Do Some Hair Transplant Surgeons Use Double-Layer Closures Instead of Trichophytic Closures?

This question, asked by a member of our Hair Loss Social Community and Discussion Forums, was answered by Coalition hair transplant surgeon Dr. Cam Simmons:

Does every doctor who knows the trichophytic closure use this? If not, why? Do hair transplant surgeons do double-layer closure if they don’t use the trichophytic closures?

A trichophytic closure is any closure that results in hair growing through the scar. It literally translates to “hair-loving” closure. It can be done with staples or sutures and can have one-layer or two-layers. The tips of the hairs and the surface of the skin can be removed from the upper edge, the lower edge or both and there are many ways to remove that narrow, superficial ledge.

If I had to choose between having a narrow scar with no hair or a wide scar with hair growing through it, I would choose the narrow one. Fortunately we can usually create narrow scars with hair growing through them.

Some patients have medical conditions that predispose them to make wide scars so hair restoration physicians ask about that possibility before planning any surgery.

To prevent wide hair transplant scars in otherwise healthy people, it is most important for the closure not to be tight and to avoid taking too wide a strip of skin away with respect to a given patient’s scalp flexibility. If a doctor takes a narrow strip then pulls the sutures too tight he or she can still make a wide scar. Other techniques that are used to minimize tension on the surface are to either undermine the edges or to use a layer of sutures to hold the deeper layers together so the outside sutures (or staples) have less tension on them. Different doctors find different techniques work best for them. I have tried many techniques when performing hair transplants but find that, in my hands, a 2-layer sutured closure produces narrow scars most consistently. I do a 2-layer closure for all of my hair loss patients.

After the deep layer, I test how easily the edges come together. If they can overlap, I remove a 1 mm ledge from the bottom edge so that the trimmed hairs will grow through the scar. I then suture the surface layer without tension. If the skin edges ever just come together, I recommend against taking more skin away to get a trichophytic closure so we can avoid tension and keep the scar narrow. I do a trichophytic 2-layer closure for almost all of my hair transplant patients. Sometimes, when we are trying to get as much hair as safely possible, we start out hoping to be able to do a trichophytic closure but change to a non-trichophytic closure if needed. It is always an option to revise a narrow non-trichophytic scar and turn it into a narrow trichophytic scar later.

In summary, you don’t have to choose between a trichophytic closure and a double-layer closure. You can have both at the

Dr. Cam Simmons

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David (TakingThePlunge) Forum Co-Moderator and Editorial Assistant for the Hair Restoration Forum and Social Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.

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