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Q: I have read that some doctors perform something called a trichophytic closure. What is this? — M.S. ~ Thornwood, N.Y.

A: Trichophytic closure is a way to minimize the appearance of the donor scar in a hair transplant using a strip incision. The technique provides improved camouflage of a linear donor scar in Follicular Unit Transplantation (FUT). Normally, in FUT, the surrounding hair easily covers the scar. For some patients with very short hairstyles, the resulting donor scar may be visible. With the trichophytic closure technique, Dr. Bernstein trims one of the wound edges (upper or lower), allowing the edges to overlap each other and the hair to grow directly through the donor scar. This can improve the appearance of the donor area in patients who wear their hair very short.

The trichophytic donor closure can be used on patients who have had previous hair transplant procedures and are looking for improvement in the camouflage of their donor scar. It is particularly useful in hair transplant repair or corrective work. Trichophytic closures work best with sutured incisions. Stapled closures have their own advantages. The doctor will recommend which type is best in your case.

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Q: Could you tell me in case there is an infection at the donor area following a hair transplant, will it prevent the hair to grow after healing if the donor area closed by Trichophytic Closure? What are the problems which may the infection cause? — S.S., Park Slope, NY

A: Infection may cause the donor incision to heal more slowly or with a widened scar after a hair transplant. It may affect any closure, Trichophytic or not.

The risk of infection after a hair restoration procedure is made worse by a tight closure, but not necessarily a Trichophytic closure, unless too much skin was removed at the edges leaving the dermis (deeper part of the skin) exposed.

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Summary of “Trichophytic Closure of the Donor Area” which appeared in Hair Transplant Forum International July/August 2005 by Mario Marzola, MBBS Norwood Australia

When hair transplant surgeons meticulously close the edges of a donor wound, they generally end up with a fine, linear scar that is approximately 1-2mm in width. Sometimes, the scar can be a bit wider and every once in a while, when the person’s connective tissue is weak, or the edges of the scar are closed too roughly or have too much tension, the scar can be a cosmetic problem. The educated patient, who has expectations of a thin scar, or the patient who is likely to wear his hair very short, hopes that their hair transplant doctor can produce scars that are practically invisible.

A Trichophytic closure is a way of improving the linear donor scars of hair transplant patients. A Trichophytic incision in hair transplantation involves trimming off the upper edge of the incision and then closing the wound in such a way the hair near the edge can grow through the scar. This has the potential to produce a scar that is virtually undetectable.

To perform a comparison study, Dr. Marzola conducted a trial using 26 consecutive patients. Each hair transplant patient had one side of their scar closed trichophytically (i.e., with the top edge removed) and the other side closed with the edge left as is.

At seven months, the study proved to Dr. Marzola that the trichophytic closure was significantly better than the traditional closure in leaving a hair transplant scar that was better camouflaged and thus less visible.

The principles of good surgical practice apply in hair transplantation as much as in any other area of surgery. Start out small, be careful and conservative, treat the tissues with respect, and above all else, avoid creating too much tension on the wound.

Summarized by Bernstein Medical, P.C.

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