4 months ago, a 30 year old female came to us after a bad hair transplant. She had a facelift that repositioned her hairline. The hair transplant to restore her hairline was cosmetically unsuccessful, leaving her with an unnatural, thin, pluggy hairline.
Although we refer to these grafts as “plugs” and call the repair “plug removal”, these are actually not 4mm plugs. They are actually very poorly placed follicular unit grafts.
The patient and Dr. Mwamba decided to move forward with plug removal and hairline grafting. Because the patient always wears her hair long, she chose the strip method of harvesting. Her long hair will easily cover the scar in the donor area.
Dr. Mwamba designed a female hairline for her. The female hairline differs from the male hairline design because it goes almost straight across the forehead. A male hairline has some natural recession in the temples.
Plug removal and grafting were done at the same time. First, Dr. Mwamba removed the pluggiest grafts and used small sutures for closure. Then, 1550 strip grafts were transplanted around the plug removal sites to add density and natural details. Because we are not able to get good density in the sutured areas, this patient may need to come for a touch up session later.
The sutures remain in the plug removal sites for 4 days after the procedure. Dr. Mwamba uses a combination of interrupted and running sutures.
For this patient, removing some of the worst plugs and grafting around the remaining plugs was the best option. When repairing pluggy hairlines, patients may opt for complete removal (giving a bald look), partial removal with grafting (like this patient), or grafting without removal to camoflauge the pluggy appearance. For this patient, removal was necessary because the pluggy grafts would stand out too much among the final result.
After 4 months, you can see that the plug removal sites have healed perfectly.
Even though the majority of the grafts have not grown in yet, her appearance is greatly improved already. The absence of pluggy grafts and initial growth gives a much more natural look. As the grafts grow in and thicken the area, her hairline will continue to improve.
Before, the patient was wearing a bandana pulled forward to hide her hairline. Now, at only 4 months, she can put her bandana in the normal position to hold her hair back. Being able to expose her hairline rather than hide it may seem like a small achievement, but to people with previous bad transplant work, it makes a world of difference.
We look forward to sharing pictures as her grafts grow in and her hairline nears complete restoration. For more pictures and larger, more detailed versions of the pictures shown here, please visit the photo gallery at mywhtc.com
