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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:

More photos:

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.