Hair Transplant Scar Revision: Best Suturing Techniques? Subcuticular vs. Fascial Closures

This question, from a member of our hair loss social community and discussion forums, was answered by Coalition hair transplant surgeon Dr. Glenn Charles:

I visited few hair transplant surgeons for a scar revision and two that were recommended on this forum had told me these two different deep suture techniques. So I ask you and maybe a physician can explain this. What is the difference (if there is one) between a subcuticular closure technique and a fascial closure technique? Which technique is better/stronger for a scar from ear to ear?

There are a lot of different suturing techniques that can be used in hair transplantation. Doctors also use different names to describe the same techniques. The “sub Q” technique is generally a buried absorbable suture that is used to approximate the wound margins and bury some of the tension deeper. It is surface tension (tension at the wound edges) that is a major factor in the formation of scar tissue.

The facial closure technique is most likely a very fine suture that is used under minimal tension that helps to leave a smaller scar. A trichophytic closure can be used in combination with both of the above techniques.

I generally use a two layered closure (deeper absorbable suture with no buried knots and a finer surface suture with two knots that needs to be removed 7-12 days post-op) and add the trichophytic technique in certain cases.

Dr. Glenn Charles

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