CORRECTIVE HAIR TRANSPLANTS

“Can bad transplants be corrected?” is a question always asked to Dr. McAndrews.

The answer is almost always “yes” or at least “improved.”
Approximately half of the surgeries performed by Dr. McAndrews are corrective surgery. Unfortunately, Dr. McAndrews is seeing a massive increase in patients seeking correction of their FUE hair transplant performed by inexperienced doctors and/or unlicensed technicians. Incorrectly performed FUE hair transplants (using Neograft, Smartgraft, Artas, or other FUE devices) are creating much need for correction in several areas-

  • Donor area- massive amount of scar tissue which creates a situation where even longer hair styles do not hide the scars around the sides and back of the scalp.
  • Recipient area- grafts are placed in the wrong direction or placed in an area that doesn’t frame the face correctly.
  • Poor survival of the grafts which are lost forever.

The unfortunate complication we are seeing more and more with bad FUE hair transplant is many times the donor bank has been decimated and there is no donor supply left to correct anything therefore SMP (scalp micropigmentation) or a hair piece is the only option.

In the right surgical hands, a bad “pluggy” hair transplant can also be corrected. The reason the traditional plugs stand out is because of the contrast in density between the plug and the surrounding existing density. As the patient continues to bald with aging, the density contrast increases, and the plugs stand out even more. In order to make the plugs blend in, the corrective hair transplant surgeon needs to increase the density in the surrounding area with follicular unit grafts. When the surrounding density is increased to about 50% density the plugs become unnoticeable. If a patient has 30% density surrounding the big plugs, then the hair transplant surgeon will need to increase the density by another 20% to make plugs look natural. Many times even density less than 50% is sufficient to hide the plugs (30%-40% is usually adequate).

The following are the most common issues that patients have with prior hair transplants, but by no means does this include all of the possible concerns. Each patient is evaluated individually and provided with all of the possible alternatives to correcting their prior hair transplant.

THESE ARE THE 3 MOST COMMON REASONS FOR CORRECTIVE SURGERY

  1. Grafts are in the correct location (i.e.- conservatively placed in the frontal forelock) but it is “pluggy” in appearance.

    Solution

    1. If donor supply (i.e.- good genetic hair from the sides and back of the scalp) is “abundant” — The hair transplant surgeon can harvest the abundant good genetic hair from the “hair bank” and place follicular unit grafts in front of and around the plugs to make the contrast go away.
    2. If the donor supply is “limited” — The hair transplant surgeon will need to remove plugs which are 100% density, dissect them into follicular unit grafts under the microscope, and the then re-transplant them in the same area at an evenly, distributed lower density.
    3. In the extreme, the transplant surgeon will need to remove the grafts and the patient will have to settle being naturally bald. Unfortunately, some scarring will remain where the grafts were removed.

      Pluggy Hair Transplant (Grafts in Correct Location)

      Following 2 Corrective Surgeries (Grafts placed in front at 40% density)
  2. When the frontal hairline is designed too low with FUE or plugs are on the forehead, the grafts need to be removed, dissected under a microscope, and placed in a more appropriate area (i.e.- frontal forelock) with even distribution of the density. Trying to hide the plugs with follicular unit grafts will hide the plugs but create an even more unnaturally low hairline. The plugs can be removed individually or in a linear strip which creates a small scar — Dr. McAndrews has never had a patient that would rather have the grafts in an unnatural place instead of the scar.The other option is to remove the grafts and settle being naturally bald with some scarring where the grafts were removed.

    Pluggy Hair Transplant with Too Low of a Hairline

    Following Linear and Punch Removal
  3. Pluggy or FUE grafts placed in the vertex

    1. If the patient has extensive baldness and very little donor hair, but desires to keep the grafts — The grafts should be removed, dissected under the microscope into follicular unit grafts, and place into the frontal forelock leaving the vertex bald.
      If the patient has extensive baldness and does not want further hair transplants — The plugs should be removed and patient will be left with a bald vertex with mild scarring.If the patient has moderate balding and desires to have further hair transplants but does not have the donor bank to fill in all the balding area — The plugs should be removed, dissected under the microscope into follicular unit grafts, and re-transplanted in the same area in a natural-appearing, evenly distributed with lower density.
      If the patient is older, has mild balding, and has an immense amount of hair in his donor area — The follicular unit grafts could be placed in between the plugs to reduce the contrast.