Hair transplant surgical techniques have come a long way since the early days of hair plugs. Even so, scarring is still an inevitable byproduct of the procedure.

There are two types of surgical techniques that are widely used today. Each one produces a different type of scarring. Your surgeon’s skill and experience, can, in large part, determine the amount of scarring you are left with.

Whichever you choose, know that wound-closure techniques have improved, along with the procedures themselves.

The technique you choose will be determined by several factors, including the type of scarring you can expect, your hair loss pattern, the amount and quality of your donor hair, and the size of the area where your hair has thinned out.

Cost may also be a factor. You and your physician can best determine which procedure will be most effective for you.

The two surgical procedures most often used for hair transplant are follicular unit extraction (FUE) and follicular unit transplantation (FUT). Both surgeries begin to produce visible hair growth within three to six months.

FUE

This procedure uses hair follicles extracted from the back and sides of the scalp (the donor areas). Your surgeon will remove each hair follicle graft individually with a micro-punch tool. Each extraction leaves a tiny round scar, up to one millimeter in diameter.

Based on how many hair follicles are extracted, this can add up to many hundreds or even thousands of puncture mark scars. These scars may look like tiny white dots after healing. Each follicle contains one to four hairs.

The hairs are then grafted onto the recipient areas of the scalp, where small incisions have been made for each individual hair. Given the painstaking nature of this process, many hours, or even days, may be required for surgery.

The procedure may also be repeated several times over the course of two or three months to achieve the best result. FUE is done on an outpatient basis, under local anesthesia. No stitches are needed, and recovery time is typically short.

FUT

This procedure requires the surgical removal of a strip of scalp that contains hair from the donor area. This is typically located on the back of the scalp. Once the hair strip has been removed, the area is sutured together.

This leaves a linear scar of varying lengths, based on the size of the strip extracted. In some instances, this scar might extend from ear to ear. The hair follicle grafts are removed from the scalp strip, and readied for grafting onto the recipient areas of the scalp, where small incisions have been placed for each individual hair.

This procedure also uses local anesthesia and is done on an outpatient basis. The stiches are removed approximately 10 days later.

The FUT procedure may produce more pain and swelling than the FUE procedure. Results vary from person to person.

Several procedures may be used to lessen, or reduce, the size of the scar created through the FUT procedure. Their success is not always guaranteed, and some scarring is almost certain to remain.

Keep in mind that as you age, your scalp will start to naturally sag. This can make the scalp reduction scar wider or more visible.

Another option might be to graft hair follicles onto the FUT scar using the FUE method. The effectiveness of this solution will be determined, in part, by the thickness of the scar. Scar tissue can be thinned using medication, making this more viable in some cases.

Scarred skin does not, however, always hold onto the grafts as well as healthy skin. Your doctor will be able to tell you if this procedure might work for you.

Concealing the scarred area cosmetically is another option. This may be possible by growing your hair over the donor area.

Certain types of scars, such as keloid scars, may be harder to conceal than others. Keloids are raised scars, which grow larger than the original, surgical scar. Keloid scars may continue to grow over months, or even years. Some people are prone to keloid scarring.

Let your doctor know if you have already had a keloid scar before you undergo any type of hair transplant procedure.

There are also procedures that can help to disguise your scar.

Scalp micropigmentation (SMP)

Also called medical hairline tattoo or scalp hair tattooing, this permanent procedure introduces injected pigment directly into the scalp, giving the appearance of thicker hair. Some people opt to use SMP instead of surgical hair transplant procedures.

This procedure can also be used to color in the scarred areas left behind by FUE or FUT. It may take several sessions to complete, depending on the size of the area being injected. The ink color is chosen to match your current hair color. Keep in mind that your hair may go gray or lighten, but the ink will probably not lighten at the same rate.

Some discomfort may be felt during this procedure.

Tricopigmentation (TMP)

TMP is a temporary form of SMP. This procedure provides semi-permanent inking, because it inserts the ink into the top layer of the dermis. The length of time that inking from TMP lasts can vary from clinic to clinic, anywhere from six months to three years.

This procedure may also be physically uncomfortable for some people.

Fraxel laser repair

This treatment may help reduce the appearance of scars and is sometimes used in conjunction with SMP or TMP. The Fraxel laser targets and removes the damaged skin on the surface of the scar.

It also helps stimulate collagen production in the skin’s dermis layer, rejuvenating the elasticity and overall appearance of the skin. This procedure was not designed specifically for hair transplant scar removal, and results may vary from person to person.

For many people, hair transplant surgery can be a safe and effective way to restore the look of a rich head of hair. This can go a long way toward restoring confidence and self-esteem.

However, scarring is an inevitable result of both the FUE and FUT procedures. The FUE procedure may provide a less noticeable type of scarring and may be a better fit for some patients.

Choosing a knowledgeable, experienced surgeon prior to undergoing either type of procedure is paramount.

Some scar removal may also be possible. Covering the scarred area cosmetically or with permanent or temporary tattooing may also be an option.

If scarring makes this procedure a nonstarter for you, talk to your doctor to learn about a body hair transplant (BHT) procedure.