Hair Transplant Repair
Exposed old-fashioned plugs are the primary reason patients present for
repairs. These are my favorite cases. These patients all tell me the same
thing. They are tired of watching acquaintances’ eyes dart back and
forth between looking them in the eyes and at their hair. It is almost impossible
to speak face to face with someone who has had a bad hair transplant without
glancing up repeatedly to look at it. Jokes are made in private. For them
it is embarrassing. For me it is bad advertising. Nobody notices a good
hair transplant, only the bad ones. After seeing a few bad ones, people
mistakenly believe that must just be the way hair transplants look. Hollywood
certainly capitalizes on bad hair transplants frequently using them as comic
relief. My happiest patients, without question, are my hair repair patients.
Hair repairs are not always necessary. Sometimes patients can learn
to use a variety of camouflaging agents, such as makeup to color
their scalp the same color as their hair so that the color contrast
is minimized, or
spray micro-fibers to temporarily fill in the spaces between the
plugs. Another trick is perming the hair to give it curl so that
the plugs underneath the curls
are less evident. Sometimes coloring or actually not coloring the
hair can help. By decreasing the color contrast between the hair
and the scalp, the
plugs will be less noticeable. Jet-black hair on a white scalp
shows the worst. By bleaching the hair blonde, there will be much
less color contrast
against a white scalp. In the opposite manner, letting hair go
gray rather than coloring it greatly decreases the contrast. Some
patients simply give
up and go to hairpieces. Recently, some have tried removing the
hair permanently with laser hair removal. Unfortunately, it usually
requires numerous treatments,
is not necessarily permanent, and it leaves small, round, punch scars
behind.
For those patients willing to undergo hair repair surgery, the results can
be dramatic. If the “plugginess” is not too great and good donor
hair remains, the simplest maneuver is to pack follicular units tightly between
the old plugs so that when the when the new transplant grows, the plugs will
be less noticeable. Depending on the case and the quality of the hair, this
could take one to three sessions to fully hide the old plugs.
If this is not an option, things become a little trickier. In these
situations, the plugs must be entirely or at least partially removed and
then recycled into new follicular units. In this way, I am simultaneously
decreasing “plugginess” and creating new follicular units. To
remove the hair from the plugs, various sized small, circular, cookie-cutter
type instruments called punches are used. The original plugs were probably
implanted in punch holes. These punches range in size from 1 to 4 mm in diameter
and can be used to remove a core of the plug. The entire plug can be removed,
but often I just remove the majority of the plug. By removing the majority
but leaving behind small strands of hair, one can recreate the look of normal
follicular units at the margins of the punch removal. After the punch is
removed from the plug, the resulting small hole may be closed with suture.
This does change the scar from the previous small circle to a small line,
but after healing this is hardly noticeable.
In most cases, after the new transplant grows in, the small scars are
not evident at all. The hole left from the punch does not have to be
sutured shut, however. In tight scalps, there is not enough laxity
to close many
small punch holes
simultaneously. If these are left open to heal, it takes approximately
a month for the hole to fill in, but the results are usually good this way
also. The final scar will be a small, whitish circle the same size as the
punch used to create it.
If the plan is to punch remove the unattractive plugs , the patient
must be warned that, over the short term, his scalp will look worse than
before surgery since I am removing hair that will not regrow for three to
five months and leaving
behind sutured or open punch holes which take time to heal. Patients
must think about the long term payoff. Having said this, actually a fair
number of patients think they look better immediately after surgery because
the “plugginess” is gone.
Each hair repair case is different and patients are warned that it may take
multiple sessions to obtain a natural appearance. In some particularly bad
cases, completenaturalness may not be obtainable, but significant improvement
should be.
Credits
-Information Provided Courtesy of Dr. Blaine Lehr, MD - The Dermatology Clinic, Inc.
Hair Transplant Adviser Blog
Provided by The International Alliance of
Hair Restoration Surgeons,
the Hair Transplant Adviser blog provides the opportunity for prospective
hair transplant patients to ask questions and find answers.
