As more and more people undergo operations on the brain and skull, and more and more people become interested in hair restoration surgery, some special considerations come into play for surgeon and patient alike. Operations on the skull and brain require incisions in the scalp, and these incisions, of course, leave scars. In many cases, a scar that was once more or less hidden by hair becomes increasingly visible as hair is lost. These surgical scars are understandably quite distressing, making people even more self-conscious than usual about going bald. Fortunately, a hair transplant may be an excellent option for camouflaging these scars; however, the presence of one or more large scars can have significant implications with regard to a hair transplant. A skilled and experienced surgeon will know what to do in this circumstance. however, certain things need to be understood by both the patient and the hair transplant surgeon before making a decision to proceed.
- Transplanted hair tends not to grow as well in scar tissue—especially if that scar tissue is the result of radiation (more about that later); it is not unusual for two or three sessions to be required for maximum coverage.
- Scars on the scalp, whether the result of trauma or surgery, can affect the blood flow to the scalp. This, in turn, may impact the harvesting of donor follicles, the creation of recipient sites, or both.
- Scars may also affect the scalp’s elasticity, making it necessary to perform donor harvesting via FUE incisions as opposed to a linear (FUT) incision.
There are three special circumstances when scars on the scalp may mean that someone is not a good candidate for a hair transplant.
- Foreign (non-biological) material used to repair the skull after brain
or skull surgery (craniotomy)
- Presence of a ventriculoperitoneal shunt for hydrocephalus (“water
on the brain”, a meaningless term)
- Prior radiation treatment
Sometimes after surgery on the skull or brain, it is necessary to secure the bone fragment(s) with cement and/or metallic mesh and/or wire and/or plates and screws. Infection after a hair transplant is rare, but if this were to happen in the case of someone with foreign material in the skull, it could necessitate an operation to remove the foreign material. Typically, this would require a lengthy course of treatment with antibiotics and a second operation to repair the skull. The patient’s neurosurgeon should be consulted prior to the decision to proceed with a hair transplant.
Whether a congenital condition or acquired later in life, enlarged ventricles (the cavities in the brain where spinal fluid is manufactured and circulated) may be treated by implanting a shunt. The shunt provides an outlet for the excess spinal fluid by diverting it (usually) into the abdominal cavity by means of a catheter connected to a valve and tubing. It is essential to avoid puncturing any portion of the shunt during a hair transplant, which means that hair cannot be directly transplanted directly over any portion of the shunt as it passes beneath the scalp. The surgeon and patient also need to be aware that, although highly unlikely, an infection in the scalp after surgery could infect the shunt and require its removal. The patient’s neurosurgeon should be consulted prior to the decision to proceed with a hair transplant.
Radiation treatment is often recommended for various tumors of the scalp, skull, and brain. Up until about 1960, radiation was also used to treat a very common fungal scalp infection known as ringworm (dermatophytosis; tinea capita). Regardless of the reason for this type of treatment, permanent loss of hair in the area is often an unavoidable consequence. Hair transplantation can restore a more normal appearance in carefully selected patients; however, prior radiation, which results in permanent damage to the scalp and blood vessels in the area, poses a special set of challenges with regard to healing and the survival and growth of the transplanted hair. Both patient and surgeon need to be aware of this.
It is always important to choose an experienced, well-credentialed surgeon—preferably one whose practice consists entirely or mostly of hair restoration surgery—to perform your hair transplant. But it is particularly important in the case of prior surgery on the skull or brain. When in doubt, consultation with the patient’s neurosurgeon is advisable.