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Dr. Rassman,

I had a transplant procedure 7 or so years ago. Since then, my hair has continued to thin and even though the hairline was done well, one can discern that they are transplants. If I was to have the donor scar repaired and buzz my head to a # 1 clipper, would the transplant sites be very discernable (on top of my head?) If I was to pluck them out, would the recipient sites have scars? I am not really sure what to do. If I hadn’t gotten the procedure done I would probably shave my head close. I would also like to know if I had additional procedures done, would I be able to go with a buzz (#1) cut? Thank You

A hair transplant is forever, which means you shouldn’t do it unless you fully understand what is going to happen to you, even in the worst case scenario. I don’t know how to answer your question without seeing you. If the transplants were follicular unit transplants (FUTs), there is a good possibility you could shave the hairline, but based upon the what you describe, I suspect that the grafts were not follicular units. When there is any significant amount of skin in the transplanted graft, the skin will have some deformities associated with it. The larger the amounts of skin (which comes with procedures like minigrafts, micrografts, larger plugs, follicular families, double follicular units, etc), the harder it would be to get away with shaving the frontal scalp. Most people like you are easy to fix with more transplants, but it has to be done with FUTs and in enough numbers to fill in the problem area, but again I can not say this for sure without seeing you or your photos.

As you indicated that you’re in New Jersey, Dr. Robert Bernstein has offices in your area, so I would suggest that you see him for a straight answer, or you can send me photos to the address on the Contact page (reference this post, please).

I have a childhood scar in the back of my head about 1 inch long and 1/2 inch wide. I’m looking to possibly get scar reduction surgery, and wanted to know how it’s works and an estimate of the cost? And any suggestion you may have.

The ability to address scars on the head depend upon where it is located. I would have to see you, examine your scalp, and then make the determination. I can not quote a cost without seeing you directly, but most costs are $3,000 or less.

I had one procedure done around 10 years ago. I was young, and like many, I jumped without doing too much research. I’m glad that I stopped at the one procedure. Now I’m looking for a way to reverse the whole thing. The scar is hard enough to keep hidden, but the hair plugs are even harder to deal with. Is there any way to get rid of the transplanted hair besides shaving it or tweazing it? Tweazing the 600 grafts takes too long, and like a beard, they grow back a few hours later after shaving them. I thought about lazer hair removal, but I’m worried that it will permanantely damage the dormant follicles, and with just my luck, they’ll find a cure a week later!

I really do not know your specific problem and the extent of the “pluggy” appearance to give you a personalized opinion. However, it may be almost impossible to completely undo old (or new) hair transplants, because a hair transplant is permanent. It goes to stress the importance of good research and being able to see the results of patients from the doctor as well as the medical group you are having the surgery with. Even 10 years ago, the pluggy transplants were not standard care.

You can try laser hair removal, but you may be left with scarring if the old grafts were the large plugs. Large plugs often leave a cobblestoned skin and depigmentation where the plugs were. Sometimes, these can be cored out, but an experienced hair surgeon needs to evaluate you for this option. Otherwise you can attempt another hair transplant to disguise the old plugs.

For more information on repairing old hair plugs, please see:

• The Art of Repair in Surgical Hair Restoration Part I - General Aspects of Repair and Basic Repair Strategies
• The Art of Repair in Surgical Hair Restoration Part II - The Tactics of Repair
• Dean’s Story - Step by step photos of a repair procedure
• Repair Work Photo Gallery - Before and after patient repair photos

Hello,

I am 33 years old and had a transplant surgery done in 1994. My hairline had receded slightly and I thought I was going bald, so made a rash decision and had the procedure done. Since that time I have lost very little hair and currently have a full head of hair.

I have never been happy with the results, as it looks unnatural and obviously not my own hairline. Now, at 33, I would like to have it fixed. I have been in contact with a local doctor who operates a medical spa and he has recommended laser hair removal. He said it should take about 4-6 months to complete.

I have 3 questions: First, is laser hair removal effective for removing transplants. Second, is scaring likely. Third, if successful at killing the hair, will laser hair removal address the issue of the bumps I feel at the base of the transplants? And if not, what are options for smoothing out these bumps?

Thanks.

Cases like yours are unfortunate, but it is an important reminder that hair transplants are permanent. As such, you need to make sure you are getting the treatment done by a physician and a medical group that you trust and that you have checked out for competence in this area. Do not search for the best deals, but rather do the research and make an informed decision. Most importantly see prior patients up close (not just photos) to gauge your realistic expectations.

Laser removal does work on transplanted hair, but you would need many treatments and there may be some discoloration of the skin. More importantly your “bumps” will still remain. In the end you may be left with no hair, but with bumps that are discolored. If this is still something you are interested in, you need to ask the doctor if he/she has had experience with cases like yours and if so, ask to see former patients and results.

You may also consider a consultation with a hair transplant doctor to see if there are repair surgeries possible to soften your unnatural hairline. As an example, you can see some before/after photos of repair work at NHI. Also, there’s a story I posted a while ago from a man that wanted to “undo” his hair transplant, complete with photos — Horror Story with a… Happy Ending?. What is important in that “Horror Story” is that the patient was happy with the results of his laser treatments, although I would imagine that many of the viewers here may not find it acceptable. Compare where he ended up with where he began, as everything is relative.

Dr. Rassman

Congratulations once again on a great blog that is truly informative and of great help to the hairloss community. My question revolves around FUE into scar.

On past blogs I know you mentioned that you like to wait at least 5-6 months to do a scar repair… but if I understood your reply correctly I think you were referring to a tryclosure revision.

I recently got a HT (2400 grafts) and part of my scar got a bit infected. One side came out perfect with no problems and the other one not so much. Luckly the infection wasn’t necrosis or anything too serious but I have experience shockloss around it and was wondering how long do you recommend before I or anybody can do a small FUE session into the scar. I seriously refuse to go the strip route ever again even for a repair. BTW, I’m only about a 1.5 months out of the surgery (which was closed using tryclosure technique) and this was my 2nd HT. I know it’s too early to panic on the healing of the scar but wanted to know a timeframe as to when is the earliest I can act to correct this if need be.

Thanks to you and your staff once again for taking he time to answer our questions.

It takes about 6 months for any scar to heal relatively fully, thus I recommend waiting out that 6 month time frame.

Hi Doc!

What if I want to “repair” a small, round scar on the top of my head, say about 1 x 1 cm wide… Will I still need propecia to prevent shock loss? That is, is shock loss even possible when transplanting such a small amount of grafts?

If you have active male pattern baldness (MPB), then yes, it could impact your hair and cause hair loss.

Hi Dr. Rassman,
How long after a strip procedure can I have a scar revision done? I need one. This last procedure didn’t fare too well and I cannot hide it. Thanks for your help.

Of course, your doctor should make that decision. I generally like to wait a minimum of 4-6 months to fix a scar. Also, you might ask the doctor if he/she knows why your scar is wide. Was the wound under tension? What type of closure was used for the surgical wound? I would also want to know if you have had scar problems elsewhere on your body and the number of hair transplant procedures you had.

I have a scar from a brow lift on both sides of my head. I wear my hair short(military style), so you can see the scar. The scars have healed (6 yrs ago since browlift), and both sides of the scar have feeling in them. I can feel something touching, scratching them. The scars are pretty flat. I want to know about the procedure to transplant hair into the scar (including associated costs, timeframe, etc.) I have very thick hair that grows quickly. I am 34 years old.

Hair transplants work very well in the scars of brow lifts by transplanting them directly into the healed wound. We do these with some frequency, as well as neurosurgical scars, which are often larger. The costs are generally between $3000-4000 for such repairs as it takes 400+ grafts depending upon length and width of the scars. Most of these surgeries take about 3-4 hours and the hair will grow within 6-8 months.

Hair Transplant - What is the best treatment for white scars which left after transplant surgery?

Today’s hair transplants do not produce a white scar if follicular unit transplants are performed. The old plugs done 20+ years ago, had white skin within the plugs and many of the older plugs never grew, so these poor souls had white scars (depigmented from the damage of transferred grafts). If this is what you are talking about, you should review our articles on repair that were published in Dermatologic Surgery in 2002:

• The Art of Repair in Surgical Hair Restoration Part I: General Aspects of Repair and Basic Repair Strategies
• The Art of Repair in Surgical Hair Restoration Part II: The Tactics of Repair

If I missed something or misunderstood your question, please write me again to clarify.

In correcting an old pluggy hair transplant,is it feasible or possible to transplant behind the old plugs first, let this mature, then remove the old plugs so the initial transplants (from the donor area) can camoflage the surgical sites of the excised plugs(this is assuming the old plugs cannot be camoflaged via a transitional zones of fue transplants). I have seen the reverse procedure on your website often when corrective procedures such as this are done. Also, if old plugs need to be excised can you use a flesh colored suture material to minimize post surgical incision lines of the excised plugs? And final question, in determining whether to excise old plugs or place a zone of camoflaging units in front, if the existing hairline is on the borderline (low or high) what is your criteria in your choice.Thanks.

The decision to remove the hairline is a joint arrangement between patient and doctor. Sometimes the social limitations of removing the frontal hairline is just not a good choice for the patient. One should outline the number of surgeries with the various approaches. The decision for FUE, or excision of single plugs and building a hairline in front of the old plugs at the time of the FUE, or individual plug excision, seems to be the choice most patients are making despite a hairline excision which may, in the long term, be a better decision. The location of the old pugs is important. If the old plugs are at least 1 1/4 inches above where the natural juvenile hairline was located originally, then just camouflage may work fine. The lower the hairline, the better is the excision of the hairline, but still many people today are opting for the FUE/selective plug excision and frontal camouflage, because it does not limit their ability to go out in public within days of this surgery.