Scarring, be it through burns, previous surgical scarring, and chemical all contain different problems when thinking of placing hair grafts into the area. The position on the scalp, depth, thinness of the scarring, surface area to cover must all be considered.
A concern can be the vascular properties in the scar tissue area; in general there is enough blood supply to sustain the growth of a hair graft as long as precautions are taken during the procedure; not placing too high a density, the depth of the incisions. The depth of the incisions will need to vary dependent on the scar tissue thickness; thick and or tough scar tissue can require a deeper incision to ensure an adequate blood supply is reached.
Thinner, atrophic scar tissue creates other concerns, the depth of the incision in the tissue may not be enough to sustain the graft survival; in this case a good degree of anatomy is required and medical proficiency to be able to place the slit at such an angle that it increases the length of the slit but at minimal depth.
Graft placement density; it is considered to increase the graft survival rate a lower than average density is placed over the surface area to be treated, and if required at a later date the density can then be increased. The time between sessions also is a factor, although the skin surface may have looked to have healed over 8 months it is better to postpone any further procedures for as long as possible, certainly 12 months.
In some cases rather than place grafts into the scarring it would be possible to excise the strip; this is determined by the size, shape and skin laxity and a high proficiency in closure techniques. If this is removed it may be possible to also harvest grafts from the removed scar tissue that can be used in and around the recipient area.
Repairing an old strip scar by englobing with the new via FUT one has the advantage of still leaving a single line. FUE can also be used to camouflage a scarred area; as FUE has a wider extraction area the grafts can be taken from virgin areas and then placed into the tissue.
The individual should be aware of the difficulties placing into scar tissue presents and on many occasions be prepared for the “repair” to be over multiple procedures; do not try to rush this as it may complicate healing and the yield that can be achieved.