I am an 18 year old male in southern California and was born with a condition called "aplasia cutis". I had a round bald spot about 10 cm2 in area at the crown of my head. The skin of the bald spot is scar tissue. There was never any hair in the area. In 2006, I had two plastic surgeries to try to remove the bald spot. Immediately after both surgeries, there was no sign of a hair loss spot, but it soon stretched. Now the bald spot is about the same size, but a different shape. I also have a fairly thin scar down the back of my head where they cut a flap to try to make the scalp reduction easier.
I've had some mixed reviews consulting with surgeons for hair transplant surgery into scar tissue in my scalp. Some are quite optimistic while others are not. How should I proceed?
Hair transplantation is a lot like gardening. Transplant hair into a healthy scalp with good circulation is much like planting crops into fertile soil. As long as the crops aren't damaged during the planting and taken care of they will grow. However, transplanting hair into damaged skin (like scar tissue) may result in poor hair growth much like planting crops into poor soil. Sure, some may grow, but some may not. That said, it is clear that you are getting some mixed input from the hair transplant physicians you've consulted with. I can't imagine how trying a hair transplant would make things worse however; I certainly understand why surgeons would want to proceed with caution, trying out a lesser number of follicular unit grafts to see if they grow. It seems evident that you may be taking a gamble on this. Whether or not you choose to gamble is up to you and your selected surgeon.