Category: Repair

I have seen your articles on the net and have a video from NHI. I’m a victim of a bad hair transplant and would like your advice. The “Doctor” transplated doll looking hair in my hairline back in 1993. At the time, I was a naive kid at 23 and was afraid of losing my hair. Today I could care less if I was bald, but to deal with this freak looking hairline is an every day battle.

Basically, I’m wondering if there is any way to replace the grafts back where they were? Remove them from the front and replace them in the back again. Is this possible?

I keep my head buzzed now, and the scar on the back really looks horrid. Any advice would be appreciated. Thank you.

The good and the bad news about hair transplants is that they are, for all practical purposes, permanent. The problem with attempting to wipe out that they were done is that you will have a ‘trail’ of scars showing each step of the process from creation to reversal.

I have written extensively on the subject of repairs. The better way is to fix it such that it does not show any more. There are many examples of this on the NHI site, and in the articles we published on the subject. I hope the photos do not scare you.

See the following links for the published articles:

• Art of Repair in Surgical Hair Restoration, Part 1
• Art of Repair in Surgical Hair Restoration, Part 2
• Dean’s Story, a complete repair from start to finish
• Repair Strategies

Again, although you can remove the transplants, you may look like a person who had brain surgery. I hope that this answers your questions.

I had a number of mini and micrografts done 10 years ago behind the hairline, so they weren’t visible. Now, because I lost more hair, these grafts are now visible and they look like a transplant. What can I do to fix the situation?

There are two basic approaches to repairing visible grafts. The first directly involves the old grafts. If they are small, you can punch them out using a 1 mm punch. This will remove the bulk of the hairs, leaving a few straggler hairs which look OK and there will be a tiny round scar. If the grafts are bigger, you can remove several small areas in each graft to break it up, or you can remove the entire graft with a larger punch or a strip excision. But the latter would leave a scar that would need to be filled in with follicular units after a couple of months. The second way is to do a transplant proceedure around and in front of the old grafts to hide and camoflauge them. If the grafts are small this works well. If the grafts are large, a more radical surgery may be needed.

For an example of the procedure, please see Dean’s Story.

I had hair transplants 20 years ago. When I had them, my hair loss was just starting. Now I have an airport runway on my head and there are these plugs in the middle of my runway (rear of my bald area) like an island in the sea or an oasis in the desert. Can I take these out or do I have to get more transplants?

Your problem is a common problem which we see wherever crowds gather such as airports and sporting events. This surgery was done in the early days of hair transplantation and as the balding progresses, the plugs are ‘abandoned’ by the surrounding hair. My suggestions would be:

• You can have them removed if there are not too many, as it should look better than to leave them, but there may be scars remaining after the removal
• You can have a modern hair transplant procedure performed and bury them in a full-appearing head of hair, assuming the hair supply is adequate. In this way you can finish what you started years ago. The good news here is that the modern hair transplant will not produce these types of results and if it has been 20 years since the last time you did it, I suspect that the hair loss is largely finished and you will therefore not become another moving target, chasing more change over time.

Your question addresses two important problems:

1. The balding process is progressive in young men unless drugs like Propecia are used to slow or stop the progression. Anything you do that alters the course of your appearance will be modified by the progressive nature of the hair loss. When you had it done 20 years ago, there was probably only some crown thinning so that the transplants made you look fuller. As you continued to bald however, the older plug technique showed itself in all of its awfulness.
2. These problems can and should be fixed. The good news is that repairs work in most situations to return a person to a normal appearance.

Here is a photo illustrating an “island of plugs” in the crown of a patient before we did his repair:

I have tried hair systems, weaves and all of these newest innovations in this field. Then I started getting transplants in 1987, with 5 scalp reductions and 7 hair transplant procedures. The more I did, the worse I looked. So I came up with the idea that I could tattoo my scalp and make it look like hair by putting brown dots the color of my dark hair. I then shaved my head. The tattoos were done on my scars as well. For a while they looked OK, but then the brown color started to turn green. Now I have a green head. Do you have a solution for this? Can the tattoo color be returned or can they just be removed? What would you suggest?

I have seen problems like this in the past. Creative people come up with creative answers to problems, but when the solutions fail, the consequences are sometime profound. I have had two such patients: The first had terrible scars that were treated with a balloon insert to stretch the normal scalp so that the tattooed scalp could be removed. The balloon was in inflated 2-3 times each week for 10 weeks before the scar was removed. It worked nicely and he was fortunate to have enough normal scalp to stretch the excised scalp defect. The second patient went through the same thing you did. He did not have a great deal of hair left, but he did have enough to start to cover some of the most prominent balding areas . The bad scars were improved with some scar surgery and the transplants did help. This second patient and his girlfriend were very grateful for the improvement and remain amongst the most happy of my patients. It was an important lesson for me – that working through problems with the patient as a partner with realistic goals, is the best way to make the best out of a bad situation.

I am a patient of yours and I read a previous blog question and response from you the other day where you worked the problem out with the patient. I came to you 13 years ago with a problem that others could not help me with. After I explained the problem to you (which you listened carefully) I went into my solution. Although I prefer you not to use my name, you might want to tell your audience my story. I have been forever in your debt and grateful.

I remember you very well. You came to me after having done two flap procedures where sections of your scalp were moved from the back and sides of your head to cover the front (like a banana peel). This was an operation invented by a man from Argentina (Jury Flap) that was popular amongst certain surgeons in the late 1980s. This left the patient with an unnatural hair line, hair lying in the wrong direction and a hair line that (on my particular patient in question) was located far too high. You had gaps in many areas of your frontal hairline and there was no hair behind the flaps, leaving you bald in the mid-head. The donor area was depleted of substantial amounts of good movable hair so the supply was very limited and you lost much of your native neck hair as a result of the stress of the procedure.

I remember our first conversation and what you told me. You said (out of context): “I have been thinking about this problem for a few years now. I have met with doctor after doctor and when I finally figured out a way to manage the problem, none of the doctors who I visited would do what I asked them to do.” You went on to explain that your hair had a very strong wave and character to it (Italian hair of medium weight) and that if some hair was placed in front of these flaps, far in front of the flaps, then you could style your hair with a comb-back and a pompadour (like Elvis but much more subtle) and an angled combing style would hide your problem. You told me that you used gels and blow drying to achieve your looks; and you were convinced that this solution could solve your problem if I could find enough hair to transplant. After the first surgery (which was experimental on my part) and the ensuing 12 months it took for the hair to grow out to a good styling length, the results were fantastic. Your creative styling did wonders for the 600 grafts we put into your frontal hairline area. The good news was that we performed four surgeries over the 8 years we worked on you and you got enough hair to address, not only the frontal defects, but also the balding in your neck hair, which was a complication of the flap procedure. Today, you still must spend a few minutes every morning styling your hair, but even my eye can not pick out any defect on you- you looked great when last we met for dinner at one of your restaurants! Thanks for allowing me to share your experience.