Category: Repair

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My Father Had Awful Transplants from a Dermatologist – Hair Loss Information by Dr. William Rassman

I have been on finasteride for 7 years. I have pretty much maintained my same density over this period. A little more thinning in the front. I am now 36. My father had many transplants from a doctor who is a dermatologist. Not from a doctor that specializes in transplants. His transplants are awful. What should my expectations be if I wanted to get off the drug and try transplants? I am fair-skinned with wavy auburn hair, and my individual follicles are thick, but not dense.

First, the old plugs can easily be fixed today. Look at the following links for articles and examples of good repair work which can and should be offered to your father:

The second part is that taking the drug Propecia is a different decision to having transplants. They can be complementary (see: Hair Transplant and Propecia Combination Results). As for expectations about transplants for yourself, meet with your doctor and have him/her develop a Master Plan with you, so that you have your needs addressed before the procedure.

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I Want My Plugs Removed and Not Replaced – Hair Loss Information by Dr. William Rassman

Dr. Rassman:

I have approximately 110 plugs (from the late 1970’s) that were placed in the frontal hairline where your hair is receding according to your picture. Can the plugs be removed and not replaced without leaving obvious scars?

If not what is a viable alternative?

Yes, the plugs can be removed. There is no way that they will not leave some scarring. Each person is different with different skin types and skin textures that reflect light differently and produce different degrees of scarring. Plugs done in the 1970’s tend to have a great deal of skin taken with the hair. These skin discs will stand out because the flat nature of them with the associated scars, when placed into a smooth, rounded bald scalp, will reflect light such that the difference becomes very obvious. When you add the ‘plugs’ of pencil size hair in the normal scalp, attention is drawn to that area. Many times, if the plugs are lined up, they can be excised as a block, or they can be removed one by one. To determine the best approach, there is no substitute for a personal consultation to make the judgments that reflect your situation.

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I Want To Undo My Hair Transplants – Hair Loss Information by Dr. William Rassman

I had a transplant procedure a few years ago and now have some grafts along the front of my hairline, an entire bald back (Norwood Class 7) and a raised scar in the back of my head where the transplated hair was taken from. I went back to the original doctor once, and he took out some of the grafts, but there is still pitting in the front and I need to wear a hair system to cover it up. How I hate that rug, I can not express enough. How do I go back to square one? Is that realistic? Am I trapped into having more transplants that I can not afford?

You asked about the skin deformity of the frontal hairline and about how realistic it would be that the small pits could be abolished. I think that it is unlikely that it can be completely taken away, but it would not be unreasonable to remove the present hair. Risks of scarring further is a real consideration as the smooth surface skin of a bald Class 7 patient will easily show any deformity by the glare of the light. The balding skin is atrophic, which means that it lost its normal texture, where small pores exist and the sebaceous glands wax the scalp. The normal skin is clearly different than the tissue paper thin skin of an advanced balding man. When something is done to an atrophic skin, it will never go back to its pre-surgical appearance. Some people ask about dermabrasion to smooth out the skin and I feel that this procedure would likely create more skin abnormalities and I would not recommend it, even though other doctors often do this.

As your goals are unclear and the amount of normal skin and hair is an unknown for me, I am assuming that you are a full, well established Norwood Class 7 patient, but I would suggest that you let your hair grow out a bit under the hair system so that a doctor can make a determination about your condition and patterned hair loss. To accomplish this goal, you will need to have your hair system converted to clips and away from the glues or tape you are probably using for the moment.

To remove the hair in the frontal hairline, an FUE procedure to remove the hairs in the frontal hairline is worth considering. To treat the scar in the donor area, you can either attempt to remove it with a surgical excision or fill in the scar with FUE grafts.

You can visit me for an extensive exam, or even send photographs as appropriate to improve our communication. Please do let your hair grow out under the hair piece after you convert to clips. Please also do not rule out a proper and complete transplant to get your original goals back as a consideration, but it would be a good idea to see patients at an upcoming open house event to make such an assessment. Whatever you do, take your time here to make an informed decision, something clearly you did not do when you started.

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Removing Transplanted Hair for Corrective Procedure – Hair Loss Information by Dr. William Rassman

What are the options in dealing with transplanted hair that you no longer want-is there any procedure that would remove the transplants but still athestically feasible?

The second related question is what is the effectiveness of corrective procedures that thin down some transplanted areas, moving the hair to other parts of the scalp that now need it.

As you can guess, I am dealing with a transplanted “head” of hair that is actually mostly comb-over because I have lost so much hair behind my orignal transplant. I can fake it at the present time but I am getting tired of being the world’s biggest user of hairspray and worrying about the wind

I have written extensively on the subject of repair and have many patient examples of repairs on our website. Also see Dean’s Story for a good example of things that can be done and how it was done on this particular patient. Removing grafts is usually the best thing to do if the grafts are in the front.

Heavy rows of grafts may be best removed just like a ‘brow lift’ surgery and then 2-3 months later, you can transplant the area and create a completely normal frontal hairline like the patient example above. I have also found the FUE / FOX Procedure to be very effective in thinning out transplanted hair and moving them to other locations to produce better coverage. However, not every patient can be a candidate for this procedure. I would need to see you first (or you can send photos, which will be treated confidentially). For FOX redistribution, I need to test each patient to be sure that this approach will work.

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Removing Pitting from Previous Transplant – Hair Loss Information by Dr. William Rassman

Do you have any suggestions for removing pitting, other than removing the hair and suturing the site. I had a corrective procedures several months ago to remove cobblestoning. The cobblestoning was successfully removed, but the surgeon’s team simply replaced alot of the cobblestoned areas with pitting where they placed the grafts too low. Don’t get me wrong my head looks alot better than it did before. I would rather not go back to the doctor who created the pitting. He is rather callous, you almost feel like he paid you to see him. You barely have time to ask this guy a question. You recommended that I go back to him. Nonetheless, what are the options?

This is one of those answers that only has validity if an evaluation is done in person. I’m sorry to tell you, but you have very few other options. I do agree that a second opinion is in order, though, especially because so much depends on what is there right now and on the physical exam that the doctor does when you are there in the office. Find yourself another doctor who you trust, who has good skills, and a good reputation, and ask him or her what they think your options are. Good luck!

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Removing the Pluggy Doll’s Hair – Hair Loss Information by Dr. William Rassman

My boyfriend has hair plugs. He got them when he was much younger (he is 35 now and has had them for at least 8-10 years).

I really don’t like them, they have a doll hair look to them that is described on your site. He is starting to bald and thin in the back now. I asked him if he can shave his head and he told me he couldn’t due to the implants.

What are his options? We are both interested in correcting or bettering the situation. It is obviously a sensitive topic for me to bring up. I love him a lot …and want to try and find a way to improve his hair situation. I know he wants to as well.

Can you help?

They say great women are behind great men and great relationships. I admire you taking the helm and trying to help your boyfriend. The pluggy look is never good, and repair procedures reflects much of what built my practice in the past 15 years. The best way to answer this is to link you to Dean’s Story, which is a step-by-step account of one patient’s repair procedure, complete with photos that might be considered too graphic for some. It’s all in there.

Other resources that will help you and your boyfriend make an informed decision:

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I Had Plugs Transplanted in the 80s – Hair Loss Information – Balding Blog

Back in 1988 I had some of the old plug transplants done.I realized I made a mistake and stopped any further transplants.( 35 in all)
I had all the transplants (Plugs) removed with some scarring.I also had the doner area removed recently by a plastic surgeon.My problem is I would like to shave my head now but have no idea how bad the scarring is and the only way to find out is to shave my head.Are there any pictures that I may view to see how the area may look like shaved.Is there any makeup I may use after I shave my head until I have the scars corrected.
The were some of the transplants still growing will they look natural when shaved, will they grow faster ( on a daily basis ) then the hair that was originally there. I am exhausted with all the effort I have had to go threw to get me back to where I was in 1988. I await your response.

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This is not an uncommon question, but unfortunately the answer is not what you want to hear. The scar from excision of your open donor area will show very well, like any scar on the body, even if it healed perfectly. People who have had any excision (even today’s modern hair transplant) will have a large ‘smile like’ line on the back of their head if they shave their head. The shaved head will bring attention to every defect on your scalp from where each of the grafts were removed and it will be made worse in bright light. Normally, a shaved scalp is smooth, but I suspect that yours is puck-marked and shaving it will only draw attention to the defects.

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Plug Repair Cost – Hair Loss Information – Balding Blog

Hi Doc,

I’m a one time hair transplant patient of Dr XXX in Rhode Island and very displeased with the results. I had it done back in 1993 at 24 years old. At first it seemed okay, but now my hairline has receded more and the graft are way too pluggy and I’m forced to pluck them, but the pitted scars still show! I shaved my head once and the donor scar is way too obvious. It looks like I’ve been in a car wreck or something. Anyway, it appears my only logical options are to:

1) remove the plugs
2) wear a piece to hide the plugs
3) repair the hairline with a competent doctor

My current hairline has been the same for about 7 years now. It’s about the same as the actor’s Matthew McConaughey at TheSmokingGun.com.

Any idea on the cost to help thicken the hairline again. I know I’ll never get back my old hairline I had in my early 20’s. Just want it to look normal.

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We have written articles for scientific journals on the repair options. Those options have become better than since the articles were written and now we can often be more aggressive when needed with far less risks. In addition, we can take follicular unit grafts from the old plugs, softening them in a more distributed way.

The costs vary per patient. At the least, I would need to see pictures to make that estimate. You can send photos to the email address on the Contact page.

For examples of plug repair, please see:

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Another Procedure to Thicken the Hairline – Hair Loss Information – Balding Blog

Hi. I have a few questions for you that I hope you can help with.

First off, I have had multiple transplants so I would ask you not to insult me by sending me advertisement-type answers. I found you by Google searching so I don’t know much about you.

As I stated I have had multiple transplants. Dr. X and then Dr. Y were the two physicians I met with. Dr. Y’s scars from the donor area are rather large, Dr. X’s less so. But I did have a problem with one large graft falling out that essentially left a small ‘holish’ scar on my bald spot in the back of my head. Something I am not happy about but it is not that bad.

My hair is thin. It always has been. I am 39 years old now. I do not think I have much hair left to give from my donor areas without the back of my head starting to look bald too. I am right at the brink of what is acceptable re-distribution of the hair from the back of my head to the front of it.

It seems like you are strictly a hair transplant outfit but I thought I would ask for your opinion anyway. I do not think of myself with a full head of hair, I just want enough up front and even on the bald spot to have a stronger looking hairline overall. What would you recommend? Thank you for your time.

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To address your question, you need to be evaluated directly. As you are local to Los Angeles, I ask you to please visit our open house on January 12 to meet some of the repair patients we have done. We have an open house event every month in our office if you can’t make this one. Read our repair articles published in respected medical journals, and get a private consultation to walk away educated with your options clearly defined. I will not insult you with propaganda and if you look at our website you will see that we are quite professional in the way we manage the medical hair restoration practice.

For more information about repairs, please read these articles:

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Revising a Scalp Reduction – Hair Loss Information – Balding Blog

I had a scalp reduction and two hair transplants. I would like to see some before and after photos of a revised donor scar.

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Scalp reduction repairs vary widely because of the types of incisions that was used, the number of surgical procedures that you had (I am assuming only one by the question you asked), and the damage to the underlying scalp. When a person has had many scalp reduction procedures, they often develop a deformity called a ‘Slot Deformity’ (see this article by Dr. Patrick Frechet) where the hair from the sides grow away from the scar and when this meets the hair in the back that point downward to the floor, a slot is created that looks most unnatural. You need to be evaluated in person. If you come to my Los Angeles office, I can lead you through the many types of repairs you need to know about. Alternatively, if you are not near either one of our California offices, let me know where you are, or send good photos to me (via mail or email) and I can try to address the question more appropriately over the distance.