Hair transplant surgery was started in the U.S. in the late 1950’s and for many years the results were slightly unnatural due to the large size grafts that were used. Unfortunately, much of the public’s impression of hair replacement surgery comes from seeing these people walking around. Since around 1990, almost all procedures have featured much larger numbers of very small grafts, which don’t appear “pluggy”. Very refined technical methods for repairing these old grafts are now available.
Approximately 15% of the procedures we perform in our practice involve the repair of persons who had their original hair transplant work done during those years and are now seeking to have this converted into a “softer”, more natural look.
Virtually everyone who was transplanted in that era can now be made to look much better with these corrective techniques. I will describe some of these new methods and show some patients’ results. These techniques enable the surgeon to bring about this conversion from harsh and “pluggy” to soft and natural.
In the majority of these formerly transplanted patients the big problem is the appearance of a “wall” of dense plugs either right at the hairline itself or just behind it. I believe that in these patients the correction is best done using a two-prong attack: first, by placing many hundreds of follicular unit grafts in front, using only 1- hair grafts at the very front, and then quickly going to the 2- hair FU’s just behind the 1- hair ones.
First, by placing many hundreds of follicular unit grafts in front, using only 1-hair grafts at the very front, and then quickly going to 2-hair FU’s just behind the 1-hair ones.
Second, we are able to use the “Lucas Technique,” which is a method proposed by the late Dr. Manfred Lucas of Germany, in which 3-6 hairs are “slivered off” from each large graft, thus resulting in a smaller graft that doesn’t look so “pluggy.” These hairs that are removed from the larger graft are then cut into micrografts and are moved to another space where needed. Thus, in summary, our approach is to both “break down” part of the “wall” and to soften the area in front of it at the same time with the placement of additional small FU grafts. The following photos show how this was accomplished in a 39 y/o male who came to us, with no more available donor hair available for harvesting.
These restoration projects usually take around two sessions to completely finish. If one is too aggressive and tries to do too much all at once, not respecting the limits of the scalp’s blood supply, then whatever is done will not grow fully. Two examples of correcting “pluggy” crowns can be seen below: The first patient is the same one as pictured in the correction of the frontal hairline above.
With the recent swing by some clinics to using 1-2 hair grafts exclusively to perform transplants, we are now seeing patients who come in complaining that their transplant result is “too thin” rather than too pluggy. In these cases, we carefully insert very small “slit minigrafts” of 4-5 hairs each into the tiny remaining spaces centrally and, at the same time, additional FU’s within the proper border FU zones, insurgery aftersurgery aftersurgery after order to increase the density of the scalp’s hair, such that the skin of the scalp cannot be seen. The following photos show such a patient who had 2 “all-FU” megasessions for a total of 3000 grafts elsewhere, and the results obtained by us with additional FU’s having been placed at the borders and small “slit-minigrafts” (double and triple-FU combination grafts) in the mosurgery afterre central area:
In our gallery of corrective cases, you can view many examples of transformations we have accomplished for these patients who had older transplant techniques.