Hello Dr. Rassman. I received my first hair transplant when I was 22. I received several procedures which gave me a horse shoe shape of plugs in my hair line. At that time my social life shut down completely and I wore a hat until 1996. At the time I located a new doctor and he doctor recommended removing only the plugs at the outer edge of the hairline and focusing on hiding the plugs with follicular grafts after three procedures I was able to take my hat off again although the plugs were somewhat hidden the hair line was very hard like a wall. I was never able to accept how unnatural it felt and behaved when groomed. The density behind the hair line would never match the horse shoe in my hair line. I have had two procedures to thin out the plugs and with each procedure it looks and feels better, but the camouflage came with a tradeoff. I now have a large donor scar ear to ear 5/8 wide I had two procedures to remove the scar. It did not work and the scar soon returned. I am currently having FUE extraction procedures to camouflage the scar and thin out the hair line. I believe this combination of procedures can get me the result I am looking for. I refuse to have any more linear procedures due to my healing qualities and the fact I find them way to invasive. Enter new problem — it has been harder to talk to my doctor. I believe he is tired of me and I have trouble communicating with him since I believe it will take three more procedures to get a natural result. Enter problem two — my last procedure was extremely painful. Each injection of local anesthesia was unbearable and very traumatic. I believe I am so close to having a hair line that looks and feels natural and a scar that is difficult to detect so I can finally go out and have a social life again before I reach forty. My goal is to end this 15 year nightmare before I reach 37. I just turned 35. I am still single.
The old plugs can be a real nightmare and I really feel for your pain. It sounds like your current doctor has kept up with the correct treatments and has brought you a long way. Life is full of trade-offs and it appears that the downside of your present nightmare is the pain associated with each anesthesia and the scar from the strip surgeries, so I will address these first.
Anesthesia: There are ways to handle the pain associated with the anesthesia. For the audience who is reading this, I will explain that when a great deal of scar is present, the anesthesia gets to be very difficult and the more scar, the more difficult will be the anesthesia. But with that said, there are ways to reduce the pain you are having by using such systemic medications as Versed and Ketamine in combination, which will wipe out any pain that you might experience with further surgeries. If you doctor is not comfortable with this approach, you might have him/her bring in an anesthesiologist to monitor you through the initial injections to set up the anesthesia. I have offered this option to a few of my patients.
Scars: Scars come with all types of surgery (100% of the time) and when you have many surgeries, there is a scar of sort associated with each, even if they are in the exact same place. I tend to separate the scar issues of the donor area (which can be covered with long hair) with the other important priorities, your appearance to the public who can often not see what lies below. The goal is, of course, a normal looking hairline and a decent head of hair without obvious plugging or abnormalities. Then when the normalcy is reached from a social point of view, I tackle the scars as my primary and last set of activities using FUE if it is needed to finalize the best end point that is socially undetectable. There are many good tools that are available to treat the scars that were created by the varying older techniques and FUE is one of the newer ones. For some people with very extensive scars, balloon expanders are a reasonable option, but these often require wearing a hat to hide the balloon expanders for the 10-14 weeks it takes to stretch the normal hairy scalp so that the scars can be removed. The good things about balloon expanders is that they often will yield a good deal of additional transplants which can nicely refine the last of the corrective work.
“Socially undetectable” means that the work is repaired so that in normal situations any person will look reasonably normal. This may require a styling adjunct with the the reconstructive work. Apparently, this is what your doctor has successfully addressed and from the little you wrote here, you did admit that “I believe I am so close to having a hair line that looks and feels natural and a scar that is difficult to detect so I can finally go out and have a social life again before I reach forty.”
Repairs: This is a nightmare which I have shared with too many patients over the years. From the articles we wrote, we have developed a sizable repair practice as doctors and patients from around the world have found us as a resource. We are a team made up of good caring doctors and focused patients who we educate on the realities of their situations. The rewards, from my point of view, have been very worthwhile. Sometimes you have to look back and see from ‘whence you came’. A good doctor goes through much anguish because he/she wants the process to end as fast and as soon as the patient does, but the doctor must be realistic and keep an objective hat on his head at all times, even when the patient gets antsy and frustrated. Those times are the tests that doctors and patients have to struggle through. I suggest that patients like you should try to understand that progress is slow at times. The tortoise beat the hare in the race, because the tortoise was steady, making consistent progress towards the goal. Some of the horribly deformed patients I have seen over the years have become normal people, leaving their freaky look as a nightmare past. With the techniques which we have developed today, almost every patient can be helped, provided that they have suitable donor hair to relocate.
Reality: When I say almost every patient can be helped, what I really mean is that I will give an honest opinion as to what can be done and if the patient will hear what I’ve said, I can usually come close to the target that I outlined in the initial consultation. I always put my opinions into an extensively written report outlining the goals that I think are reasonable and which are not. Most of the patients with the old style plugs suffer greatly because of the deformities created by these old techniques. Many feel that they have been abused, taken advantage of, and become victims. They often have lost trust in all doctors. Anger is part of the problem that stands in the way of getting the best out of a good doctor/patient relationship. The key for the doctor embarking on such a project is to try to establish trust and confidence, a sense of teamwork, and a genuine feeling of caring. I have helped people who I could not bring back to a normal looking full head of hair, but I have made a point to communicate with them (in advance) the reality of what we can accomplish. The greatest problem I have seen is that some patients have run out of donor hair, so that even using the old plugs as a source of donor hair by harvesting with FUE techniques, there may still not be enough hair to get it all fixed.
See Dean’s Story for a complete repair process from plugs to a normal looking head of hair.
How many licks does it takes to finish a 
