Thank you for your consult at DoctorSpring.com.
The scar from the FUT is very prominent at this stage as is evident from the picture. The picture also shows the surrounding areas both above and below the scar to be devoid of hair. Let us analyze the possible cause and line of treatment.
You have mentioned that you have used Fractional CO2 and PRP for scar management. However, both of these modalities are usually not associated with alopecia. Therefore, the possible cause of alopecia was probably at the time of FUT when the adjacent follicles were damaged during the harvesting process or too much traction was applied to the skin flaps which has resulted in a slow alopecia over the adjacent areas (the areas most subjected to tension with resultant low vascularity).
Whatever might be the cause, the area now looks quite unsightly and should be addressed in a proper way. I would say that primary excision of the area of the alopecia along with the scar is the best provided the adjacent skin has now developed good elasticity. This would result in a thin scar which can be concealed by growth of the adjacent hair.
Another option is FUE from the surrounding areas to cover up the area of alopecia. If adequate follicles can be transferred then the scar can be successfully concealed using FUE only. This would be less invasive compared to the previous outlined method but is more expensive and requires greater technical expertise.
If you are opting for FUE then the scar can be dealt with using steroid injections and a variety of silicone containing creams to produce an improved aesthetic appearance.
Hope this helps, please feel free to discuss further.
Dr. Souvik Adhikari, MBBS, MS, MCh (Plastic Surgery)
Assistant Professor of Plastic Surgery
Institute of Post Graduate Medical Education & Research, Kolkata.
Consultant Aesthetic, Plastic & Reconstructive Surgeon.
Patient replied :
Hi doctor , thank you for the reply . You are right that the hair fell from FUT , that was 13 years ago and left less hair above and down the scar , but today after the fractional it fell again , there was less hair before ,but today even more . This has nothing to do with the FUT this time . after the PRP i felt traction , the doctor was like pulling the scar .
Fractional laser generates quite high temperatures and conduction of this heat can sometimes result in alopecia although in most cases it acts as a stimulus for hair growth. Fractional CO2 with PRP is usually used for scar management elsewhere but if you ask me I would not use it for a FUT scar.
However, if there are intact follicles then the hair would grow back but if these have been destroyed then you might have to go in for either of the treatment protocols I have outlined.
Patient replied :
Hi doctor , last question , how will i know if the follicles are destroyed or not ? Should i just wait . If so , how long ? Thank you
If you are seen by a hair transplant surgeon he can tell you if the follicles are still there otherwise wait for around 3-4 months to see if any new hairs erupt at that site.