Is it appropriate to call hair transplant repair a “re-do” of a hair transplant? This question is the basis of a discussion Dr. Bernstein had with a UK-based hair restoration physician. Read on for the full exchange.
Q: I had a hair transplant in 2004 of mostly plugs. The plugs are in an angle which doesn’t really look natural, far from it. I have lost a lot more hair since I did the hair restoration procedure. I regret ever doing a hair transplant. I prefer to reverse the surgery. I have read a lot about repair work on the net, and I have come to the conclusion that using FUE to take the plugs out, and put them back into the scar might be an option, but it may just make it worse on top. Also I can do electrolysis to remove the plugs, might be better because the possibility of scarring is smaller, and as I already have a lot.
A: If you had plugs, then a graft excision with suturing will generally give a better result than FUE, since a graft excision removes the underling scar tissue as well as the plug. FUE only removes the follicles, but leaves the underlying scar tissue. In addition, the shape of the follicles in scar tissue is often distorted, making extraction difficult and leading to more transaction (damage to follicles).
Q: I would like to have the donor area from an old hair transplant repaired so it does not show the scar when I cut my hair shorter. What are my options?
A: Widened scars can be improved in two ways: they can be re-excised to make the scar finer, or hair can be placed into the scar to make it less visible.
Q: I was wondering if it was possible to use Follicular Unit Extraction (FUE) on the old plugs instead of graft excision.
A: Graft excision generally works better than FUE in removing old plugs and mini-grafts. In these grafts, the hair is not aligned due to the scar tissue that forms from the large recipient sites. Because the hair direction is altered from the scar tissue, there is much more damage when the grafts are removed with FUE.
Q: What’s the best way to camouflage a scar left behind from a scalp reduction that I had in 2001? I am currently wearing DermMatch to cover the area, but the hair parts like the “Red Sea” on top around the scar so the makeup does not look so good. I would like to fill in the area with hair but I am not sure if a hair transplant will grow into scar tissue.
A: Hair will grow in the scar but, as you allude to, the problem is often the abnormal hair direction rather than the scar itself.
Besides adding hair to the scar, if one transplants hair adjacent to the scar in a direction that causes it to lie over the scarred area, the visual affect of the “Red Sea” effect can be lessened.
Q: Can dermabrasion help eliminate the circular edges of raised plug grafts caused by old hair transplants? Is this similar to the suturing and excision look?
A: Although dermabrasion can flatten elevated edges, it will not eliminate the round, white, circular scars that result from old punch graft hair transplants. The scarring in these procedures goes all the way through the dermis to the fat. Dermabrasion can only go down to the upper part of the dermis without causing further scarring.
Graft excision with suturing removes the plug as well as the underlying scar and eliminates the tell-tale circular marks of the older hair restoration procedures.
Q: I had several prior hair transplants that left me with a pluggy look, I was hoping to re-utilize the removed hair and re-implant it, perhaps in the front as a new, more recessed hairline. It is possible? A: The hair from the excised grafts is always re-implanted. The grafts that are removed are dissected […]
Q: Can I have plugs removed by FUE (follicular unit extraction) which would probably result in less scarring – but would probably take more time and be more expensive.
A: Follicular units in a plug are already compressed and scarred down. Trying to remove them individually will result in a worse cosmetic outcome as the underlying scar tissue will not be removed.
In addition, extraction of individual follicular units from scar tissue is more likely to cause damage to the hair follicles. Removing the entire graft is generally better for these reasons.
Q: I had an old hair transplant and I’m hoping to remove these plugs and of course am concerned how much additional scarring would result. I’m wondering if removal of the total hair plugs (which are perhaps 2 or 3 mm in diameter) by coring them out would result in a lot of additional scarring. […]
Q: I recently had a hair transplant procedure done in Florida and it has been about 8 months. When I am in direct overhead light and when sunlight is behind me, I see many tiny holes that are not visible under normal light. I know these are where they placed the transplanted hair but need to know if there is a way to remove these tiny holes. I am obviously not getting any answers from the doctor that performed the hair restoration. I am wondering if dermal fillers, dermabrasion, or laser treatment would work to fix this and if so, do you offer these treatments?
A: This condition is often referred to as pitting and occurs when grafts are placed below the surface of the skin. It is more common with large grafts rather than small ones and is almost never seen in Follicular Unit Transplantation (FUT).
In general, visible holes can result from mini-micrografting hair transplant procedures where the grafts (and thus the recipient sites needed to hold them) are larger than approximately 1.2mm. Recipients sites smaller than 1.2 rarely leave any mark. In follicular unit hair transplant procedures, the grafts will fit into sites smaller than 1.2mm so surface changes are generally not seen (even if the grafts are not placed flush with the skin).
Q: I was looking at your prices for repair work and you mentioned that you charge $85 per graft removed. I had a hair transplant and received follicular unit grafts (one-hair follicles) but I think my hair loss is going to continue so I might in the future want to remove them. Am I interpreting your fees correctly, or does this price apply to people who have had the plug like transplants?
A: The fee applies to the removal of plugs and includes graft (plug) excision, suturing of the site, dissection of the plug into individual follicular units and re-implantation.
Generally the best way to reverse a procedure of follicular unit transplantation is with laser hair removal. This is particularly true if the hair restoration was done properly and the underlying skin is normal. Alexandrite and diode lasers are the best for hair removal. Typically, there are too many small grafts in FUT procedures to make excision practical.
Q: Hi Dr. Bernstein. My question is: if you have a surgical scar or incision on your head that is relatively large, is it possible to do a hair transplant into this scar? A: Hair can grow well in a scar. Since scar tissue generally has a somewhat lower blood supply than normal tissue, we […]
Q: After a bad hair transplant, can you use lasers or electrolysis to remove the transplanted hair?
A: Electrolysis does not work well, because the follicular anatomy is distorted and it is too difficult to insert the needle in the right position.
Lasers will work as well with transplanted hair as it will with normal hair but, in either case, it takes multiple treatments.
Q: When performing a repair on an old, pluggy hair transplant, why can’t all the grafts be removed at once? A: We always try to do this, but it is not always possible. If the large grafts (plugs) are spaced too close together, suturing one will put tension on an adjacent graft and make it […]