Benefits of "Artistic Hair Simulation on African American"|Scalp Aesthetics Treatment

Natural Results for Donor Scar Camouflage Using Tattooing in African American Patients

By William D. Yates, MD, FACS, Dipolomat ABHRS, Chicago, IL  60611 
Pho: 312-391-0419


            More and more African American patients are completing hair transplantation procedures.  In my experience, many patients post operatively will opt to style their hair uniformly closely cropped.  With such short hair, even the best of donor closures will appear to be unacceptably visible by these discerning patients.  During the pre operative consult, all pertinent issues are discussed including scar visibility when wearing the hair very closely cut.  Additionally, the optimal hair style/length to cover and conceal the donor scar is clearly illustrated to the patient before surgery is performed or even considered.  Despite the detailed discussion on scar visibility with very short hair, several patients will eventually opt for this look.  Some of these patients will not be bothered by the appearance of the scar even though it will be clearly visible to others.  The majority of patients, however, will voice some degree of displeasure with the scar’s appearance even after the elaborate pre operative admonishing.

            I have found that these patients displeasure with the donor area scar will taint the noteworthy results of the recipient area.  The donor area is just as important as the recipient area to achieve maximum patient satisfaction.

            To improve upon the scar quality/visibility, I have personally closed several African American patients with the trichopytic technique.  The benefits of this specialized closure still does not allow for hiding of the donor scar when the hair is worn very close to the scalp.

            Several strategies are available to camouflage and/or improve the appearance of the donor scar.  Surgical options include; scar revision and grafting hair in to the scar.  These options appear to work well but still allow the scar to be visible with closely cropped hair.  Non surgical options include makeup, topic like products and now expert tattooing of the scar area.

            In my opinion, tattooing allows for natural, immediate results and is virtually maintenance free. Of course the tattoo is permanent and must be done by a tattoo artist familiar with the correct technique, and the variability associated with donor scars.  The tattoo offers the benefit of no daily maintenance and daily mess that is experienced with makeup and different camouflage techniques.

            I have included several before and after photographs of patients completing the tattoo process.  All the donor tattoos have been done by Cheryl Rosenblum in Atlanta.  She is a specialist in this technique and has tattooed several African American donor scars.

(2nd photo – the crown has also been tattooed

             The process of tattooing commonly takes between one and three hours, and may require a touchup yearly to keep the tattoo crisp.  Scars normally do not hold ink as well as healthy tissue so additional sessions are usually required.  The tattoo strokes are done to match the pattern of hair growth.  The proper ink and color must be used to match the hair color and prevent fading to an unacceptable color.  Complications from the tattoo are minimal and of course results are immediate. If not done properly, the tattoo ink can migrate and appear to have a bluish or greenish hue over time further necessitating the need for an experienced tattoo artist.

            It is well known that African Americans have a higher incidence of keloid formation in the donor region.  1, 2 Keloid scars and hypertrophic scars should be pre treated before the tattooing process to allow the scar to flatten as much as possible.  Patients with very wide scars can also be completed with very satisfactory results (see photos). 

(wide scar before and after)


The area tattooed can still be used for hair transplantation for the future.  If this area is utilized in transplantation, the excess pigmented skin would be trimmed away from the follicle and then the follicle implanted as usual.

            I must also mention the follicular unit extraction technique is also a good technique to allow African American patients to wear the hair closely cropped without the traditional donor area scar.  I have employed this technique in African American patients and patient’s satisfaction has been good.

            I believe that donor scar tattooing is an excellent method for permanently camouflaging the donor scar, which allows African American patients to wear short hair styles.  Expert tattooing appears to give cosmetically superior results to surgical revision or placing hair in the scar.  Tattooing also allows maintenance free care unlike the makeup solutions that are applied.

            As in any discipline, the results associated with tattooing the scar are operator dependent.  At present, I have only found one center in the United States that specializes in this discipline located in Atlanta, Georgia.  (Artistic Hair Loss Solutions)



1.  Callendar, V.D., McMichael, A.J., and Cohen, G.F. Medical and surgical therapies for alopecias in Black women.  Derm Therapy, 204; 17:164-178.

2.  Cooley, J. Hair transplantation in Blacks.  In:  D. Stough and R. Haber (Eds.), Hair Transplantation.  Elsevier Saunders, 2006.  P. 143.

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