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What is Hair Transplant Ridging?

hair transplant ridging
Note the raised skin in front of and inside the hairline.

Ridging is an unintentional complication that can arise over the course of a traditional hair transplant if the doctor is overly ambitious or simply lacks caution. It is where the “recipient site” – or the area where hair has been transplanted – forms an unsightly ridgeline of raised scar tissue. This most commonly occurs in the hairline area, and can extend across the entire anterior recipient zone.

 

What Causes Ridging?

Ridging typically occurs on behalf of unexperienced hair physicians who think they can easily “dense pack” a small area of the recipient scalp. Ordinarily, hair grafts are exactly the same size as the recipient sites that they are inserted into. However, if the hair graft contains an excess amount of tissue (due to surgical error), the transplanted follicular units will not heal evenly. When the grafts are too bulky, the excess tissue fuses with the scalp and pushes upwards. This is what creates the scarring as well as the raised appearance (not to be mistaken with cobblestoning).

 

Ridging and Hair Plugs

Older hair transplant methods used to cause ridging much more easily. When the punch devices used to remove donor hair were up to 4-milimeters in diameter, it was much harder (if not nearly impossible) to keep excess tissue off of the hair grafts. This is what created the “doll’s hair” effect, which is where the hair of the recipient scalp looked as if it was placed in patchy rows.

Modern technology has drastically culled this undesirable outcome by reducing the size of diameter of the punch devices to 1-millimeter or less (via FUE), as well as by using smaller incision sites. The advent of FUSS also played a big role in reducing the number of cases resulting in ridging. Therefore, ridging nowadays is almost always the sign of a new hair physician at work, or one that clings to the old ways of surgical hair restoration.

Is Ridging Permanent?

No, not always. If you suspect your scalp is displaying this trait, most doctors will tell you to wait a number of months and see if the scarring subsides. Sometimes, this side effect resolves itself on its own without further treatment.

What are the Treatments for Ridging?

Unfortunately, the methods of treatment are complicated, carry their own risks, and often do not work. The odds of a 100% recovery using these three treatments is highly unlikely, though they may help to make it less noticeable. The three most current ways to treat this type of scarring are:

  • Laser surgery – while a laser treatment may be able to reduce the swelling and bumpy texture, the heat from the laser can cause a form of scarring all of its own as well as hair loss.
  • Endoscopic scar removal – under a special operating scope, the physician makes two or more small incisions and removes the scar tissue from beneath the scalp tissue.
  • Kenalog injections – some claim that a steroid called Kenalog can reduce the scarring over time. Injecting this steroid into the ridgeline can cause a breakdown of fat, which can cause the graft to settle back into the skin. If the excess tissue was not fatty tissue, this treatment will not help much. This treatment can actually worsen the symptoms by sometimes causing discoloration, irregular atrophy (which further misshapes the scalp), and additional hair loss.

 

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