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Hair Transplant

Answers to frequently asked questions about hair transplant repair.

Hair Restoration Answers

What is the Difference Between “Hair Transplant Reversal” and “Hair Transplant Repair”?

Q: I have read a lot on the forums about hair transplant reversal and hair transplant repairs. Are they the same thing, if not, what is the difference? Can you reverse a hair transplant? — K.J. ~ Park Slope, N.Y.

A: A “hair transplant repair” refers to techniques that improve the appearance of a poorly executed procedure or one performed with outdated methods. A “hair transplant reversal” refers to techniques that enable the individual to appear as if no hair restoration surgery had been performed. Although the techniques in attempting to perform a repair or a reversal may be similar, the ultimate goals of each are quite different. It is important to understand that although significant improvement can often be achieved; perfect repairs and/or full reversals are generally not possible.

The main reasons for seeking a repair include; large grafts transplanted to the frontal hairline giving an unnatural, “pluggy” appearance, a frontal hairline placed too far forward, hair placed in the wrong direction, and donor and recipient site scarring. Outdated procedures such as scalp reductions and flaps also need to be repaired.

If the transplanted grafts are large (“hair plugs”), it is possible to surgically excise these grafts, microscopically dissect them into smaller follicular unit grafts, and re-transplant them into the scalp in a more natural-looking, aesthetic way. After these large grafts are removed, the sites are sutured closed and heal with very fine, often imperceptible, white scars. Hair plug removal is often followed by one or more sessions of FUT or FUE in order to harvest additional hair for use in camouflaging any remaining plugs or improving the appearance of the region where the plugs had previously been. These combined repairs can lead to excellent outcomes.

If the grafts at the hairline are not large, but are placed too low or too broadly, it is possible to use laser hair removal and/or tweezing to remove these hairs. Repeated treatments may be necessary until the hair ceases to grow back at these locations. Additionally, hair which was placed in a direction different from the way hair naturally grows will usually need to be removed.

Another challenge in hair transplant repair is fixing widened donor scars that had resulted from poorly performed FUT/strip procedures. These scars are permanent and may be visible if the hair is not worn long enough. Scars from FUT procedures can be repaired by harvesting hair from the surrounding donor area (using FUE) and transplanting these follicular unit grafts into the scarred tissue.

Scalp micropigmentation (SMP), a permanent micro-tattoo, may be useful to further camouflage these linear scars. SMP can also be used to improve the look of the stippled scars of FUE in patients. This can occur with over harvesting, when patients wear their hair too short, or when the balding is more extensive than anticipated and extends into the harvested area.

A hair transplant reversal, in theory, has the goal of having the person look as though a hair transplant had never been performed. While a complete reversal is not possible, the techniques previously discussed can be utilized to achieve a number of important things. The donor site scarring can be minimized and/or camouflaged and the smaller follicular unit grafts in the recipient zone can often be removed without leaving behind any visible scarring of the underlying skin. What is not possible is to restore the person’s density to a pre-procedure level as improperly performed transplants always result in wasted hair.

Hair Restoration Answers

Can Hair Transplant “Plugs” be Repaired by Lasers or Electrolysis?

Q: After a bad hair transplant, can you use lasers or electrolysis to remove the transplanted hair? — N.C. ~ Newark, N.J.

A: You can remove the hair in plugs with electrolysis, but it is difficult since the scarring distorts the architecture of the hair shaft and makes it hard to insert the electrolysis needle. Laser hair removal is a far more efficient way of removing the hair, but takes multiple treatments. However, the problem with either of these techniques is that the hair is destroyed and the underlying scarred scalp is not improved. In fact, it is made more visible when the hair has been removed.

Our preferred method of repair is to completely remove the plugs, dissect out the individual follicular units from those plugs and then re-implant them in the proper location and direction. In this way the hair can be reused and the appearance of underlying scarred scalp can be improved, as well as camouflaged with new hair.

Hair Restoration Answers

In Hair Transplant Repair, Do You Always Harvest Additional Hair Via FUT or FUE? Which is Better for Repair Procedures, FUT or FUE?

Q: In hair transplant repairs do you always harvest additional hairs to give the hair restoration a better result? Which is better for repair procedures, FUT or FUE? — E.Z. ~ Fairfield, C.T.

A: We do not always harvest additional hair in repair procedures, but we do if possible because it can improve the aesthetic outcome by adding additional density and camouflage. This is called Combined Repair. As for whether we use FUT or FUE in repair procedures, the answer depends on the clinical situation. For example, a loose scalp favors FUT. If the person wants to wear their hair short, that favors FUE. If donor scars from the plugs need to be removed, that favors FUT. If scarring in the donor area needs to be camouflaged rather than removed, that favors FUE.

See Patient ETI’s before/after repair photos
Read about Combined Repair techniques

Hair Restoration Answers

In Hair Transplant Repair, Can You Remove Plugs By Follicular Unit Extraction?

Q: I was wondering if it was possible to use Follicular Unit Extraction (FUE) on the old plugs instead of graft excision. — N.B. ~ Westport, C.T.

A: Graft excision generally works better than FUE in removing old plugs and mini-grafts. The reason is that, in these grafts, the hair is not aligned due to the scar tissue that tugs on, and bends the hair. Because the hair direction is altered from the scar tissue, there is much more damage when the grafts are removed with the tiny FUE punches. In addition, FUE only removes a very small part of the plug. If the hair in the plug is pointing in the wrong direction or the plug is in the wrong location, the entire graft needs to be removed.

Another benefit of graft excision is that we can remove the underlying scar tissue and improve the appearance of the underlying skin. In FUE, only a tiny bit of the scar tissue is removed and, since FUE holes are left open, FUE actually causes its own scarring. With graft excision, the sites are sutured closed so some scar tissue is removed and the quality of the underlying skin looks more natural.

Read about Hair Plug Removal
Before/After Photos of a Plug Repair Patient

Hair Restoration Answers

In Hair Transplant Repair, What is Hair Follicle Survival Rate for Re-implanted Grafts?

Q: When you remove hair plugs and re-use the hair from the grafts, what is the survival rate for those follicular units? — W.B. ~ Upper West Side, N.Y.

A: The survival rate is close to that when grafts harvested via FUT or FUE. However, if the grafts are placed into a significantly scarred scalp, this can have a negative impact on growth.

Read more about Hair Plug Removal

Hair Restoration Answers

Using the Term “Re-do” in Describing Additional Hair Transplant Repair Procedures

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.

Hair Restoration Answers

What Is Best Way To Remove Hair Plugs: FUE, Electrolysis, Or Graft Excision?

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).

Hair Restoration Answers

What are Options for Fixing Wide Donor Scars?

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.

Hair Restoration Answers

Can a Hair Transplant Repair Scarring from Scalp Reduction Surgery?

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.

Hair Restoration Answers

Can Dermabrasion Repair "Pluggy" Hair Transplant Scars?

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.

Hair Restoration Answers

In Hair Transplant Repair, Can You Re-use Hair Follicles from Old ‘Plug’ Grafts?

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 […]

Hair Restoration Answers

In Hair Transplant Repair, Can You Repair Scars from Old ‘Plug’ Hair Transplant?

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. […]

Hair Restoration Answers

Can Second Hair Transplant Repair Pits in Scalp from Prior Procedure?

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).

Hair Restoration Answers

What is Cost of Hair Plug Removal?

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.

Hair Restoration Answers

Can a Hair Transplant Repair a Large Scar on the Scalp?

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 have to make some adjustments in the technique.

When we perform a hair transplant into a large scar, we place the grafts into the perimeter first i.e. the outer edge of the scar. This allows new blood vessels to develop and permits additional hair to be added more centrally at a later date until the whole area is filled in.

If the scar is small or thin it can be transplanted as with normal tissue.

Hair Restoration Answers

Can Repair of Old Hair Plugs be Completed in One Session?

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 […]

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Updated: 2017-10-05 | Published: 2013-06-06




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