It has been estimated that between 30-40% of old hair transplants have required fixing. This large percentage results directly from the poor techniques used before the mid-1990s, after which the quality of work improved greatly at professional and skilled clinics. Though it may be difficult to gain the trust of past victims of poor procedures, good surgeons and clinics today have been doing a remarkable job at repairing the flaws of the past with the skills of today.
Some of the many reasons a repair may be needed are listed here:
- Pluggy (too large) grafts
- Hairline problems
- Unrealistic coverage attempts
- Cobblestone effect
- Hair wastage
The use of large plug grafts prior to the mid-1990s resulted in the doll’s head look. This situation does not occur with today’s technology, and the problem has been completely resolved. The issue occurred when large plugs of hair were placed into a bald area, and they subsequently contracted in size. If all the hair survived the surgery, this resulted in a higher hair density in the plugs than the surrounding hair. If the donor area was sparse, the surgeon had to choose between a pluggy look scattered over a large area, or an uneven look with hunks of hair surrounded by empty spaces. Either way there’s an aesthetic problem.
Thankfully, the strip harvesting and follicular unit extraction methods used today solve these problems entirely and can indeed repair the poor surgeries performed in the past. However, other issues can still need repair today if done by an inexperienced surgeon, and these are described in more detail below.
Hairline problems are another common concern of poor surgeries. There are four basic types of hairline problems that prevent a natural look. Each of these situations results from poor placement during the surgical procedure, and each cause a different problem.
- Hairline set too far forward: If this occurs it may not be able to be remedied. This is a common mistake of the inexperienced surgeon who sets the hairline to the adolescent rather than the adult position. This not only distorts the natural proportions of the face, it also sets the patient up for failure, since it sets the bar too high for sustainable coverage as aging continues.
- Hairline set too high: Even though the grafts are comprised of follicular unit grafts with single hair in the front along the hairline, it still looks abnormal. Placing the frontal hairline requires artistry and practice.
- Hairline too broad: The normal adult male hairline occurs about one finger width above the upper brow crease than the male adolescent hairline does. If too broad, it the hairline will appear awkward and unnatural.
- Hairline askew: The natural hair direction of the patient must be exactly adhered to in order to result in a natural look. Some surgeons erroneously plant all hair perpendicular to the scalp and this results in a distinctly unnatural look. The hair should be placed pointing forward toward the horizon at the front then gradually set at an angle as work progresses backward.
Unrealistic coverage attempts result when donor hair is limited, making it a real challenge to distribute properly. Some unethical surgeons add grafts where not necessary calling these preventive hair transplanting. This pushes fees higher. Others plant behind the targeted bald areas to increase fees. This can actually be damaging to the hair and may even cause hair loss. Under no circumstances should grafts be applied where not needed.
Ridging is the result of the older mini-graft and larger graft techniques of the past. This does not occur in modern hair restoration. When an area of heaped up skin at the frontal hairline where the plugs were placed, it causes an elevation of extra tissue separating the forehead from the area behind. When the ridging is made worse by a reaction of the surrounding tissue this is called hyper-fibrotic scarring which accents the abnormal contour of the treated area.
Cobblestone effect is another unattractive result, which occurs when too much tissue is implanted with the hair follicle. To avoid this it’s essential for the surgical team to cut the FU’s correctly, which helps minimize the risk of this issue. However, the main way to avoid a cobblestone effect is to find an experienced surgeon and surgical team, who should be skilled enough to avoid it completely.
Scarring is a universal phenomenon that occurs as the result of all surgery to some degree. However, if the scarring is made to be invisible and it does not impact hair growth, it’s not considered to be a problem. Visible scarring is usually caused due to surgeon error by harvesting donor sights too near the lower hairline at the nape of the neck or when grafts are placed in the non-permanent zone. when the scarring is severe and visible, it becomes a cosmetic problem for which there are remedies.
Hair wastage can be avoided with careful surgery and a good surgical team using modern microscopic or magnifying harvesting. Wastage in the hands of an inexperienced surgical team can be as high as 50%. Other causes of hair wastage are the following:
- Substandard graft harvesting and dissection
- Improper graft storage and handling
- Keeping the grafts out of the body too long
- Improperly preparing before surgery
- Improperly caring for the area after surgery
Probably the worst consequences of hair wastage is that it leaves the patient with less hair if future transplants are needed as well as only being able to either cover a small area or produce low density and unnatural result.
Overall, today’s modern techniques do not result in needs for repair unless the surgeon or the team of assistants are inexperienced. This is a marked change from past decades when even experienced surgeons had a difficult time producing a natural-looking head of hair via restoration. Most often, then, repairs are required as a result of surgeries before the mid-1990s .If a patient is unsatisfied with results from such surgeries, consulting with an experienced clinic on the new methods of treatment is highly recommended and will often provide significant relief for the concerned patient.