What is Pitting?

Pitting, also known as “pit scarring”, is a visible deformation along the scalp that can sometimes occur after having a surgical hair restoration procedure. This unwanted outcome is almost always due to surgical error, and can be prevented by choosing a well-qualified hair physician. It is especially prevalent in older hair transplants, where larger punch devices were used.

What are the Symptoms of Pitting?

Pitting is an unmistakable sight, and often causes the patient a fair amount of distress. The scars are especially apparent when the scalp is seen under a powerful light. The hairs themselves look as if they are growing out of a deep divot, or a pit (hence the name). In some cases, the pitting can be so extensive that the patient’s scalp resembles the surface of a golf ball.

What Causes Pitting?

During a hair transplant, the physician makes numerous tiny incisions (called recipient sites) into the scalp to place the follicular units. Pitting usually occurs when the incisions are too deep, and the follicular hair unit is placed too deeply in return. As the wound heals, it becomes unnaturally concave. Although the resulting hairs are healthy, the divots can be noticeable. The opposite of pitting is called cobblestoning – it’s when the hair graft is placed at too shallow of a depth. This gives the recipient site a bumpy, raised appearance.

Are there any Treatments for Pitting?

The following treatments may be able to alleviate the pit scars:

  • Wait and see – it is possible that the scars may even out over time. Most doctors will recommend waiting a number of months for the skin to heal on its own before electing any follow-up procedures.
  • A second transplant – depending on the individual’s situation, a second hair transplant performed at the correct depth may be enough to cover the affected area. Sometimes the hair surgeon may even remove the pitted hairs via FUE and redo the area completely. This is usually a multi-procedure approach.
  • Laser surgery – this procedure carries risks of its own, including additional scarring from the heat of the laser.

Overall, it is very hard to treat this complication. All of the treatments are slow to yield results, and a complete recovery is often not the case. Ultimately, preventative measures are always the best way to deal with pitting. Be sure to carefully select a professional physician with a long history of successful surgeries.

Pitting and Epidermoid Cysts

In some cases of pitting, an epidermoid cyst can form on the scalp. Epidermoid cysts are fleshly nodules that range in size. These special types of cysts will sometimes grow larger over time and may even emit a foul-smelling discharge, though not always. They also may or may not have a large open pore in the center. Fortunately, epidermoid cysts can be removed via minor surgery, though the surgeon must be sure to remove all of the cyst tissue or else they can reoccur. Sometimes, a corticosteroid named triamcinolone is injected into the cyst to reduce redness and inflammation as well as to improve healing. Antibiotics may also be required to prevent any infection.

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