Linear Morphea en Coup de Sabre (LM ECDS)

Case Presentation

Before Surgery

History: A 15-year-old female presented to our clinic with a medical history that involved severe burns during childhood to the scalp and had undergone previous skin grafting to the affected burned scalp area.

I would like to emphasize that what is most interesting about this case is performing hair restoration surgery to transplanted skin graft secondary to burns.

Many cases have been performed previously on scars due to burns; but, in my research, I could not find any publications documenting a similar case to the one above where hair was transplanted to transplanted tissue. Therefore, I conclude this case to be unique and informative as one of the first cases performed successfully


Marwan Saifi, MD, FISHRS



Plan and Procedures: We planned two hair transplantation procedures for this case, using the FUT technique with a total of 1,910 follicular-unit grafts.

During the first procedure, we used 510 follicular units for the temporal area.

The second procedure took place one year later, and 1,400 follicular-unit grafts were transplanted to the hairline and to the right temple.

Immediately Post-op first session (510 grafts)
Immediately post-op second procedure (1,400 grafts)

Discussion: The two challenging factors we had to be aware of and to deal with were as follows:

14 months after the first session and immediately post-op the second session.
  • The hair transplantation was performed not only on scarred scalp secondary to burns, which is usually not only considered as a compromised area in terms of adequate blood supply but also the transplanted skin graft that make things even more challenging.
  • The balance between the technical aspect of placing the new grafts with a certain depth and density into this rather compromised area and, of course, the emphasis on the final aesthetic successful outcome, which created a natural-looking hairline, especially for a young maturing female.
Before and After 2 Sessions (1,910 Grafts)

The two surgeries were performed pro bono, and the patient was very pleased with her new look and regained her confidence and self-esteem.

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