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ToothpicksThis patient received 250 grafts just a few years ago (not from me, obviously). He knew things were going wrong when the doctor put wooden toothpicks (which could leave behind splinters) into the recipient sites which were made on his head. He overheard the staff chuckling at how he looked. He told me that before selecting his original doctor, he researched the field over the internet and had a few doctor consultations. He selected the original doctor because he was promised a great result and he believed that promise. As the hair started to grow, he became very self conscious and progressively depressed. Going out into social situations made him uncomfortable, even just going out of his house (something he rarely did once the grafts started to grow).

Cosmetic surgery of any type reflects people and their innermost feelings about themselves. I wonder if doctors understand how substandard cosmetic surgery like this can impact a person’s life. This nice young man’s life was in ruins and his fear of going to still another doctor who could possibly do even more harm, did not drive him to learn how to correct the problem until very recently when he ran into us on the internet. First, we spoke over the phone and then he set up a surgery with me and flew in. When I saw him this week, he was frightened with flashbacks of his original horrific experience

Just to be sure everyone is clear — the photos that are shown below are of this man’s substandard work and an example of what a doctor could do if he/she does not use state of the art hair transplantation technology. The term “hair plugs” is still incorrectly used for the modern technology we invented, but the lingering images (reinforced by patients such as this) are hard to abandon. Looking at the results that were once commonplace, one can clearly see that referring to this old technique as “plugs” is not out of line. Fortunately, I took steps to correct the appearance of these plugs by coring some of them out and transplanting more hair to fill in the entire frontal area. All of the plugs that were removed were cut into follicular units, and then re-transplanted into the scalp. I expect that he’ll be much, much better off after this first procedure with me of 2600 grafts grows in, which was done this week.

Here are the photos of his pluggy look referenced here (click to enlarge):


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


Doll hairI saw two patients recently that are worthy of discussion here…

Patient #1:
He had a typical result from the hair transplant surgeries of the 70s, 80s and early 90s. He had hair transplant plugs in the early 90s which gave him a doll-like hairline in the frontal area. I have worked with him over a 10 year period with four surgeries to remove and thin out the 3 inch wide plugs, redistributing the hair from the plugs to other adjacent areas in an attempt to make them less detectable. He is about 80% closer to his goal over what he had when he first came to see me and now wears a crew cut, but he is still frustrated over the remaining plugs which still bother him when he looks into the mirror every morning. I will continue to work with him, thinning out more plugs until he is satisfied that he looks normal. He shared what it has been like over the past many years, as too much of his life focus revolved around his head and his freaky pluggy look. Fortunately he and I put together a Master Plan 10 years ago to get him back to a normal appearance, and even now, after a decade of my working on him, the process will continue.

Patient #2:
This man has a far worse story. This young man (in his 30s) has had hair transplant work by many doctors over 10 years. Unlike patient #1, he never had a Master Plan and always sought out the best doctor who promised him a quick fix and he believed what the doctors told him. In the midst of the process, he even had a brow lift to raise a hairline that was too low, leaving him scarred in the hairline area. A series of transplants to fix the hair loss from the brow lift in the frontal area failed, compounding the problem further. The donor strips that were taken in the back of his head were all taken in different areas of the scalp and they all stretched and widened substantially. It seemed that the doctors just kept on removing donor hair from different areas to avoid the wide scars previous doctors created.

This man paid tens of thousands of dollars and each successive surgery seemed to leave him worse off. The recent transplants apparently did not work and he asked me if there was something wrong with his skin and recipient areas. I asked him if he called the doctors who did the failed procedures and he said he did call them over and over again, but they never returned his calls. Now he is massively scarred in the back of his head with at least three wide scars each measuring over 1/2+ inch in width. He received body hair transplants into the scar, but the difference was marginal. Each “fix” addressed one problem in isolation of the other problems, resulting (at times) with him being left worse off in the total scheme of things. I don’t know what he will do, but I suggested that he consider working with just one doctor, and building a Master Plan to deal with his problems. One option might be balloon expansion of his scalp to remove the scars in the back of his head by stretching the normal scalp in the crown of his head. The use of balloons to stretch the scalp will take at least 8 weeks of constant inflation of the balloon. If he wanted us to do it in California, he would either have to move to California for the period that the balloon expansion was being done or find a local doctor willing to do the incremental expansion of the balloon in his home town. We have done similar patients with outstanding results, but the commitment of time is substantial. What I gave him was a Master Plan to get him back to a manageable state. Anything short of such a radical approach will just victimized him again and again by some of the doctors who see $$$ in each successive procedure that they can offer him. Too much of his life is being centered around his scalp and the various poor choices he made.

I often end with the statement: “Let the Buyer Beware,” which is so appropriate in this situation. Doctors are not immune to being scummy. I unfortunately see horror stories like this almost every week, and I post these as a way to educate you (the consumer) so that you can make informed decisions and avoid being taken advantage of.

How do I end a post like this positively? Well, today’s hair transplants in the hands of good and honest doctors are spectacular. At last night’s Open House event in our LA office, Steve Hartman (CBS Sports announcer and radio show host) who is himself a hair transplant patient, told me that not only was his procedure undetectable, but that he and many of the patients who were there looked like they never lost a hair on their head. Those horror stories I wrote about above rarely happen today. There are rotten applies in every barrel, but there are many really great doctors also in that barrel. You just have to do your research before you jump.

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


I have a small, linear non-transplant scar above my ear. It has healed pretty well, and is looking more and more like normal skin each day. I’ve been thinking about transplanting hair into the scar by an east-coast doctor, about 100 grafts is my guess. If this were to be done with FUE, is there a huge risk that the scars produced from such a small FUE procedure will be worse than my linear scar? I want to be able to wear a buzz cut (somewhere around #2) as I believer my hair is thinning and short hair is a better look. Should I be very worried about moving just 100 grafts from the back of my head into this scar to minimize it?

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Follicular unit extraction (FUE) is a good way to fill in a scar, but not all FUE is the same. Different doctors use different techniques and instruments. As long as the FUE instrument is less than 1mm (ideally 0.8 of 0.9mm diameter), you should be OK.

I am flattered you would ask me, but I would ask this question to your doctor since you need to trust the surgeon that will be performing the procedure on you!

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


I have a long scar on my head from an accident that happened just over a month ago. I want to know is there any thing that can be done to make it smaller and reduce the appearance of the scar. also wanted to know if there were any treatments that could make the hair grow back were the scar is?

Thank you for taking the time to review my questions

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I looked a the photo you sent, and although I won’t publish it on your request, your scar appears to be about 2 inches long and 1/4 inch wide. This is a scar that has no hair elements within it. The only solution for this is hair transplantation, something that can be fairly easy to do. I have done surgery on patients with cranial scars from brain tumor surgery and even injury scars like this, and they can take a transplant fairly well. This particular scar can not be removed without returning.

Tags: scar, hair transplant, hairtransplant, hairloss, hair loss, injury


I have followed this site for a few years now and I am so impressed. First off, your integrity seems to be apparent in how you run this site. There is none of the cheap salsmanship common to some of the hair replacement surgeons with whom I have spoken. You provide so much disclosure that it is obvious that you truly want educated patients. It seems to me that the medical hair replacement industry was crying for someone like you.

With that, I am happy to share with you my story and ask you my questions. I am a 45 yr old male who began losing his hair at 19. I was told early on by a few surgeons that I was an excellent candidate for hair transplantation because my donor hair was so good (it was rated a 9 out of a possible 10). I believe that I am a Norwood 6 but I know that I have long lost all the hair that I was to lose. I have had 13 hair transplant procedures with Dr. X [editor’s note: name removed] and 2 scalp reductions with another doctor. The procedures were performed between 1989 and 2001. In total, I had 1679 “large” grafts, 379 “medium” grafts, and 321 “single” grafts. My hair provides decent coverage for someone who by this time would have been left with only what I call “clown fringe” (I am sure the visual will resonate with you) but I do use a concealer (Fullmore) to hide some small patches of my crown which show, and some of the scarring. My goal is to surgically get more coverage – or at least more uniformity in my existing coverage – so that I can stop using the concealer. I would like a good evaluation on what surgical options may be open to me, as I have already had so much work already performed and donor hair is not so plentiful. These are my questions:

  1. Do you ever do any work in NYC/LI?
  2. If the answer to #1 is no, can you recommend any good and caring surgeons in the NY/LI area?
  3. It seems like FUE2 would be a natural choice for someone who has had so much work performed already and where so much donor hair might not be harvestable in one strip. Is this a correct assumption?
  4. Is it possible to do many smaller strips so as to increase yield for someone who has had so much work performed already? Does it matter from where the strips are taken? I think that I may have some donor hair on the high sides.
  5. I have not heard of too many people having as much work as I have had. Does the work I describe sound like it is so much? Are you aware of many people who have had more work?
  6. I have been using a concealer for 15 years – just during the week and just during the day. Are there any health affects of such prolonged use?
  7. How does the cost of the FUE2 compare with the normal strip method?

Any of these questions which you can answer would be appreciated.

Keep up the site.

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  1. At the moment, I only have offices in California and do not plan on going to New York.
  2. Dr. Robert Bernstein is a caring and competent doctor with a Manhattan location.
  3. Follicular unit extraction (FUE) is less productive when donor densities are down from multiple surgeries and when there is lots of scarring.
  4. With regard to taking high strips, it is generally not a good idea as high strip scars tend to show and they may not be in the permanent zone, so the hair may not last your lifetime.
  5. I have seen many patients that have had more than a dozen surgeries plus scalp reductions. One patient I met had 27 procedures, of which I believe most were sham surgeries. Without seeing you, I can not comment on what you did and did not get.
  6. Your approach with the use of concealers is well defined in my new book, Hair Loss and Replacement For Dummies, for the readers who do not know much about them.
  7. FUE costs are high compared to the strip method, but more important, they may not be very productive. FUE costs roughly 2x the amount of strip procedures, per graft.

The problem with your situation is donor scarring and your donor area must be a mess. It’s difficult to make any real advisable points without first seeing what I’m dealing with, but you might be able to excise the highly scarred donor area (probably using a balloon expander) if that is bothersome to you. Good luck.

Tags: fue, repair, strip, hairloss, hair loss, hair transplant, hairtransplant,


i had a hair transplant in 1987. I only went for one session. Now, I have plugs near the temples on both sides of my head. I have shaved down the plugs but there is the “cobblestone” scars
left. Is there anything that can be done to remove these scars. I don’t want to shave my head completely, just get rid of the “cobblestone” scars. Thanks

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These cobblestone scars can be excised one-by-one. With a well done procedure, the scar from an excision will not be as bad as what was originally there.

Tags: cobblestone, hair plugs, hairtransplant, hair transplant, repair


The following comes from Dr Paul Cotterill in Toronto, Ontario, Canada:

Here is an example of why proper training and regional workshops are a pretty good idea:

I saw this patient in my office yesterday that was referred to me for assessment. This 38 year old fellow ( Class IV-V ), had a transplant 4 weeks ago in Ludhiana, India. He felt that the procedure didn’t go very well.

On examination the crown had been transplanted with 60 – 65 punch grafts that were 2-3 mm in diameter and the distance between grafts was 1 – 1.75 cm, very irregularly, across the crown. Peri-folliculitis was evident and residual crusting on some of the grafts. There was up to 7 hairs in some of the grafts. The grafts were removed via FUE from the occipital area. The procedure took 1 hour and he was told to return next month for a second session of the same. The cost – $500.00 for both sessions.

I have swabbed for C&S what I could, cleansed the scalp, started an antibiotic and suggested Propecia, with follow up in 1 week. He would like further sessions to the crown. He needed a proper consultation as to planning and the consequences of starting the crown in a 38 year old with certainly further thinning in the future. Further sessions at this point are unwise. I will be following up with him closely.

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Dr. Cotterill has given me permission to repost these photos. It is unfortunate that people treat a hair transplant procedure as if they’re just getting a haircut. This is surgery! You want to do your research and know what you’re getting into. How could anyone recently get the old, ugly plugs of decades past? It’s disturbing on many levels. So he only spent $500 on 2 sessions to get this look. Now how much time and money will he have to spend to try to undo this foolish mistake? A bargain indeed.

Click the photos below to enlarge.


Tags: plugs, repair, photos hair transplant, hairtransplant, hairloss, hair loss, cotterill


From time to time, I get emails from men that are incredibly embarrassed about the results they got from an old, pluggy hair transplant. They’re so embarrassed that they request I don’t even publish their emails (even if there’s nothing identifiable in there)… and that’s fair enough. So I just wanted to write a post to quickly explain the best way to fix a pluggy hairline: you need to cut out the plugs and then put transplants in the place the plugs originally were. This is generally done in two sessions (8-10 weeks apart) and we have been doing this for years. It turned out that this man’s scar (from excising the grafts) healed very well, so well that it could not be detected. I put hair wide enough in front of where the scar was so that his hairline was lowered quite a bit. We built a wide transition zone in the leading frontal edge. Here is such a case on a man with black hair.

Before on the left, after on the right. Click the photos below to enlarge.


There’s another plug repair case at the NHI site — Dean’s Story. Be warned, some of the photos there contain surgical content, so if you have a weak stomach, you may want to avoid that link.

Tags: hairtransplant, hair transplant, hairline, repair, photos, hairloss, hair loss


How long for a full skin recovery after a plug removal? (punch size 1 mm)

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A 1mm punch excision will usually fill in over a week’s period of time. Large punches will take longer unless they are sutured together.

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


This patient came in last week, a few years after having 709 grafts taken from a very depleted donor area. Half of the grafts contained just one hair. Getting those 709 grafts was a challenge, as his scalp was tight and the donor area heavily scarred. Because of the anticipated poor yield, I elected to spread the grafts over an inch from the plugs (forward) creating a loosely built thin hairline. When he allows his hair to stand up rather than pull it back as shown here, the results are even more spectacular. This patient gave up his wig and is thrilled with his result. We will try to do another procedure with up to 700 grafts in the recipient area to thicken it, but that will be even more of a challenge because the scarring is very bad and the density of the donor area is very low and he knows it.

Many of what I will call the “normal transplant patients” we perform surgery on today who have not had the old type of plugs, may look at pictures like those shown here and get very frightened. I understand the fear that gets invoked by these patients, but some of my most satisfied patients are those who walked around for years and found that people never looked into their eyes, only to their hairline. This man is an example of a patient where just a small change had a major impact on his life, allowing him freedom from a wig he despised to cover a pluggy look he hated.

Click the photos below to enlarge.





Tags: hairtransplant, hair transplant, hairline, repair, photos, hairloss, hair loss


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