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This is a patient who I just performed a corrective procedure on. There were many mistakes made here in the past with his other doctors and I wanted to share those problems with you. Knowledge is power, and I hope this will teach you what to look out for so you can prevent them from happening to you. So let’s jump right in…

The Problem

First, let’s take a look at the “Before” photos (click to enlarge):

 

  1. The patient had received around 3000 grafts total in three surgeries on the frontal hairline at another clinic.
  2. The hairline is harsh, without single hair grafts in front of the larger grafts. Plus, these were not follicular units, but the old type of minigrafts of 3-5 hairs each.
  3. The hairline was placed too low and too straight, creating an abnormal edge which made the transplants obvious to the patient.
  4. The surgeon made incisions in the scalp that were not kept in the same place, so the patient had two scars rather than one (see arrows in photo above). The second and third surgeries should have been performed at the same location as the first surgery. The location of the upper scar was too high as well, so transplanting into the upper scar made sense to me.

 

The Solution

Here are the “After” photos, taken just moments after the completion of his surgery (click to enlarge):

 

  1. I transplanted 1637 grafts total (1391 into the hairline and 246 into the upper scar in the donor area).
  2. I built a wide transition zone with only one-hair grafts to break up the leading edge of the hairline so that it would not look transplanted.
  3. I had to lower the hairline to get in front of the harsh hairline created by the other doctor. This brought the hairline almost back to its juvenile position, something that I rarely do, but was forced to in this situation.
  4. Those 246 grafts transplanted into the upper scar (see arrows in the photo above) should almost completely wipe out its visibility, so he’ll have one scar in the back of his head instead of two.

I find it amazing that this happened recently by a surgeon not far from my office who does a great number of such cases. If this patient had asked to meet some of that doctor’s patients, I am sure that this is the type of work he would’ve seen. People just don’t know or think to ask a doctor to meet with other patients ‘one-on-one’. There is no substitute for meeting patients directly and talking to them about their overall satisfaction. We offer an Open House every month to allow prospective patients the chance to meet up to a dozen of our patients who had surgery. A detectable hair transplant is not what you want and it is easy to see the quality of a doctor’s work by engaging with one-on-one patient interviews.

Tags: hair transplant, repair, hairline, hair loss, hairloss, photos, scar, physician, mistake, problem

 

I have some questions about hair transplant in skin with extensive scarring. I’ve tried looking for information on this online, but the vast majority of the information available is on transplantation into normal skin, and any information on scarring is generally limited to scarring as a result of the procedure itself. This seemed like a good place to ask.

A friend of mine was in a fire about 11 years ago and has had extensive skin grafts and reconstructive surgery. One of these procedures was an attempt to stretch the areas of his scalp that still grew hair to cover the areas that did not. However, the skin proved to be too thin to completely cover the hairless areas, and he was left with 2 areas of scalp with no or very sparse hair, each about 2″x3″. While he is comfortable with the grafts on his body, I know the hairless patches on his head really bother him. He has jokingly mentioned getting hair plugs in the past, but he doesn’t think his hair is thick enough to provide donor sites, and I think he worries that transplanting into thin or scarred skin would be impossible.

So, basically, my questions are, can living hair be transplanted into large areas of scar tissue? Can hair follicles be harvested without causing other noticeable thin spots, or can it be donated from another person with similarly textured and colored hair?

Thank you!

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Yes, hair can be implanted into scar tissue to provide a cosmetic benefit. We have done that on many occasions, but the status of the skin is critical in making the determination to go forward. Skin grafts, for example, with no thickness to them may not be able to tolerate hair grafts. Your friend’s issues are not unique and there are patients who have had hair transplant surgery to cover the bald areas from such tragedy. We have done many with neurosurgery scars and face lifts scars that easily support hair grafting, but each and every patient is very unique and can pose challenges.

I really cannot answer your question without seeing the patient in person or at least seeing a photograph. If your friend is considering options, I would have them make an appointment with a good hair transplant surgeon to discuss those options. (Also, “hair plugs” is a term used for the outdated procedures done in decades past. Current techniques can create an undetectable result without a pluggy look.)

Tags: scar, skin grafts, hair transplant, hairloss, hair loss, fire

 

This is in response to My Hair Transplant Made My Skin Cobblestoned!

So, Selective removal of the grafts via FUE is not an option to reduce the cobble stoning? I too have this issue, and I only Have a few hundred grafts, not all of them are cobble stoning, maybe a total of 200 are cobblestone. I know FUE leaves a small scar, but would the removal of 2-300 grafts over my entire scalp really be that noticeable? Why do you say more hair transplantation is the only option?

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Follicular unit extraction (FUE) is done with very small punches where a follicular unit is removed one at a time. Cobblestoning is a whitish scar with no hair in it. If you want these white scars punched out, then they will form new white scars, i.e. no gain. Removing the entire larger graft with the cobblestoned skin is the only real way to do this, and the scar that may be formed will probably be less detectable than the cobbled area. Depending upon the location of the cobblestoned area, camouflaging it with a hair transplant may be needed.

This is a very difficult question to answer without seeing just what you are concerned about. Please send me photos and I can be more pointed in my answer to you.

Tags: fue, repair, hairloss, hair loss, hair transplant, cobblestone

 

Hi,

First of all I want to thank you for this informative blog. I have searched this wonderful blog and have found numerous postings relating scars and hair transplant. Here’s my case: I have what “they” call a coronal scar that runs from ear to ear. What I want is to completely cover the scar through a FUE procedure, but I want my scalp to be like how it first was, normal. My research has been conclusive and I first want to have a scar revision surgery to reduce the width of the scar, once that is done i want to follow some type of scar treatment to make the scar less obvious in color (seems like the scar gets pink/red after a scar revision surgery). Afterward get the FUE procedure and go from there. Is there any treatments that you would suggest?

I want the scar to be inconspicuous to the point to be able to cut the hair in the military/short hair style, because ultimatley i want to join the military as an officer.

Best Regards

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Your plan is good, but it may not be realistic to have the scar completely hidden. Even if the hair in the scar is brought up to near normal density (which may take a few FUE procedures), there is often a color difference in the remaining scar, though of course it will be hidden with FUE grafts.

As you are local to my Los Angeles office, please arrange to see me so that I can ascertain a plan that matches yours. Any preparatory treatments can be assessed and recommended when you see me. You can call 800-NEW-HAIR (or 310-553-9113) to schedule a free consultation with myself or Dr Pak.

Tags: fue, scarring, scar, repair, hair transplant, hairloss, hair loss

 

Hey Dr. Rassman,

Appreciate all you do on the blog as well as answering my questions in the past. I had a less than desirable result from a HT procedure to say the least. Make a long story short, if I ever need to get one again, which I will since I have small gaps on my head still, I will be visiting your office before.

The grafts that did grow, which was on the low side, are coming in at all different angles and growing in different directions than both the other grafts and of my current hair. When I mentioned this to my doctor and the dissatisfaction of my results, he mentioned that it might be possible to change the angle of the grafts with a new tool? Is this possible to your knowledge? If not, is there anything I can do or this is just the way my grafts will grow forever? Also, do you ever have any open houses in the New York area?

Thanks so much.

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It is unfortunate that your grafts were placed at poor angles and your results are questionable. Your story of a bad procedure result illustrates the fact that hair transplant is for LIFE and you should do your research of the doctors and see their work first hand before going ahead with the surgery.

There is no tool or technique that will change the direction of your hair. I suppose you can individually excise them one by one and try to re-implant them, but that could potentially cause more damage, trauma, scarring, and failure to grow. Plus why would you place more trust and risk a poor outcome from the same doctor who already put the hairs in the wrong angle? You are a brave man!

I don’t have offices on the east coast any more, but Dr. Bernstein does have open houses in his NY office.

Tags: hairloss, hair loss, hair transplant, trust, surgeon, doctor

 

Dr. Rassman,

Do you think that 100% elimination of donor scars will be possible in the future? Technology is always improving and it seems like scars could be emliminated. Are there any other possibilities other than Juvista and Acell that are being researched? Thank you for all the helpful information.

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Scarring happens as a result of all surgeries. There is no such thing as 100% elimination of a scar and treatments like Juvista and Acell will not dispose of scars entirely. The key to dealing with scars is to keep them very, very small. In the case of a donor scar, it can be as small as 1mm wide naturally in good healers, or reduced to that level on occasion. For bad healers, there really is no solution. By “bad healers” I mean those people who stretch their scars after the wound has healed.

Techniques such as the trichophytic closure repair of a wound in the donor area works well in many, but not all patients. For more info on the trichophytic closure technique, see here and here.

Tags: donor scar, donor area, hair transplant, juvista, acell, hairloss, hair loss, scar, scarring

 

As a young man 25 years ago, he had a hair transplant with the old fashion plugs. After seeing what it looked like (it was partly hidden with some hair at the time), he came to the conclusion that he made a mistake and immediately went to using a wig. Between his wig and a baseball cap, he had hidden his secret. About a year ago, he realized that maybe he could undo his plugs and after a year doing internet research, he came to my office to ask me an important question I’ve heard quite a few times before — “Can you just remove these plugs and make me bald so I can shave my head?”

Remember, this is NOT the standard of care today. Click the photo to enlarge.

 

To see the deformity, he lifted up his wig, which was tightly held to the scalp with tape. Although he is a Norwood Class 5A pattern with high density in the donor area, he never really wants to do hair transplants again, and just wants to be a normal bald man. This is a common finding in people who lived with the horror of the plug deformities of the old transplant work. Unfortunately, this type of problem is what so many people believe is today’s standard of care. Nothing could be farther from the truth as today’s hair transplants can not be told apart from a normal natural head of hair in a non-balding patient.

We agreed that I would remove each plug one-by-one and sew him up, making him a normal bald man. Removing these plugs may leave some minimal scarring. He wants me to transplant the hair extracted from these plugs and put them into the place they came from, to hide two obvious small neck scars. This should easily be done in one surgical session.

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

 

Snippet from the article:

THE HIGH Court has awarded €70,000 damages to a sales and marketing manager over a botched hair transplant which left him disfigured.

Mr Justice John Quirke made the award to Niall Clancy (32), Scholarstown Park, Rathfarnham, Dublin, over the procedure which was carried out in the UK on January 12th, 2004.

The award included €30,000 general damages plus €40,000 for medical expenses to repair the damage.

Mr Justice Quirke also said Dr Maurice Collins, the surgeon who treated Mr Clancy after the transplant, had given him “very poor advice” not to have reconstructive surgery until after the court case was completed.

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LawRead the full article at Irish Times – Man wins €70,000 damages over botched hair transplant

The online currency converter tells me that’s over $99,000 (USD)! I’ve not seen the botched work, but when the doctor told the patient to not have the repair work done until after the case was settled (which took years), it just added to the money the patient was awarded in damages. It is unfortunate that the transplant was so disfiguring, but without seeing photos I’ll have to rely on this article and the court’s decision for my source of case information.

Always remember to do your research on the clinic and physician before getting yourself into a permanent procedure like this. Perhaps this disfiguring hair transplant could’ve been avoided. See:

  1. Selecting a Hair Transplant Doctor
  2. How to Avoid Dishonest Hair Transplant Doctors
  3. Why Should You Visit Us?
Tags: hair transplant, repair, damages, hairloss, hair loss, ireland, irish, uk

 

Dear Dr,
I’m a man 38 years year old, writing from italy. I had an HT 2 years ago with about 2000 graft implanted FUT. I take 1 mg Propecia for 2 years.

This is my problem:
I have very small pimples (less than 1mm) on each graft implanted there are very visible i.e. under the sun light.they don’t hurt me and seems like the hair is pulling up the skin. I don’t have any of them on non tranplanted hair… I searched on this site but almost all of the discussions I found are on bumps or normal pimples or pitting or scars. the most valid explanation I found is that it is due to the graft that was implanted too deep in the scalp.If it is true, what can I do for improve the situation? Dermabrasion or laser? may I start trying some remedy for folliculitis or is completely useless?pls give me some good hope on what I can do,I’m really desperate. the doctor who make me the surgery (in Mumbay while I was in a long trip for job…)after the first telcon, don’t reply to my calls or mails…however I don’t trust him anymore! I contacted another Dr who said that the only solution maybe is to make another transplant to hide the thin pimples, but I leave this as the last solution and I won’t make another bad transplant. pls tell me if there is something I can do for making less visible these pimples.Thanks in advance. sorry for my bad english. Best Regards

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If what you’re describing is a cobblestone appearance (and not actual pimples), then please see this post. Without seeing you, it would be impossible for me to tell you what the problem is caused from.

Dermabrasion to the scalp causes visible scarring and only benefits the doctor’s pocket, not the patients who receive it. There are two types of lasers that can impact hair:

  1. Low level light laser therapy (also known as LLLT), which I feel does not work at all
  2. Higher powered lasers for hair removal, which do not work 100% on killing the hair

Neither offers much benefit to your situation. If you have bumps, some hair killed with the high powered lasers will just make what remains more visible and the laser itself can cause depigmentation (whitish areas) of the lasered skin. I would need to see you, but it is not an easy trip from Italy to my office in Los Angeles.

Tags: bumps, pimples, hair transplant, hairloss, hair loss, hair restoration

 

can anything be done with plug scars from transplants in 93? scars in the back of my head. i mean im desperate for short hair but i know the scars will notice. i dont have time for make up and that might make more paranoid than i already am…

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Scars in the donor area vary by person, surgeon, and the amount of transplanted hair you had. Some of them can be repaired or reduced, but I would have to see you to make such a determination.

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

 

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