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.
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.
A 2012 Korean study states that injecting PRP into the skin of mice caused hair growth within three weeks. They theorize that PRP is able to prolong the anagen (growth) phase by preventing the dermal papillae cells from undergoing apoptosis (cell death). Dermal papillae are structures under the follicles that provide a connection to the blood supply so that hairs may grow. Instead of undergoing apoptosis, platelet rich plasma therapy seems to cause the dermal papillae cells to undergo an increase in mitotic activity (cell division), which increases the blood flow to the follicle itself. Furthermore, the PRP allows for the growth and regeneration of epithelial cells, which are cells that compose of the lining of a bodily cavity, such as hair follicles.
In addition, the study suggests that PRP can be used after the hair transplant so as to minimize the amount of blood lost as well as to stimulate a quick surgical healing. After the PRP is injected into the scalp, the enriched blood platelets will prevent bleeding and allow the wound to regenerate more quickly.
Lastly, the study claims that more follicular units are able to be successfully extracted when PRP is used during male pattern baldness (MPH) surgery, most likely referring to follicular unit strip surgery (FUSS) or follicular unit extraction (FUE) procedures.
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.
The following treatments may be able to alleviate the pit scars:
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.
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.