What is Cobblestoning?

Cobblestoning is a specific type of scarring that can occur when transplanting hair grafts into the recipient area of the patient’s scalp. Cobblestone scars are patches of tissue that are raised in such a way that they resemble the cobblestone side streets of yesteryear. Cobblestone scars are typically very prominent and noticeable complications, and can potentially botch the entire hair transplant.

What Causes Cobblestoning to Happen?

No matter what type of hair transplant procedure – be it follicular unit extractions (FUE), follicular unit strip surgery (FUSS), or otherwise – the physician must transplant multiple follicular units from one area of the body (the donor zone) onto the patient’s scalp (the recipient site). With this in mind, there are two ways that cobblestoning can occur:

  • The first way is if the physician removes too much tissue from the donor zone. When the hair grafts are placed into the recipient site, the excess tissue heals incorrectly. This results a raised, bumpy appearance.
  • The second way is if the physician does not place the hair graft deep enough into the recipient site. The hair graft is placed too high, so the surrounding tissue raises as the incision heals. This elevated healing causes bump scars to form as a result.

Does Cobblestoning Happen for Every Hair Transplant Procedure?

No, it does not typically happen at all. Cobblestoning is almost always a direct result of surgical error, meaning that it is a rare complication that is not a common part of the procedure by any means. This unwanted scarring can be avoided by choosing an experienced hair doctor that knows exactly how deep to insert the follicular units into the scalp, and has the patience to perform the task correctly. When selecting a hair transplant surgeon, always be sure to obtain their credentials and talk to previous clients to receive firsthand testimony if possible. Be wary of any hair doctor that makes unrealistic promises, does not have a fully-trained team for assistance, or has little experience with previous surgeries. This will prevent any unnecessary scarring.

Is Cobblestoning Permanent?

The prominence and permanence of cobblestoning is determined on a case-by-case basis. There are many different factors to take into consideration such as the patient’s age, if previous transplants have occurred, the size and scope of the operation, and the exact depth of the transplanted follicles in question. Most hair doctors would recommend waiting a number of months to see if the scarring resides on its own.

What are the Treatments for Cobblestoning?

If your cobblestone scars do not heal on their own, treatment is very difficult – very few cases fully eliminate the scarring because scarred tissue does not heal in the same way as healthy tissue. With that said, the available treatments are:

  • A second hair transplant – sometimes the cobblestoning can be covered by transplanting new follicular units at the correct depth. Once the new hairs grow long enough, they can conceal the damage.
  • Laser surgery – while this may sometimes smooth out the skin, laser surgeries can also cause additional scarring of their own.
  • Scalp micropigmentation – a special dye and a super-thin needle can sometimes reduce the appearance of minor cobblestoning. One must be very careful with this option as SMP clinics are unregulated.

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