Hair transplant into scar tissue is a distinctly different surgical scenario from transplanting into normal scalp, and understanding the differences in candidacy, technique, and expected outcome is essential before pursuing this approach.
Scar tissue has reduced vascularity — fewer blood vessels — compared to normal scalp. Transplanted follicles require a blood supply to survive and establish themselves in their new location. In scar tissue, this blood supply is less reliable, and graft survival rates are typically lower than in normal scalp — sometimes significantly so, depending on the age, type, and extent of the scarring.
The type of scar matters considerably. Atrophic scars — flat, thin scars with some remaining tissue architecture — have better graft survival than hypertrophic or keloid scars, which are raised and fibrous. Very old scars with established vascularisation from the surrounding tissue may support grafts better than recent scars where the vasculature is still immature.
Technical adjustments for scarred tissue include smaller recipient sites, lower packing density, and in some cases staged procedures rather than attempting to restore full density in a single session. The first procedure in scarred tissue is often as much about improving vascularity for subsequent procedures as it is about achieving final density.
Causes of scalp scarring that may be amenable to transplant include: burn scars, traumatic injury scars, surgical scars from previous procedures (including previous strip harvest scars), and stable scarring alopecias. Each requires individual assessment.
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