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All Repair related posts


I had a procedure of 3000 grafts placed in the front and now 8 months later, the hair that grew out stands straight up like toothpicks coming out perpendicular to the scalp. Can this be fixed?

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ToothpicksThe direction that hair grows after a transplant is determined by the transplant surgeon. Some doctors place the hair straight upward reaching for the sky like you reported, while others place them in a radial direction so that the hair looks like the spokes of a bicycle wheel. Some hair restoration procedures (like those of flaps), have hair that grows 90 degrees off pointing to the side. In all of these situations, the transplants or flaps permanently point the direction of the hair.

These are tricky repairs and most of the time the repairs are not able to correct the entire directional issue. I would advise setting up a consultation with me or a good hair transplant doctor in your area with lots of experience (I’m not sure where you’re located) to ascertain what, if anything, can be done to correct the problem.

Tags: hair transplant, hair direction, hair restoration, repair


I am 43. I had a scalp reduction at 24 along with 4 sessions of hair transplants. I was disappointed with results so I have been wearing a hairpiece the last 15 years. Now I wish to shave my head. Can the flaxel laser help with the scars on the back and top of my head? Or should I consider transplants in the scar areas or both options? I am a little leary to do transplants again. I appreciate any advice, don’t want to make any more mistakes.

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In general, fixing a bad hair transplant or a bad scalp reduction surgery is very individualized and difficult. The results are often not perfect, so there must be a full understanding of expectations and what you are trying to achieve. There are always options for repairing your look, but you need to see a hair transplant doctor who specializes in these type of cases. It would be doing you a disservice to offer you specific advice for your case without seeing exactly what you’re talking about.

For the readers that aren’t familiar with a scalp reduction (see image at right), it was a procedure some doctors did that essentially just excised the bald spot. We’ve written before about how patients that underwent scalp reduction surgery often developed a “slot deformity”, where the hair from the sides grows away from the scar, causing an unnatural slot to appear.

Lasers will likely not achieve what you are looking for. Meet with a doctor in person that can advise you about what to expect the end result to look like. It might not be perfect, but I wouldn’t be able to outline your options until your repair area is examined.

Tags: repair, scalp reduction, hair transplant


Thirty years ago I had 4 or 5 sessions hair transplant sessions done using the old punch graph method. For most of those years I was fairly satisfied. Lately that has not been the case. The appearance of corn rows is starting to show in the front and it is getting harder to cover up the donor area in the back. Twenty years ago I spoke to a specialist in Philadelphia who disappointed in the methods used in my procedures and he implied that I was not a good candidate for future transplants. If this is the case I would prefer to shave my head instead of continuing trying to cover up, which can only become more problematic in future years.

The scarring at the donor site is a concern. Are there any procedures to reduce this scarring? Thank you in advance for any information and/or advice you can give me based on this limited description.

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We have routinely performed surgeries for men who are in your situation. You can read about one patient’s journey here and see some of my repair patients here.

As you undoubtedly know, everyone is different and unique so I really cannot comment on your particular case without examining you. Many patients who had 4-5 sessions of the old hair plugs have heavily depleted donor areas, and a skilled surgeon with experience in this field can often soften the plugs by harvesting the recipient plugs as well as redistribute some of the remaining donor area. If you want to explore options, please send me photos and set up at the least a phone consultation with me.

There is no simple answer to your problems, and each person must be evaluated one on one before recommendations can be made. This goes for both repairing/removing the “corn rows” and seeing what can be done about fixing the donor scars.

Tags: repair, hair plug, hairloss, hair loss, hair transplant, donor, scarring


Hello Dr. Rassman,

I had a couple of HT procedures in the late 90’s that placed several hundred “micrografts” and “minigrafts” into my hairline. While the result is not as bad as some of the super-pluggy transplants I’ve seen, I now know that an FUE procedure could produce much better results. The issue is that the surgeon placed my hairline too low – it was lower than my juvenile hairline, but still along the forehead muscle. Due to this, I have no room to have a “transition zone” transplanted in front of it.

Would it be possible to have my hairline taken back a centimeter or so over a few sessions by individual graft excision and then have some refinement with FUE? I have spoken to one doctor who wants to bring my hairline down further, but I am completely opposed to this (I would like it to be a little higher at the end of any repairs).

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Without examining you, I wouldn’t be able to define your options (particularly based on your unique case, which might be very difficult to correct). Generally, a brow lift may essentially bring the hairline up to a level that can be worked with, but it’s really not a sure thing. There will always be some risk of scarring when you take out old grafts in the front, but with a brow lift and a surgery to bring up the hairline you might be able to have follicular unit extraction (FUE) to thin it out some. People have entertained using laser hair removal which may expose the micrograft scarring (I personally have not seen a successful one yet) and even with FUE there are issues of scarring and a risk of an unnatural appearance.

You need to find a surgeon that will work with you, and assess the risks and benefits. You have limited options, but you need an expert to analyze your problem.

Tags: hairloss, hair loss, hair transplant, hairline, hair restoration, repair


BlueprintWithout a Master Plan, a Norwood Class 7 patient can be exposed to the worst of the problems in planning. An unfortunate example of this is a patient with a complex surgical history that I just saw who had three procedures with three different doctors over the past 10 years. His balding pattern was heading to a Class 7 and none of his doctors seemed to understand where he was going with his hair loss problem. This man had transplants that were spread all over in a most unnatural look, with areas left completely untouched. Some hair was placed in areas that should not have received transplants (they weren’t beneficial to the appearance), and he now has a massive scar in the donor area with no significant donor hair left. He asked I not post his photos here, but what are the options for a case like this?

  1. Use beard and body hair transplants to fill in the areas that do not look normal. Fill in the scar with beard hair transplants as well. Learn to use transplants as an aide to styling and hair length needs to be planned. I’m not a fan of body hair transplants (BHT) in the great majority of cases, but his options are extremely limited.
  2. Use cosmetic camouflaging such as Toppik or DermMatch.
  3. Consider scalp tattoos.
  4. Get a wig.

Some people still don’t get why a Master Plan is even important, so think of it as a surgical blueprint that plans for the worst case scenario of your hair loss progression. I can not stress the importance of a good Master Plan. Some doctors made a lot of money from this man, but did him no favors. And as I sound like a broken record, never forget — let the buyer beware!

Tags: hair transplant, bht, hairloss, hair loss, master plan


I had grafts put in about 12 years ago, the method that was used left me with many large white holes in the back of my head in the donor area. My goal is to shave my head completely and not see those white marks. Is there a way to get rid of them? Something you can do? What about Lasers as well? By the way, what are those white marks called? It is not a strip scar but it has another name.

Thank you very much….

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I suspect that you are talking about the drill holes that were the original way to harvest the grafts. Originally, the doctors used a hollow drill (maybe an old model of a Black and Decker) to make drill holes to core out the hairy donor skin. Some doctors never sutured these closed, leaving huge holes which filled in with white scar tissue that reflected that the wounds were left open (the process of healing is called secondary intention healing). There is little you can do about them.

They can be filled in with transplants taken out with the FUE technique or tattoos can also possibly work, but the problem is that when your hair turns white as you age, the tattooed hair will remain close to the original color (black or brown, perhaps) and over time I would suspect it’ll start to blur. In other words, I think that for a short term solution, you could create a long term problem with the tattoo.

Tags: hair plugs, repair, hair loss, hairloss, hair transplant, tattoos


Hi there,

I’m hoping I can get some guidance on craniotomy scar issue I am having. I am a 27 year old male, and about 6 months ago I had a craniotomy for the removal of a benign tumor which was discovered shortly before the procedure. The surgery went well and all is good now health wise. However, I now have a 6″ long scar that is about 5/16″ wide in the back of my head.

I would now like to address how I can improve the aesthetics of the scar, as I prefer to keep my hair short. The good news is with longer hair (shown in the photo), I am able to cover the scar, but I’d really like to wear my hair shorter. I have visited 2 cranial plastic surgeons and one hair doc in the Bay Area, California. Here is summary of their recommendations on how to improve the scar:

– UCSF plastic suregon: Scar Revision and change scar to a zig zag shape.
– Stanford plastic surgeon: Standard Scar Revision. Advised against doing a zig zag as it would change hair growth directions and “make it look weird”.
– Hair Doc: Standard Scar revision and possibly hair transplant on scar if scar needs additional improvement.

Is it true that changing the scar to a zig zag shape would change the hair directional growth? If that is the case, why would the UCSF surgeon recommend that? Do any of you have any recommendations on the best way to improve aesthetics of the scar? My end goal is to not get rid of the scar completely, but to at least improve the aesthetics of it. I’d appreciate some feedback!

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I really cannot give you good, personal medical advice via the internet, so I’d suggest if you’re interested you can see us at our office in San Jose or Los Angeles (the consultation is free). We have transplanted hair into craniotomy scars with very good success. Many of these patients have had scar revisions that failed to resolve the cosmetic issues. You may need more than one transplant depending on the case, the size of the scar, and the location of the scar. Dr. Pak recently performed a FUE/FOX transplant into a craniotomy scar where a zig zag attempt was made. Sometimes a zig zag revision can make the scar worse.

Ask your surgeons for examples with before and after photos. Maybe it will help disguise the scar, but it’s still a scar nevertheless. Hair transplants to the scar does not mean the scar will be removed, but at least there is hair growing “ON” the scar and if there is enough hair in the proper direction, the scar will not easily be seen.

Tags: hair transplant, craniotomy, scarring, scar, tumor


Hi Doc,

I am 27, and stupidly got two procedures (~800 grafts each) done about three years ago. Have been taking propecia since the age of 18 and just started on rogaine a few months ago. I guess I’m about a Norwood 3, moving towards a 4 (except no thinning on crown).

Anyway, the problem is that the transplanted hairs came in much thicker and more wiry than the natural hairs, and they were not always individual hairs, so I’m about a year into getting them removed as best I can via electrolysis. The skin is slightly scarred, but I’m unsure exactly how it will end up looking once it gets time to really heal and start to fade.

I’m trying to weigh my options for proceeding as my hairline continues to recede, and am deciding if I should continue to get the rest of the plugs removed as my natural hair goes or if it’s worth more transplantation but done with more care. The question is really do you have any knowledge about different types of hair responding differently to transplantation? My hair is dark brown and curly, would it be more susceptible to coming in thick and kinky than someone with finer straight hair? Because the last thing I want to do is get more transplants and have them be obviously fake and just compound my problem!

Thanks a lot, and I love your site.

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As I’ve said many times before, the good news about a hair transplant is that it is forever… but if you have a bad hair transplant, then you probably aren’t looking at that news as being too good. Even removing the hairs may still leave a scar and cause an unnatural hairline, as you’re noticing with the electrolysis. Something concerning me though is that you’ve had 2 procedures at 27 years old of what you describe as “plugs”. I hope you aren’t referring to the ugly, old hair plugs that you commonly see in men that had surgery decades ago. Perhaps you’re just using the wrong term and you meant “grafts”, which are made up of 1-4 hairs. Modern hair transplants will look natural and the hair shouldn’t change character or color.

There are still options even though you may have a bad transplant, but BaldingBlog is not a place for second opinions. You’ll need to have an evaluation to see what options are available to you since each repair case is unique, so you should see a hair transplant physician (just don’t go to the one you already had two surgeries with, obviously). If you want to come out to Los Angeles, our consults are free and we have plenty of experience with patients who are in your situation. We have performed corrective procedures on many sub-par hair transplants.

See Dean’s Story for an example of a repair process, and check the Repair category for even more posts about this.

Tags: hair transplant, hairloss, hair loss


I had an old fashion hair transplant using the large plug method. Now, I would like to cut my hair short (or shave my head). The plugs on the top of my head are virtually undetectable. I can probably have a laser treatment to completely hide them. No hair really grew anyway. But here is the real question, how do I get rid of the .75 inch high by 4 inch long rows of plugs where the donor area exists? I have spoken to several surgeons and have been told things from FUE to simply cutting around the entire area and sewing it back together. I am no surgeon, but cutting the area out and sewing it back together just seems like a waste of good tissue and hair follicles. Why can’t a surgeon simply re-cut the existing holes and sew them back together leaving the surrounding skin and hair intact. This is similar to the way he/she would do it if removing plugs on the top area of someone’s head? Any thoughts or comments would be greatly appreciated.

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There is an art to managing this problem and we published the various methods of repair in distinguished medical journals in the 1990s. One way, when the hairline is too low, is to remove the frontal hairline surgically — and then re-transplant it with modern techniques. This approach leaves minimal scarring and what scar may be developed is completely covered by the hair transplant. Another approach is to remove the big plugs one at a time. Using FUE, we can often just thin the plugs.

As you indicated you’re in the Los Angeles area, you should come in for a free consultation and then allow us to make a recommendation. Also, see past posts about Repair, many of which are about fixing old plugs.

Tags: repair, plugs, hair plugs, hairloss, hair loss, hair transplant


Dear Dr. Rassman:

I am a 44 year old male with obvious hair plugs. I had three sessions from strip grafts back in 1995. In considering all of my repair options, I would like to just be naturally bald. Two surgeons have dissuaded me from having plug removals claiming that scarring would be a limiting factor. I was wondering how you would feel about a staged FUE removal of individual hairs over time allowing healing between sessions. I noticed that you replied to another inquirer that individual graft removal take a week to heal. Therefore, why not just space out the sessions to allow for adequate healing in the meanwhile? I’m not averse to small scarring as anything would be better than my current state. I am not interested in additional grafting as I’m convinced I am continuing to bald and will eventually have an island on the top of my head.

Any thoughts? Thank you.

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PlugI can not really address your specific issues, particularly when it comes to scarring, without at least seeing what you’re dealing with. You can use follicular unit extraction (FUE) to extract the big hair plugs, but sometime excision of the plugs work well. It all depends upon the extent of your problem. How many plugs do you have and where are they located (photos should tell me the answer)?

Sometimes if the frontal hairline is very pluggy and there is a concentration, removing the frontal hairline does not leave much scarring in many people. Is it your intention to be go completely slick bald (very difficult) or just a repair (much easier to do)? Send me good digital photos (reference this post when sending) and then we can set up a telephone consultation.

For those interested in seeing the difference a repair can do for a pluggy look, take a look at this patient.

Tags: hair plug, repair, hair transplant, hairloss, hair loss


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