Fixing Bad Hair “Plugs” With Recent Hair Transplant Techniques

By Robert M. Bernstein M.D., F.A.A.D.

The Old Way of Hair Transplantation

When hair transplantation first came onto the scene, men and women with thinning hair or bald scalps (who had been hiding under their hats and scarves for years) finally had some hope. Those who could afford this new technology ran to the first doctor who claimed they could cure their baldness.

Unfortunately, the technology, which seemed advanced for the time, could often result in pluggy, unnatural looking hairlines. For many who had these baby doll transplants, the results were both cosmetically and psychologically disastrous.

Older methods of hair transplantation included punching out circles of hair-bearing scalp that were then moved to the balding areas. Practices such as scalp reductions (literally cutting out the balding areas of scalp and raising the two sides of hair-bearing scalp toward the center) often left long visible scars. For a time, there was also the method of planting synthetic hair directly into the scalp and then surgically sewing it beneath the skin, a procedure that is now illegal in the United States. This latter was a short lived experiment which caused the hair to be rejected and the scalp to be severely scarred.

Problems with the Surgical Procedure

The older surgical procedures presented numerous cosmetic problems, the most common of which were the large, unnatural look of plug-grafts. These punch graft techniques of hair transplantation also tended to leave circular scars throughout the donor area (the donor area is the area of scalp where the hair is harvested from for the transplant). Other problems included poor hair direction, inconsistent hair growth, and a generally unnatural look to the hair restoration procedure. In many cases the results were so bad that patients were left wishing they were bald again.


From Old to New

With the introduction of todays state-of-the-art techniques there are now ways of not only restoring hair in a natural way, but also of repairing and redesigning the results of the older techniques. Procedures such as Follicular Unit Hair Transplantation (FUT) are able to address the issue of transplanting hair without the consequence of unsightly scarring.

Undoing the Damage

Reversing the unnatural appearance of the older plugs and repairing scars is obviously more involved than using the right technique in the first place, but it can be accomplished in most cases with excellent results. Addressing the repair of existing scars requires finesse and careful assessment of the problem area as well as the remaining donor supply. Choosing the correct restorative technique is critical as the wrong strategy can make the situation worse.

Different techniques must be used to resolve different problems. Large plugs can be removed, divided microscopically into individually follicular units and placed back into the scalp in a pattern which is much more natural in appearance. Smaller grafts can be camouflaged. Scars that are raised can often be helped with cortisone injections. These can help to decrease the inflammation which is often present in a raised scar. Sometimes excessive scar tissue can also be excised and removed in itself, particularly when associated with poorly positioned grafts of hair.

The Proper Way to Transplant Hair

A lot of improvements in scientific techniques, medical developments and methods of artistic design have been made since hair transplantation was first introduced. Todays hair transplant techniques can mimic the way hair grows in nature. The most important advancement is the identification of naturally occurring tiny bundles of hair called follicular units. This discovery has been fundamental to the major advances in literally all of the surgical hair restoration procedures used today.

These methods not only enable the physician to produce results that mimic nature but provide the hair restoration surgeon with the tools to actually fix the problems of old unsightly grafts and scars. The number of people who will benefit from hair transplant repair techniques will continue to grow over time as more people become aware that the older procedures can actually be corrected.

With the introduction of Follicular Unit Hair Transplantation (FUT), a technique that transplants hair in its naturally occurring groups of follicular units, patients are able to have much more predictably natural results. The technique, however, requires substantial knowledge and skill and is performed well by only a limited number of physicians. Thorough research is important in picking the best physician for the job. The decision to have this or any cosmetic procedure should never be rushed.

Hair transplantation has changed dramatically since the first cases were performed. We have now gone beyond the Wild West days of the old hair plugs and there is new hope for people who have been harmed by bad hair transplants. Most importantly, with adequate research in finding the proper surgeon, now there is a much better chance to get it right the first time around.

About the Author: Robert M. Bernstein M.D., F.A.A.D. is Clinical Professor of Dermatology at Columbia University in New York and founder of the

New York Hair Transplant

facility: Bernstein Medical – Center for Hair Restoration. Recognized world-wide for developing Follicular Unit Hair Transplantation, the procedure that has revolutionized modern hair restoration surgery, you can visit his award winning

Hair Transplant Blog

for answers to all of your hair loss questions.


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