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Lets talk about repair of bad hair transplants


#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Unfortunately, there is a large number of people who have had hair transplants performed by outdated methods over the past 5 decades.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It is important to devote a special thread to particular types of outdated HTs to explain the repair options available to them.
In this respect, I am devoting this thread to a particular type of bad/outdated hair transplant and how it can be corrected/treated.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)




#2
  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.

#3
  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).

I look forward to your suggestions and queries for additional treatment options available to such patients.
Regards,
Dr. A


#4

Great post Dr. Arvind. Sadly there are many many patients who fit i nthe repair category.

Depending on the patient’s donor I would say a few larger sessions using Strip to consolidate the scars in his donor if possible. Starting at the hairline place grafts in between the plugs to conceal the pitting and give a natural looking hairline with density tapering back towards the mid scalp.

Once the patient has no more laxity and can no longer do strip he could turn to FUE to fill in the crown with lighter density.

Lastly once his donor is exhausted he could use beard hair and perhaps chest hair to give more coverage in the crown.

Some questions I would like to ask. How many grafts was his initial procedure??

How many grafts would you say are available in his donor? This would give a better idea what can and cannot be done.

  • Pats

#5

Dear Pats205,
Yes, what you have suggested is one possible option.
In fact, it is the most preffered one among the patients. However, its a good idea to start with some grafts from the beard area right from the start instead of waiting till the scalp laxity finishes off.

In Bejan, there is an additional problem of some plugs that are too wrongly directed, wrongly angled and placed inappropiately in the temples.
I will upload some pictures later to show that aspect more clearly.
Regards,
Dr. A

» Great post Dr. Arvind. Sadly there are many many patients who fit i nthe
» repair category.
»
» Depending on the patient’s donor I would say a few larger sessions using
» Strip to consolidate the scars in his donor if possible. Starting at the
» hairline place grafts in between the plugs to conceal the pitting and give
» a natural looking hairline with density tapering back towards the mid
» scalp.
»
» Once the patient has no more laxity and can no longer do strip he could
» turn to FUE to fill in the crown with lighter density.
»
» Lastly once his donor is exhausted he could use beard hair and perhaps
» chest hair to give more coverage in the crown.
»
» Some questions I would like to ask. How many grafts was his initial
» procedure??
»
» How many grafts would you say are available in his donor? This would give
» a better idea what can and cannot be done.
»
» - Pats


#6

How long ago was this plug surgery done on this patient?
I ask because i think that there are some doctors there who do this sh*t even today!:frowning:


#7

Dr. Arvind,

A big question for me is, how did you evaluate his remaing donor. Can the patient have another strip? How many grafts are available via Strip and FUE?

The answers to these of course would determine what can be accomplished.


#8

hey dr A, im along term repair patient, whose donors are depleted and i dont see hm coming anytime soon, a viable alternative would be person to person transplant, either strip or fue, if the immunity aspect of it can be overcome, recently stem cells have been used for this purpose, do you see any hope for this type of procedure, otherwise im done cause i still need alot of grafts to make my hair look normal. thanks


#9

» hey dr A, im along term repair patient, whose donors are depleted and i
» dont see hm coming anytime soon, a viable alternative would be person to
» person transplant, either strip or fue, if the immunity aspect of it can be
» overcome, recently stem cells have been used for this purpose, do you see
» any hope for this type of procedure, otherwise im done cause i still need
» alot of grafts to make my hair look normal. thanks

hi scarred5,
Besides drA,I think i have an opinion about this one!!
i think person to person hairtransplant has a major problem of immunological reactions.
our body rejects all non-self objects…and MHC-HLA(antigens)lie at the core of this process…even if donor is selected with matching of MHC-HLA complex -say a sibling-it is hard to have the results unless you are ready to take immunosupressants life long…now there is only one tissue that can be transplanted without worrying about immunity and that is cornea and that is because it is avascular and its cells derive nutrition by imbibtion nd osmosis as any transplanted tissue graft does in first few days before new blood vessels are formed which bring with them nutrients,oxygen and immunological cells…thus trigerring the immune response nd you cant reprogramme these cells not to do so coz thats what is encrypted in your DNA. But yes u can inhibit them --thats what immunosupressant medications do nd that too partially!!

i dont wanna discourage u but thats what i know.

Hairlove


#10

Not only are these plugs (below the drawn line) placed too far forward in the temples, their wrong angle and direction will ensure that they will not let the correctly transplanted hair remain correctly layered to give the desired benefit.
Therefore, these plugs will need to be excised and sutured.



#11

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.


#12

» 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.
»
»

OMG!!


#13

»
»

The treatment options available in this case are

  1. Scar revision followed by trichophytic closure.
  2. Transplant scalp, beard and robust body donor hair into the strip scar.

Both the methods are viable options. However, it is good for the patient to keep moderate expectations. Hair growth in strip scar is unpredictable on one hand, while stretchback following a strip scar revision is a possibility that can not be ruled out.

Regards,
Dr. A


#14

» 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.
»
»

OMG, do you know why this happened? This is the first time I see a scar like this.


#15

» hey dr A, im along term repair patient, whose donors are depleted and i
» dont see hm coming anytime soon, a viable alternative would be person to
» person transplant, either strip or fue, if the immunity aspect of it can be
» overcome, recently stem cells have been used for this purpose, do you see
» any hope for this type of procedure, otherwise im done cause i still need
» alot of grafts to make my hair look normal. thanks

scarred5 what about beard donor?


#16

» » 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.
» »
» »


»
»
» OMG, do you know why this happened? This is the first time I see a scar
» like this.

I second that, its horrifying, how did he end up with this scar?