transplant to reduce swelling.

Will it hurt?

It’s common to feel pain or discomfort on or around the area of the transplant and in the area where hair was extracted from. In the first few days after the hair transplant, your surgeon will likely recommend:

  • medication for pain, such as ibuprofen (Advil)
  • antibiotics that may help reduce the risk of infections
  • anti-inflammatory medications like steroids for swelling
  • hair growth stimulants like minoxidil (Rogaine) or finasteride (Propecia)

Aftercare tips

Your surgeon may also instruct you to do the following to help with your recovery after the hair transplant:

  • Don’t wash or immerse the transplant area in water for a few days after the surgery.
  • Try to get a few days off work or other activities to let the area heal.
  • Don’t apply a lotion, ointment, or other substance to the area unless your surgeon directs you to.
  • Don’t comb or brush the hair for at least 21 days if the hair was transplanted onto your scalp.
  • Try to wear minimal clothing over the area or keep the area open for a few days while the skin heals.
  • Don’t work out for a week or more to prevent the area from being injured or irritated.

It’s normal for hairs to fall out of the transplanted area

It’s normal if hairs fall out of the transplanted area. Hair may not also grow consistently in line with the surrounding area at first, so don’t worry if it looks a little different from the area around your scar.

The time it takes for hairs to grow in the scar can vary widely.

A 2013 study of 25 cases of hair transplants on scars found that a majority of patients had 75 percent or more hair growth at the six-month follow-up appointment.

And a 2014 study found that anywhere between 64 percent and 95 percent of transplanted hair in scar tissue survived after about 13 months following the surgery.

A 2019 study of 37 people found those who underwent hair transplants to rate their level of satisfaction from 1 (very dissatisfied) to 5 (very satisfied). The average satisfaction score was 4.6.

Talk to your doctor if you notice any of the following:

  • symptoms of infection
  • fluid or pus drainage from the area
  • crust forming around the area
  • intense or unbearable itching or pain
  • noticeable swelling of the hair follicles (folliculitis)
  • blood coming from site
  • numbness around the area
  • dissatisfaction with how the newly transplanted hair looks in comparison with the surrounding areas
  • hair loss from the surgical area or even nearby areas

Possible side effects from medications

Here are possible side effects from medications like Rogaine or Propecia:

You have plenty of options for hair transplants on scar tissue.

Talk to a doctor about what type of hair transplant may work best for your scar tissue, and what to expect during and after the procedure.