Any incision through the skin, whether by machine or by hand, that enters the skin beyond a superficial depth, causes a scar to form. There is also no machine capable of performing all aspects of hair restoration surgery. There is only technology that can assist an expertly trained surgeon performing hair restoration surgery.
We constantly hear of cases where hair surgery patients were operated on and harmed by non-doctors. Do not let yourself be lured by false and exaggerated hair transplant advertising claims, such as “scarless surgery” or that hair restoration surgery can be completely performed by a machine.
I have been performing hair transplants since 1994, both the strip excision technique and the follicular unit extraction punch technique. It is vitally important that every patient is fully informed of the pros and cons of the different techniques (which affects hair survival, donor bank, scars, etc.) in order for him/her to make an educated decision.
The strip excision hair transplant technique removes hair from the sides and the back of the scalp in order to transplant it to the balding area. The benefit of the strip excision technique is that it minimizes the surface area of donor tissue being exposed to dissection, minimizes the amount of hair being transected, which in turn maximizes the survival of the transplanted grafts. This technique should leave a very fine line of a scar in the donor area that even a short haircut should easily hide.
The nature of the scar also depends upon the surgical technique of the physician. The wider the strip taken, the more likely there will be tension on the suture line creating a spread scar. Many of the mega-session clinics remove very wide strips, which create the “bad donor scars” easily seen. The width of the donor strip should be thin in order to create a fine line of a scar, barely visible to the eye.
Follicular unit extraction (FUE) punches out a 1mm plug and then the hole in the donor area heals on tis own, over the next week. The advantage of the FUE technique over the strip excision technique is the patient is not left with a fine linear scar in the donor area. The disadvantage of the FUE technique is that it drastically increases the surface area of donor hair being exposed to a blind excision technique, which leads to increased damage to the good hair follicles and ultimately wastes the very limited donor hair supply. This technique permanently removes the good genetic hair and replaces it with very tiny circular scars.
It is imperative that, as hair transplant surgeons, we do everything in our power to use only those techniques and technologies that ensure the highest percent of grafts survive and grow in a person with limited hair donor supply, with the best natural looking results.