Hair Transplant Scars: What to Expect and How They're Minimised

Every hair transplant leaves scarring. Any clinic telling you otherwise is not being straight with you.

What differs between the techniques is the type of scarring, where it sits, and how visible it is at different hair lengths. That is a real difference and worth understanding, because for many people it is the factor that decides which technique they choose.

This page sets out what each method leaves behind and what genuinely affects how noticeable it ends up.

Why there is scarring at all

Both techniques involve removing tissue from the donor area at the back and sides of the scalp. Skin that is cut heals by forming scar tissue. There is no version of the procedure that avoids this.

The recipient area, where grafts are placed, also involves tiny incisions. These are small enough that they generally heal without noticeable marking once hair is growing through them, which is why discussion of transplant scarring focuses on the donor area.

What FUE leaves

Follicular unit extraction removes follicular units individually using a fine punch, typically under a millimetre across.

Each extraction leaves a small circular scar. Individually they are minute. Collectively there may be hundreds or thousands of them distributed across the donor region, appearing as small pale dots once healed.

How visible this ends up depends almost entirely on two things:

How densely the extractions were spaced. Over-harvesting a small area produces visible thinning and makes the dots more apparent. A surgeon working across a wider area at lower density leaves a much less noticeable donor region.

How short you wear your hair. At moderate length the dots are covered. At a grade two or three they are generally not obvious. Shaved or at a grade one, they can become apparent as a faintly stippled or moth-eaten appearance across the back of the head.

The common assumption that FUE is the choice for people who shave their heads is only partly right. It is better than a strip scar for very short hair, but it is not invisible at a shave.

What FUT leaves

Follicular unit transplantation removes a narrow horizontal strip of scalp, and the wound is then closed.

This leaves a single linear scar running across the back of the head, usually somewhere between the occipital region and the nape depending on where the strip was taken.

A well-executed closure produces a fine line. Hair growing above it falls over the scar and conceals it at almost any length beyond very short. At moderate length it is generally not detectable without deliberately parting the hair.

Where it becomes visible is at a very short clip or shaved. A linear scar at a grade one is more conspicuous than dot scarring at the same length, because the eye picks up a continuous line more readily than scattered points.

Factors that affect the outcome: scalp laxity, closure technique, whether the strip width was appropriate to the available laxity, individual healing, and post-operative care.

The honest comparison

If you wear or expect to wear your hair very short, FUE generally suits better.

If you keep your hair at moderate length or longer, FUT's single line is easily concealed and the technique's other characteristics, particularly higher graft yield per session, become the more relevant consideration.

If you are undecided about future hair length, that is worth discussing at consultation, because it is one of the few factors that is difficult to change your mind about later.

See FUE vs FUT.

What affects how a scar heals

Several factors are within your control or your surgeon's.

Discussing your hair length preference beforehand. This should inform the technique choice and, with a strip, where the incision is placed. Raise it before surgery, not after.

Appropriate strip width. Taking a wider strip than the scalp's laxity allows creates tension on the closure, and tension is the main driver of a stretched or widened scar.

Trichophytic closure. A technique used with strip harvesting where the wound edges are trimmed so that hair grows through the scar line rather than stopping at it. This can make the line considerably harder to detect. Whether it is appropriate depends on the individual case.

Following post-operative instructions. Keeping the area clean, avoiding tension on the closure, not bending or lifting heavily in the early period, and completing any prescribed course of antibiotics. Infection or wound breakdown is the most reliable way to end up with a worse scar than necessary.

Sun protection. Healing skin is more prone to pigmentation change. Keeping the area out of direct sun while it heals is worth the effort.

Not smoking. Smoking impairs the microcirculation that wound healing depends on.

See hair transplant aftercare.

Options for existing scars

If you already have a donor scar from previous surgery, whether performed by us or elsewhere, there are approaches worth discussing. Whether any is appropriate depends on the scar itself.

Scalp micropigmentation is a technique that deposits pigment into the scalp to reduce the contrast between scar tissue and surrounding hair. It can work well for both linear scars and areas of dot scarring where the pale marks are the visible feature. It suits flat scars better than raised ones, and it is a permanent procedure, which means the quality of the work matters a great deal.

Grafting into the scar is possible in some cases, placing follicular units directly into scar tissue to break up the line. Success is variable because scar tissue has a poorer blood supply than normal scalp, so graft survival is less predictable.

Steroid injection may be considered for raised or hypertrophic scars, with the aim of flattening them. It is not appropriate for all scar types, has its own side effects, and tends to work better on newer scars than established ones.

Scar revision surgery may be an option for a widened scar, excising and re-closing under less tension.

Which of these is suitable, and whether any of them is offered, is a matter for consultation. Do not assume from this list that a particular approach is available or appropriate in your case.

Why we would rather be direct about this

Two reasons.

The first is that expectations set honestly before surgery are easier to live with than surprises afterwards. Someone who understood they would have dot scarring and finds dot scarring is in a different position to someone who was told the procedure was scarless.

The second is that scarring is one of the things a patient can reasonably weigh in choosing a technique, and they cannot weigh it if the information they are given is marketing rather than fact.

What to ask at your consultation

• Which technique do you recommend for me, and what will the scarring look like?
• How short can I wear my hair afterwards without it being noticeable?
• Where exactly will the donor harvesting be taken from?
• If a strip, will trichophytic closure be used, and why or why not?
• What is your approach to donor density to avoid over-harvesting?
• What happens if the scar heals worse than expected?

See questions to ask at your consultation.

Before you decide

Scarring is one of several risks associated with hair transplant surgery. Others include bleeding, infection, swelling, altered sensation, folliculitis, cyst formation and poor graft survival. Outcomes vary between individuals.

Read our risks and complications page in full before making a decision.

A GP referral is required before a cosmetic surgery consultation. Book a consultation at our Bankstown clinic.

Related reading: hair transplant recovery: the first two weeks, hair transplant surgery in Sydney: the complete guide.