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Lets talk about repair of bad hair transplants

Dr Arvind

Dr Arvind

Valued member
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#1
Dear forum readers,
Unfortunately, there is a large number of people who have had hair transplants performed by outdated methods over the past 5 decades. Probably, hundreds of thousands. Even today, at a very conservative estimate, I would say that a hundred wrong/bad hair transplants are performed, worldover, each day, for every correct one.

It is important to devote a special thread to particular types of outdated HTs to explain the repair options available to them.
In this respect, I am devoting this thread to a particular type of bad/outdated hair transplant and how it can be corrected/treated.
Please note that there are numerous options available to correct the predicament.

I would welcome treatment suggestions and inputs from fellow HT doctors as well as forum readers.

Let us document the different options available to this patient (nickname - Bejan)





 

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janna

janna

Invaluable Member
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#2
Hi Dr. Arvind,

I agree with you that there are way too many out dated work being performed each day and it's a great idea to dedicate a thread to it. Perhaps we should request a "Repair Work" section of its own here. In any case, great topic starter!

We encounter repair cases similar to your pictures and the way our doctors have approached the repairs is to punch out the most noticeable plugs, especially at the hairline, dissect the punches and redistribute them properly in another area in need of hair. Since the crown takes so much hairs to cover and you are not likely to make it dense enough to cover all the plugs, those plugs will need to be punched out and redistributed as well. Sometimes if there are too many plugs that need to be removed, another session or two of punch outs will be scheduled so that a proper ht session can be performed in the future. This will be dependant upon patient's donor supply and his goals.
 
Bigmac

Bigmac

Administrator
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#3
Great post Dr A.

Looking at the pictures it appears the pluggy grafts are exiting the scalp in an upward direction,they will create a problem if you were to leave them and plant new grafts around them as they will always look un-natural.

Therefor i would have them punched out and re planted elsewhere.If he has good donor which it looks like he does i would concentrate on the frontal third giving him a nice age approprite natural hairline.

The pluggy grafts in the crown could also be punched out and used elsewhere.If donor allows i would have a second surgery to address any issues with the frontal third and to give a light coverage in the crown to hide the scarring from the plug extraction sites.

Dr Arvind,have you any pictures of his previous donor scar.

Thanks for posting.

bm.
 
Sparky

Sparky

Valued member
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#4
A repair section would be mint on this website that has no hidden agendas. I'd post my full case.
 
J

JJ09

Member
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#5
Great post! I'm another patient with outdated procedures...it would be good to get some opinions on the options available to me too.
 
H

hairtech

member
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#6
Another option is to not punch out the plugs entirely... but to thin the plugs by punching out a few hairs within the plugs then adding grafts around the plugs. ;)
 
bullitnut

bullitnut

4 awesome repairs with SMG
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#7
Sparky wrote:
A repair section would be mint on this website
i agree!! any chance of this BM?..... would be a cool idea and would help lots of people imo;)
 
D

dominik

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#8
I had a similar bad HT experience. Hairs were transplanted in my temple regions in bundles of 2-4 hairs in one plug which gave me a completely unnatural result, pluggy appereance which anybody could notice. But in the package with this i got also two 1 cm thick bad strip scars in the back of my head which i had to cover having long hairs. The whole procedure was extremely painfull during and after the treatment..

Of course i wanted to get rid of this look so after wondering a while i went to Prohair clinic in Belgium. I was a bit tense in the beggining of the operation because i expected again pain during the anestesia application and also after. But at this clinic they managed to develop a method by which this procedure is basically painless! And not just comparing to my HT experience before but also some other medical procedures, like dental surgery. Honestly, i couldn ´t belive it, the thing was as stressfull as brushing my teeth (you do feel a bit but on a scale of 1 to 10, i give 1). Incredible. Of course once the anestethic kicked in i didn ´t feel anything. Now i am maybe ten days after the treatment. I had 2600 grafts inplanted in the front part of my scalp (including temples) also in between of my old grafts. 6 days after the OP all my crusts went away and the swelling was gone so if i haven ´t had scars at the back of my head i could have this haircut forever. Plugs are invisible since they blended with the added hairs and also my previously unnatural hairline looks great since it was filled with densly packed hairs. And the whole thing wasn ´t such a big deal, so much troubles viped out so easily, i still cannot belive it.

Guys i tell you - go to Belgium, you will get rid of your problem in such elegant way tha you won ´t belive it. I am not advertising, this is my own 100% pure experience, this people are really experts.You won ´t regret it.




 
M

michaelmast

Member
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#10
Hi, I'm from CR do you know any specialist could help me with my problem?




Yea quit smoking those cigars you keep linking to;;Dbm
 
D

dominik

Valued member
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#11
just go on their web site,you can ´t miss it. 2 strip scars on behind the head, front temples pluggy grafts.this is for before. for after we will still have to wait a bit..
 
W

wylie

Valued member
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1
#12
On the left temple, I would punch out the 6 plugs just forward of the temple. The top row of plugs likely could be reinforced with a traditional transplant and disappear. So assuming this patient wanted to go forward with his hair transplant, his best option is to use his remaining resources to reinforce the front of his hairline.

The crown would be best served, I believe, with a complete removal of the plugs. I think this scarring could be concealed but that bald spot is very likely to get larger and concealment of these probably is not going to be an option. I'd say removal is your only choice unless you were planning on also adding to the crown.

That might require more donor and/or investment than the patient wants to commit to, so again, removal is the best option IMO
 
Dr Arvind

Dr Arvind

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#13
The problems

1. The obvious large plugs
2. The visible scars, cobblestoning or pitting at the base of these plugs if the hair on the plugs are simply shaved off.
3. The shotgun scars in the scalp donor area (makes it impossible for the patient to try shaving off the entire head).
4. Donor depletion, of course.
5. Wrong angles and directions of the hair growing in the plugs (99% of the times, the plugs were placed vertical to the scalp skin resulting in hair growth pointing to the skies).
6. Wrong area of placement. The plugs are placed in an inappropriate location.


-----------------------------------------------------------

The Options available

1. Shave off the hair on the plugs. Works in rare patients that have minimal scar visibility at the base of the plug.
2. Excise the plugs and suture close the wounds. This makes a big improvement. Plus the hair thus obtained can be transplanted into the shotgun scars in the donor area. This is hair transplant reversal. This is a good option but I have found very few patients opting for this. Actually only 1 in the past 13 years.
3. Extract hair from the plugs by FUSE/fue method. Basically, thin the plugs to oblivion. This takes multiple sessions to extract all the hair. The extracted hair should, of course, be used. Either to fill in the donor area scarring or the bald area of scalp.
4. Drown the plugs in a flood of follicular unit grafts. This is the most favoured option chosen by patients. However, it has its own delimmas mainly on account of the incorrect hair direction and angles in the plugs.
The grafts for this option could either be taken by
- a) strip FUHT (this will have the additional benefit of taking out a large chunk of donor area shotgun scars),
- b) FUSE/fue grafts from the scalp, beard and robust body donor area (there will be the disadvantage of having less grafts available from the scalp donor areas AND the scalp donor shotgun scars being visible for a couple of months due to the fact that the scalp donor area will need to be buzzcut),
- c) A combination of the above (usually for patients who want to maximize the graft numbers).


 
J

JJ09

Member
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#14
If I was the patient my preference would be to extract hairs from the plugs, either all or just thin them out using the FUSE method depending on whether the direction of hair growth is suitable, as from my own experience €¦plug placement is flush with the existing scalp and if the hair is course €¦the hair €œwill € point towards the skies, it would be difficult to place the plugs in any other manner to allow for a more natural look (thank development of new techniques for the abolishment of plugs). Abolishment? Well, I hope so.

I would then follow up with a FUHT and FUSE combination and personally €¦utilise some beard hair to assess its outcome.
 
Dr Arvind

Dr Arvind

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#15
This is a recent example of another patient (nicknamed Repair262),who came to us for repair after undergoing a "hair transplant" somewhere else.

Apart from the routine mistakes, what amazed me was the strip excision scar. I frankly do not know what the operating doctor did to be able to give such a scar.

 

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Bigmac

Bigmac

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#16
This picture is sad,that poor guy having a scar like that.

Dr Arvind,how long ago was this patient operated on to give him that scar.Also,as he is now your patient,what have you been able to achieve for him.

Thanks bm.
 
Nervousnelly

Nervousnelly

The Coolest Member
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#18
Ofcourse every case needs to be addressed seperately but I do concur with the obove options for this patient in the photos.

Unfortunately for the patient the "staged" approach where so much work is done at a time and likely multiple sessions are needed is very scarey and possibly why most will go with the barrage of follicular units to surround the plugs if it is an option. We all want the quick fix (likely what got us in the mess to begin with).

Just thank God that there now are options to correct poor work. The key now is to educate the hell out of future patients so that poor HT clinics are forced to close. I still shutter at the endless advertising of Bosley.

NN
 
Dr Arvind

Dr Arvind

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#19
Dear BM,
Unfortunately, the patient Repair 262 got his "HT" performed from a plastic surgeon in 2009.
I think it is wrong to assume that since better techniques are available now, we would not see bad hair transplants from newer doctors.
Quite the contrary in fact.

We did a scar revision cum strip FUHT for this patient a few days ago. I will share the result in due course of time.

Regards,
Dr. A