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.

Another benefit of graft excision is that we can remove the underlying scar tissue and improve the appearance of the skin.

Finally, graft excision sites are sutured closed so they heal with an imperceptible scar. FUE sites are left open and the white scars at the hairline can be visible.

A: Joe Biden — former Senator from Delaware and now the Vice President of the United States — apparently had a hair transplant many years ago using the older hair restoration techniques. This included not only transplanting hair in large plugs (corn rows), but using them to create a broad frontal hairline; a design that generally does not look natural as a person ages.

Also, the older grafts were transplanted in a vertical orientation giving a sprout-like, unnatural appearance.

The use of large plugs and the inefficiencies of the older procedures waste a considerable amount of donor hair, leaving Senator Biden with a dense rim of hair in the front part of his scalp and little coverage behind that.

The repair strategy would consist of removing the larger plugs, microscopically dividing them into smaller grafts (individual follicular units of 1 to 3 hairs each), and then placing the smaller grafts in a more forward direction and in a more natural distribution. This involves using the 1-hair units to soften the frontal hair line and the 2- and 3-hair units to extend the transplant further back on the scalp.

In addition to the hair transplant repair, Biden received significant cosmetic improvement from the natural graying of his hair over the years, as this tends to make the hair appear fuller and any irregularities less noticeable.

A: Although dermabrasion can flatten elevated edges, it will not eliminate the round, white circular scars that results 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 will eliminate the tell-tale circular marks of the older hair restoration procedures.

A: The hair from the excised grafts is always re-implanted.

The grafts that are removed are dissected into individual follicular units and then placed back in the recipient area in a more natural distribution and angle. See this patient’s hair transplant repair in the Hair Transplant Repair Photo Gallery on the Bernstein Medical – Center for Hair Restoration website.

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.