Hair Transplant Plug Repair

[Hair transplant plugs]

I am 45 years old, around 20 years ago I had a hair transplant to strengthen my hairline. I was never happy with the overall appearance of my hairline but still had native hair which helped. I believe these were called micro-mini grafts. As my hair loss progressed over the years the large grafts became more visible until I had no option but to wear a hat all day every day. Its been this way for years as I don't want people seeing these ugly plugs.

I`d like to know what repair options are available ? And who are the best repair doctors ?


Thanks in advance for any help.

 

[Hair transplant plugs]

Here are more pictures of my donor area.

 

[Hair transplant plugs]

side shot

 

[Hair transplant plugs]

side shot.

 

[Dr. Josephitis]

There are a few options available out there for you currently. The first question I would pose for you would be: What are your goals? Would you prefer to have more hair on top (i.e. additional hair transplant(s)) or would you rather just have a natural appearing balding scalp. If you think that you would like to have the latter, the grafts can then all be removed. This process may take more than one session, as sometimes a few hairs continue to grow after the first pass. Still though, after the initial pass and after the areas have been healed, you will notice an immediate improvement. The downside of this strategy is that you may still have some noticeable scarring in those areas. Depending on how you heal normally, these scars may be minimal. Laser resurfacing can also be done as a measure after the grafts are removed to also help with the irregularities of the scalp and the scars that are created.
The other route to take, would be to continue with hair transplantation in the frontal half of you scalp. It does appear that you have adequate donor from the photos of the back and sides of your head. A repair session would most likely require initially two steps. It appears that when had your first surgery the grafts were placed very low in the corners of your hairline. At your age now and taking into account the amount of hair loss that you currently have, I would recommend bringing those corners back a little to make them appear a little more natural. The first step would then be to remove those grafts and to "recycle" them into an area on the top of your head. At the same time, I would probably break up and reuse a few of the other grafts in the very front row or two of large grafts just to create a softer hairline. Finally, and about 3 months later, I would recommend a full hair transplant session to cover your existing grafts and to recreate a new and softer hairline. I would maximize that surgery by doing 2500 -3000 grafts if possible. I would recommend the "strip" (FUT) method, as with this we would be able to get a large number of grafts and you already have graft scars on the back of the scalp from the prior surgery.
12-18 months later you can then decide if you desire an additional session to go farther into the crown and / or increase the density in the frontal region.
I would recommend looking into experienced local doctors and asking if they work much with repair cases. Most experienced docs will also have before and after pics of cases.
I hope this helps.

 

[Hair transplant plugs]

Thanks Dr. Josephitis for your response. Your approach is what I was hoping for ~ have these plugs removed and create a hairline with some coverage behind. Viewing my donor area, how many grafts do you think I have available ?

 

[Dr. Josephitis]

From your photos, it appears that your donor area covers the existing donor scars quite well. Typically, I would expect to get at least 2500 grafts in an FUT case with a history like yours. If you have great laxity and your donor density is above average, we might even be able to get 3000. Now, if you note increased scarring in the donor and / or you have slightly lower density, we may only get 2000 grafts.
I know these are all very rough estimates for you. Still, having said that with the goal in mind of softening the hairline and filling in the frontal area 2000 grafts at a minimum should accomplish this, albeit with a light coverage. Any additional grafts will allow us to go farther into the middle of your scalp. Subsequent surgeries if desired can add more density or enable us to go farther back. In general most men have somewhere between 4000 and 8000 grafts available in total over the course of their lifetime. Severity of hair loss, initial density, and use of preventative meds all play a part in that.

 

[Hair transplant plugs]

Thanks Doc for the advice. I'd be happy if I had 3000 grafts available to correct my situation. How do I check my donor laxity ?

 

[Dr. Josephitis]

Scalp laxity is really something that you will have to get the operating surgeon to check for you. You can get a subjective "feel" by moving the skin on the back and sides of the donor area up and down and to the left and right with the pads of your fingertips. If you feel that it does feel "tight," there are scalp stretching exercises available. We routinely recommend these for our patients, especially if they have had a transplant session or two already. You can most likely find a few of these scalp stretching exercise online.

We recommend doing these exercises a few times a day for as long as you can prior to a procedure. Typically this is a few weeks to a month or two.

 

[Hair transplant plugs]

My scalp feels loose and easily pinched which I guess points to decent laxity. I will do some scalp exercises to improve it before I have surgery. I have another question.
Some of the plugs are sunken in my scalp, once they are removed what happens to the holes that are left ?

 

[Dr. Josephitis]

There is a divot at the base of the grafts because they may have been placed too deeply in the scalp. This can create a shadow. When these grafts are removed, the skin is typically sutured together. This should create a nice and even texture to the scalp. There still may be a fine scars that result though. Subsequent new grafts that are placed in and around this area will thankfully easily conceal this.

 

[SOS 1980]

Hi HTP. How do you feel about having scar revisions to sort the plugs out ?

 

[Hair transplant plugs]

Hi SOS 1980. Do you mean having a strip cut from the my scalp ? Or individual holes sewn up ? Dr. Josephitis do you have experience with these types of cases ? Plus some examples of patients in the same situation as myself ?

 

[Dr. Josephitis]

Hair Transplant,

I believe the plan I described in my first post would be a great way to go with regards to keeping the grafts that are appropriate and re-using the others that are a little too abrupt and forward on your scalp.

Unfortunately everyone has a different situation and I don't have an exact set of photos with your circumstance. Still, we have done countless similar cases at Shapiro Medical Group, and I am sure you might be able to see some helpful examples in our "repair gallery"

http://www.shapiromedical.com/our_patients/patient_photo/repair_gallery/

I hope these help to give you an idea of the improvement that can be expected.

 

[Hair transplant plugs]

Your plan does sound the right approach I should take. If I were to do a skype consultation could my laxity be assessed ? Thanks for the link to the repair gallery, there are some good examples on what can be achieved.

 

[topccat29]

HTP if I were in your position I would have 5 plugs from the front removed and sutured. I would do the same with 5 extractions sites on the back. Then I would assess it over 1 year. It €™s a very safe start and gives you hope towards the future without causing additional problems for yourself.

If everything looks good then move forward with a larger procedure. It might be possible to place those grafts in front back into the original extraction sites but they also look like they have been damaged from the original procedure and it might not look natural. Maybe better to just extract the scar tissue from the donor and just suture.

I €™m not a doctor so I can only give you my opinion as just a general observer of what I have seen over the years. You don €™t appear to have very strong donor and even if you use the hair that you have what would be the plan? How would you place it and might having no hair in front be a better option?

Additionally if you go slow you will heal better.

 

[Hair transplant plugs]

Hi Topccat. I`ve been hiking all weekend with no internet access. One of the few activities I can do whilst wearing my trusted hats.

I`m at a point in my life where I want to have this hideous look fixed. I`m willing to sacrifice density to have a natural looking thin hairline that progresses back covering the area where the plugs exist. I hear what you`re saying regarding a safe approach, however with the advancements I`m seeing in repair work I feel I can achieve what I need in the approach Dr. Josephitis has suggested.

My donor supply is not the greatest which is why I feel I should go for FUT to maximise the amount of grafts in my first pass. My existing scar healed well so if my laxity is still in good shape I`ll hopefully get a similar result.

 

[topccat29]

HTP always do what you believe is best.................always.

I tend to harp on certain topics just to get the information out there. This is what is important for me to get the information out there. What others choose to do with it is up to them. I just like to give my point of view.

It's like punch sizes. I tend to harp on that issue too. Yet I see guys come back to the forum with substantial white dotting and my first thought is that looks like an awfully large punch was used. When I ask the patient what sizes the punches were they don't know. Sometimes I find that incredible.............it's like they think this is all a big joke. How can they not know the punch size. It's only after that they realize how this is going to affect their life. I'm sure you can relate to that. Can't wear a hat to a funeral or wedding and that is only getting started.

All the best to you and I look forward to following your case. It's good for the young guys to see what others are willing to do to another for money. We live in such a corrupted world sometimes. Where the greed for money has taken a hold of a large percentage of the population. It's like they are being tested and many of them are failing.

Having as much information as possible cannot be understated. Hopefully I was able to offer you something.

 

[Hair transplant plugs]

Fire away Topccat29 as more information is always a plus. I'm testament to punch size with the huge plugs I have, although this size punch is outdated now.

 

[Bigmac]

There are lots of examples of plug repairs on the Internet, many illustrating the techniques used. Take your time researching and consult with as many clinics you feel you need to. I personally would have them punched out and the grafts redistributed. This may take a few sessions. Good luck on your road to repair