is now a well known method to hide old hair transplant linear scars. You can view many before and after photos on my website. Nowadays there is an uptick at my clinic in Los Angeles where I am seeing many unhappy patients with FUE scar. These unhappy patients are finding out FUE is NOT a scar-less or “no scar” surgery often advertised on the Internet and misrepresented by their doctors. Look at the FUE scar before photo and Scalp MicroPigmentation treated after photo. The before photo shows the result of a mottled, moth-eaten appearance, the consequence of a about 1000 graft FUE session. This condition which is now springing up all over the world as more clinics offer large FUE sessions ranging up 3000 or 5000 grafts a session. There are reports of skin necrosis and open wound infection. If you add up the total wound from a 3000 graft FUE surgery the collective open wound would be the size of a baseball. Imagine a bleeding open wound the size of a baseball on the back of your head. When you put it this way, FUE is not necessarily a minimally invasive surgery after all. While I’ve always been an advocate for large “Mega-Sessions” during the 1990s with strip surgery, you must think twice about FUE Mega-Sessions. These large FUE Mega-Session depletes the donor area and many men often complain about the see-through look on the back of their head. In an attempt to avoid a linear scar, these patients inherited another set of problems. In certain cases, the FUE scars can be treated with Scalp MicroPigmentation but the low density issue still remains. In my practice we try to limit the FUE session well below the 3000 graft range to avoid the moth eaten appearance of the resulting FUE scar.
Can I have a Scalp Micropigmentation (SMP) and later a hair transplant surgery? What if I want to grow out my hair as well? I don’t want to always keep my hair shaved.
You ask a great question! We have been combining SMP with hair transplant surgeries using FUE or Strip FUT. After all we are a medical practice that specialize in all aspect of hair restoration!
This patient came to us with a old hair transplant surgery scar. He had a strip FUT surgery which didn’t really give him a full head of hair and he just gave up with the idea of having a full head of hair. But he had the strip scar which he couldn’t hide when he decided to cut his hair short. So he went to local doctor for FUE to the strip scar. As we tell all our patients, FUE to the strip scar doesn’t really give perfect results when you are looking to shave your head. So he ended up with MORE SCAR, many ‘punctate scars’ from the FUE surgery. Needless to say he was angry and was very skeptical when he came to see us. We didn’t blame him. He didn’t trust any doctors at this point. Although Dr. Pak thought he would be a great candidate for the SMP procedure, he actually turned him down because the patient’s expectations seemed unrealistic with a bad attitude.
Eventually, the patient came back for another consultation and even saw other SMP patients in person at our monthly Open House Seminars (where prospective patients can meet with former patients and see an actual SMP or Hair Transplant surgery taking place).
This patient eventually had SMP to the entire scalp and covered his FUE scar and strip scar with great results. In the process he came to know and befriend Dr. Pak to trust his work. So after about a year he came back to Dr. Pak for a FUE procedure (about 1500 graft) to add density to the top and soften (corrective surgery) his front hair line from the old transplant work.
While the FUE transplant didn’t give him the full density, the SMP provided a cosmetic benefit to provide a look of fullness. Now he has the option to shave or grow his hair out long.
This patient had one Scalp MicroPigmentation (SMP) treatment on his hair transplant scar. The AFTER video was taken immediately after SMP, so you can see some redness on the scalp, which will go away in a day or two.
In general, SMP to a scalp scar takes two to three sessions. The patient above will come back in one week to make sure everything blends in. The redness you see in this patient is due to the fact that it was taken immediately after it was done and there was a little bleeding present. He will be able to shave his head or keep his hair long without worrying about the scar. For more information you can visit scalpmicropigmentation.com or email us at email@example.com. You can include a photo of yourself for a consultation. The most common questions asked about SMP can be found here.
I had bad hair transplant surgery 3 years ago and its bad looking. I made it in the front hair line with 1 to 1.5 cm width. it consists of plugs and scarring that make the skin bad looking, elevated and thickened. please tell me how to remove this. many thanks
Unfortunately, there is no way to completely remove the scarring from a bad hair transplant, but there may be options to make it “better”. It’s imperative that you do your own research. You need to first find another hair transplant doctor (one you can trust), then consider another surgery if it is recommended. In the end, it will likely end up costing you more money and time, but hopefully you’ll find yourself satisfied with the end result. Plugs are not the industry standard (and have not been for many years), so to have a surgery like that done just a few years ago is troubling.
For transplant surgery repair, each case is unique and there’s no single solution I can provide without examining your scalp and knowing more about your situation. If you live in the Los Angeles area or are planning a visit this way, you can give my office a call at (310) 553-9113 to schedule a private consultation or come to one of our monthly open house events. These events are free to attend and provide attendees with the opportunity to meet patients that had restoration done.
Here’s a story about a patient that has had four total hair transplant procedures — procedure #1 and #2 in 1995-1996 with us totaling 3286 hair grafts, procedure #3 with another doctor a couple of years ago of 1000 grafts, and finally procedure #4 (to fix procedure #3). This gentleman continued to lose hair after his first two procedures in the mid-1990s, and although he did not like what was happening to him, he was reluctant to have another procedure.
That is, until he saw an advertisement for hair transplants at $2/graft. At that price, he decided that one more surgery would solve his problem. Unfortunately, this cheap procedure produced a harsh, detectably grafted hairline which made him never really satisfied with the final results. He came back to us to correct this harsh hairline to some degree about a year ago with one of our standard hairline repairs, but he still did not like his look and the larger grafts from procedure #3 still showed.
We are all torn between what we hope to achieve and what we really end up achieving, and progressive hair loss during the treatment phase does not help the problem. This particular patient had unrealistic expectations and that is why he went to another doctor who, based upon promises, sold him a procedure that just made him angry with himself for falling for a sales pitch. As planned, after the repair of the frontal hairline that we performed a year ago, he came in for Scalp MicroPigmentation (SMP) about a month ago and told me that he is now euphoric with the results (today was the last SMP procedure).
“Why didn’t you offer me this 15 years ago,” he asked. I told him that it was not available until three years ago. “Innovation moves at its own pace, driven by problems that need solutions,” I told him. This innovation took time and the right circumstances to find its place in our treatment regimen. He continued to discuss the personal toll that he experienced with his hair loss and his recent dependency on surgery to fix something that he did not like. “It was not pleasant, but now things are different,” he continued. And he can put the entire hair loss experience and the toll it took on his self confidence behind him. It was rewarding to hear this from him, so I decided to share it with our readers.
Many people can not achieve their goals of a perfect end look because they either:
- don’t have enough hair to cover the balding area
- their balding pattern is advanced and the supply/demand equation for hair does not math out, or
- they continue to lose hair without a Master Plan that took into account the progressive nature of the hair loss.
Scalp MicroPigmentation bridges the gap for many people who fall into the above categories. Doctors want to believe that given enough money, every person that they treat can get a full head of hair; however, nothing can be further than the truth.
I continue to write this blog because it is an important part of our practice, educating patients and bringing them to understanding what is happening to them. At the last ISHRS physicians meeting, I was told many times that the doctors in this industry read my blog and that it has become a resource for them when dealing with their patients. That just adds to our (editors) satisfaction in knowing that this blog is a good community service.
Dear Dr. Rassman:
I am a 45 year old male with obvious hair plugs. I had two sessions done back in 1993. In considering all of my repair options, I would like to just be naturally bald. I wonder the hair transplanted can be removed. I am not interested in additional grafting. I like to be bald. Thank you.
Shaving your head will probably bring out the pitting in the recipient area that often accompanies the old style of hair plugs. We have developed a process call Scalp MicroPigmentation (SMP), which works well when the hair is clipped very short to make you look like a normal fellow with a shaved head. The pitting I mentioned is often hidden by this process, but I would have to see you to tell you what can be done.
Here’s an example of a patient that had SMP done to hide his plug scars in the donor area. The photo was taken immediately after one session.
If you are not in California, send some good photos with multiple angles to the email address on the Contact page and I will try to give you an opinion over the phone.
The pluggy hair transplants of the 1980s and 90s, and even the strip surgeries in the years following that, caused considerable scarring in some percentage of patients. Few of them complained unless their donor area was depleted from multiple surgeries so that long hair would not cover it. Even today, scars from follicular unit extraction (FUE) are causing problems for some patients who have had donor area depletion. I’ve seen a few men for consultations recently that have shown a see-through appearance at the back of their heads, asking us what they could do to help make this less noticeable, and prompting me to write this post.
The best solution for unmanageable scars was introduced by us in 2010 — Scalp MicroPigmentation (SMP) — and it can be effectively used to camouflage scars so that they can be made undetectable. Scars are more of a problem when patients have multiple surgeries, each surgery adding to the amount of scarring.
In the past, we have recommended scar revisions with variable success. Usually the scar would be reduced following the revision, but the biggest problem we found with this solution is in the patients who get poor scarring after strip surgery, get it because that is the way they heal. So when trying to repair it, we found limited value with occasional good results, but always leaving some level of detectable scar. There are people like me (three strip surgeries and no detectable scar) who heal very well, but there are some that aren’t as lucky. Treating these scars with SMP seems to always work regardless of the patients tendency to scar.
We’ve posted some outstanding results in the treatment of scars of all types and this is usually what happens to all patients, not the select few shown on this website.
Is it possible to smooth out just a small area where old hairline used to be that was damaged from surgically removing old plugs? I am a 45 year old male who had a hair transplant in 1984. I had one session (47 plugs, about 8-10 hairs each plug) around the frontal-hairline part. I did not like it as the result was not what I had expected so did not go back for another one.
In 1988 I had all of the plugs surgically removed. For the most part it looks ok except for the right side above the right temple but close to the forehead. In certain lighting you can see the scarring and tell that it was where the old transplant hairline was as they fall in or pitted is the word used to describe it (where 5 plugs were removed on this side). So instead of having cobblestones I now have the opposite.
I would be interested in seeing if just this area can be improved by either laser therapy to smooth it out or to do a surgical scar repair and pull the skin tighter on these 5 only or any other recommendation? If it improved just 50% it would be a great improvement. I would not be interested in another hair transplant. I keep my hair long enough so the donor area is ok as is.
Also, would massaging this area help smooth it out or make it worse? Thank you and your site is amazing and very much appreciated.
In general, scalp scars (or any scars really) are very difficult to treat. If there is something that can be done, it would involve understanding that the outcome will not be perfect.
You are asking a very specific question for a case that is likely quite unique. You would need to visit a doctor one-on-one and have him/her examine you for their assessment and recommendations. Since you indicated that you’re in New York, you could check with Dr. Robert Bernstein.
Iam 64 yrs old. I had transplants done in the early 80’s. Donor hairs from the back of my head to the front. In time the rest of my hair from the top fell out. The transplanted plugs looked ugly and I resorted to wearing a hair piece. I recently started to shave my head and I like it except for the scarring on the back of my head and the in front of my head where the plugs were inserted and hair grows. What can be done? The shaved look is really in style and I don’t want to go back to using a hair piece.
Your options are very limited, unfortunately. The plugs can possibly be removed, but you’ll still be left with scarring in that area and in the donor area at the back of your head.
Scalp Micropigmentation could be an option for covering the scars from old plugs. Many men with bad plugs and bad hair transplants have opted to shave their head and cover the scar with SMP, giving them the appearance of a closely cropped hairstyle. Each case is unique, but I doubt you’d be able to completely remove scalp scarring.
This patient has dark hair and white skin, and visited our office to repair his hairline. He had the old pluggy hair transplants that were common in the 1980s and 90s. He’s a Norwood class 6 pattern with slightly wavy, fine hair.
The repair took 2 procedures totaling 3401 grafts. These pictures show the entire story of building a frontal transition zone in front of the old plugs to camouflage and hide the deformities. He is very grateful that he now has a natural looking hairline, recently stopping by to say hello and show me the results of his repair. Click the photos to enlarge.
Before on left / After hairline repair on right:
Left– Another angle before repair / Center– 8 months after 1st session / Right– Less than 4 months after 2nd session:
I have had 5 hair transplants. All were done by way of the strip method and I am very pleased with the ultimate outcome. However, the linear scar from my 4th surgery is horrible. It is very wide and red. The scars from my prior surgeries and the one subsequent surgery look fine. Because of concerns about elasticity issues, between the 4th and 5th HT I did scalp exercises to improve the donor elasticity which I found on Youtube. My Doctor said that the elasticity between my 4th and 5th surgeries was greatly improved and attributed it to these exercises. With this improvement, I am considering a scar revision with the hopes that the scar from my 4th surgery can turn out like the one from my 5th surgery. Is this realistic?
Lastly, in general would you recommend a plastic surgeon for the scar revision or a hair transplant Doctor? I traveled some distance to have my last hair transplant and don’t plan on making this trip again for a scar revision so I would look for local Doctor to do this procedure.
Thank you for your time
Scar revisions in the hands of an experienced surgeon that deals with hair transplant scar issues on a regular basis is generally better than a plastic surgeon for this type of work. Experience is everything in this process. I don’t know what is realistic to expect, as each case is unique and I haven’t seen you.
If you want to find a doctor in your area, I’d suggest using the physician search at ISHRS.org.
I had my first hair transplant in the mid 1980’s with punch grafts and over the years i have had micro grafts and more recently single grafts taken from strips. the old punch grafts were removed and then re-implanted via single grafts. My hairline looks pretty good but i am now losing a lot of hair on my crown but have very little donor hair left do i have any options?
Donor hair is finite and many people in your situation have depleted donor supplies with significant donor area scarring. More surgeries will often make the scarring worse. I see people like you all of the time and lately I have been seeing more of them. Everyone is different and an individual assessment based upon remaining donor supply, donor area scarring, the existence of old “plug grafts”, hair color (graying is good), and hair characteristics all must be considered in the equation on what to do.
I could write a book on this, but this is not the place. I would suggest that you find a hair transplant surgeon with a lot of experience in repairs.
To many people that aren’t familiar with the advances made in hair restoration, “hair plugs” are still the norm. There’s nothing pluggy looking about today’s hair transplant procedures, but those bulky hair plugs of yesteryear were easy to point out and looked incredibly unnatural. I saw a patient that had an unusual placement of these old plugs and was looking to correct it.
This patient first came in about a year and a half ago with a large bald area and old-style transplant plugs that were placed far too low on the right side of his hairline. I suggested that he fill in the frontal area, and he also wanted additional grafts placed into his balding crown. A total of 1919 grafts were transplanted.
You’ll notice that the achieved result shown below is an uneven, but fuller looking hairline (we were limited to what could be done because of the placement of his old plugs). He recently came in to see me again lower the frontal hairline and I agreed to lower the left side a little to balance it out. I remembered how much he hated the plugs on his right side when we first met, and now we succeeded in managing the plugs with styling and camouflage. While that 2nd procedure hasn’t happened yet to even out the hairline, I’m glad he was so happy with the results thus far from the repair and he’s allowed me to share the photos here.
Before photo on left / After photo on right. Click to enlarge.
This is a Norwood 6 patient who had a hair transplant done at a clinic in Europe in the 1990s with the old pluggy technique. He wanted to shave his head, but the old hair transplant donor scar and the visible plugs were a problem for him.
This patient chose a combination of (1) SMP to camouflage his old scar, and (2) the surgical removal of his old plugs. The hairs that were in the plugs were redistributed into the crown. We also transplanted a few hundred FUE grafts taken from the donor area and used them on the top of the scalp. As he does not live in the United States, he will return at his convenience on another visit for the needed touch ups. He will likely go on to cover his entire head with SMP, may also undergo more FUE grafting into the frontal hairline, which will make it appear even more natural.
At the point I last saw him, the patient was very satisfied with removing his old plugs with FUE and having SMP done into the old scar. He can stop here if he is satisfied with the result, but I anticipate more work to be done. The after photo shows the temporary redness common just after surgery. We will keep you posted when he returns to the US.
The before (left) and after (right) photos show a work in progress. Click photos to enlarge.
What if my transplant is bad and I’m scarred badly?
I really don’t have enough info about what is bad about your transplant, but since I’m sure I’ve answered questions about repairs before, perhaps another physician’s opinion would be valuable to the readers of this site. Coincidentally, I recently read a post on the IAHRS site from Melike Kulahci, MD that answers your question about corrective procedures — Is It Possible To Have a Normal Looking Head After a Bad Hair Transplant?
Side note: I have met Melike Kulahci, MD at the various physician meetings and she is clearly one of the outstanding doctors in this field today. We have shared some stories from time to time and we agree on most of the clinical issues before us.