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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.

Before:

After:

Dr. Rassman I want to first thank you for maintaining such a top notch site. I have a question for you regarding transplanting hair into scarred tissue. I recently (4 months ago) had hair transplanted into a 1 and 1/2 inch long scar running front to back. I am seeing very little growth…if any. What seems to be present are a few graft which never fell out and have continued to grow. I am aware that growth in scar tissue may take a little longer than if it was to be transplanted into virgin scalp, however, to put my mind at ease I was wondering in your expert opinion, what is a reasonable timeline to expect growth in the scar? Thank you very much in advance for your reply.

It’s only been 4 months, so seeing a little growth is completely normal. I tell all patients to wait for a full 8 months before judging the hair transplant results. You just have to be patient.

Hi,

I had transplants which were placed in an erratic fashion and running counter to one another. Now that my normal hair is disappearing this leaves a noticeable effect. These people were in my opinion very unprofessional.

I am resigned to baldness but I would like it to be normal and something I dont need to think about every day I see my hair in the mirror. I would be so eternally grateful to you if you could guide me to someone who can remove the transplanted hairs via laser while not disturbing the normal hair. I imagine this would require the use of some magnifying glass to distinguish exactly the transplants (easily noticeable once washed and blow dried) and a single hair laser remover.

This may take some time but I am willing to pay the appropriate charge and to travel. I would also like to have the scar from the back of my neck reduced to a fine line by excision and treatment.

I am going into baldness but I would like to do so with my dignity intact and not the way I am now. Whatever you can do to help me, I will forever be in your gratitude.

I have had a number of patients that just want to be bald. I couldn’t say what your personal options are, as every case is different. Electrolysis, for example, has a 50% failure rate per hair and the use of pinpoint lasers are generally not effective here either. Surgery works, but I would have to examine you to see just what has to be done. Extracting one follicle at a time may work, provided that you are not badly scarred in the transplanted area, but even then, fixing the scarring at the back of your head is something we do often.

When I was young the hair on the right side of my side was burnt off, all you can see now is a abnormally white white scalp with no hair growth. I try to cover it up by making the hair on the top grow longer and cover up the bald spot.

I was wondering if their is a solution to my kind of problem. Thanks you.

These areas can be treated very well today with a variety of surgical procedures which vary based upon the size of the defect you have. I have seen children who have lost 1/4 of their entire scalp receive a balloon expansion with wonderful results, and the same goes for adults. The smaller the defect, the easier it is to repair. You can see a hair transplant surgeon or a good plastic surgeon to find an appropriate referral. This is a very specialized area where most plastic surgeons have not developed the expertise.

Dues FUE removal of small plugs with a 1mm punch leave “rolling” athrophic scars or just a tiny white scar?

A 1mm FUE (follicular unit extraction) punch has the potential to leave atrophic or tiny white scars, however it is rare. We routinely use a 1mm FUE punch to remove unsightly “plugs” from patients who have had old style hair transplants. Keep in mind that almost all patients with these type of repairs will additionally require a normal, modern hair transplant to fill in the area between the “plugs” to soften the pluggy look.

I am a 20 year old male and was wondering what type of procedures there are, if any, to have hair grow where a scar is from surgery. My freshman year of college at Indiana University I was playing basketball and collided with another player resulting in a depression in my right orbital bone above my eye. To fix the depression a plastic surgeon had to peel my face off to get access to the depressed bone resulting in a scar going from one side of the head to the other. My family having a history of baldness I was wondering if its possible to have hair grow over a scar. Thanks for the help.

I would want to see photos or meet with you in person. I have had one patient with that type of deformity and his transplanted area (including the eyebrow) did correct most of his problem, but everyone and every scar is different. Let’s start off with some photos though, as that is probably most convenient for you. Send them here and reference this post when sending, please.

Having a hair transplant to fix a scar is reasonable provided that you know what would happen to you if you should bald. That means to me that you should, at a minimum, have a Master Plan for your worst case scenario understood.

I came across your post “Horror story with a happy ending” and I would like more details. I have had several surgeries beginning in the early 90s, from plug work to micrografts and FUE. Most of this was corrective work. Unfortunately it wasn’t particularly successful, and the distribution of hair is abnormal. Fortunately though my donor scar isn’t that bad, as I was careful with the scar revisions to minimize a bad outcome. I am left with approximately 1 scar from my last revision, where a trichophytic closure was used. It runs from ear to ear and varies in width from 2 mm to 8 in a few places. Overall, considering the number of surgeries I’ve had it’s remarkably good. I’d like to fill in the thin spots with the “stippling” type of tattoo you mentioned in your post. However I am very concerned with the discoloration over time. Can you provide contact information of the dermatologists who had the tattooing done, or some more information about it (eg. type of ink, who did it, etc.). I’d much rather put my faith in the hands of someone who has seen success with this than take chances on an unknown. FUE, etc aren’t really options for me at this point for filling in the scar.

Thanks

Although I don’t have any information about the tattooers of the patient you mentioned, from what I’ve seen, tattoos on the scalp and scars have turned green over time. While it may not occur every time, this is a real problem for the two patients that come to mind. For that reason, I would hold off doing the scalp tattoo for the time being unless you are sure that the color will last and this is what you want, as today’s tattoos are not reversible (laser removal is quite painful and may take many sessions to get a decent result).

A new product is coming sometime later this year that is reversible, so if you did not like it after getting it, then you can make it go away a lot easier. It doesn’t make the pain any less intense, though. For more general information, see InfinitInk from Freedom2, Inc.

Dr. Rassman, you won’t believe this. Maybe you will. I have had I guess 7 scalp reductions. Brandy did a lateral with that Y incision, but not a scalp lift, per se. Marzola, Stough, all did a couple of procedures. I saw my scalp under bright lights (the last thing one wants as that is very unforgiving) on a big screen last night and was shocked by the 1 inch by three inch or so bald thin area in the midline. Dr. Hitzig performed two large midline graft sessions around 1999 or 2000, fixing the scar but the density leaves something to be desired. I see you mentioned Dr. Frechet of Frechet extender fame I imagine in a response to a patient. Some sort of triple flap procedure. I have some donor left but can’t get over my lack of crown density despite a large number of grafts. I know Dr. Hitzig always grafted the midline before reducing a scalp. Do grafts just not grow after reductions, especially that many reductions? I could emply better styling but I wish I had followed the late C.P. Chamber’s advice and avoided reductions altogether. He knew what he was talking about. It sounds like there is no practical fix at any price.

Your case is complex. I have no idea what densities you have or the extent of your scar and wound defect. Most people who’ve had 7 scalp reductions are left with a slot deformity. I would like to see some good pictures of your scalp from the front, top, sides, and back. I am sure that you know that scalp reduction is no longer the standard of care today, because they do not work. I have seen men who had up to 16 scalp reduction surgeries and the last ones never really accomplished anything. I wonder about your 7th procedure and what you were trying to accomplish that the prior 6 have not.

It is best to be examined carefully by an expert and then see what your needs are. Patients should make a list of priorities and then try to work down the list. Patients who have had so many procedures never really get too far down that list, so be realistic.

For more information on scalp reductions, see:

• History of Scalp Reductions
• Repairing Scalp Reductions

Dr. Rassman, my story is long and will probably bore you. I would just like to say that probably the most humiliating situation a grown man can be in is having a very noticable hair transplant. I am the recipient of 2 procedure in 1991, 3-4 fin NYC 1992-1999. Since then the new hair outlived the existing hair and I had to resort to shaving my head-scars, cobblestoning, high hairline and every humiliating situation that goes with it. Before this, I was a good looking young man with the world for the taking. I remember the day after reading the sports section on the Daily News and making that quick decision. I was losing, but not that much. Cut to chase- I am a NYC Firefighter for 18 yrs and I haven’t relaxed and enjoyed one second of it. Always worried about comments (which have happened) and living in close quarters with crazy guys does not help. I have spent thousands on redistribution, skin resurfacing, and all the rest of the corrective procedures. WHen my hair grows in a bit, you can still see the doll hair look after just 4-5 days. What you can also see is the fact that I don’t need that much more in order to fill in. I have alot of scar tissue and my donor area is limited. I don’t know what to do. Your websites reveals very frank talk while revealing good work. Doctor, I am so tired of living this 100% selfconcious life. I don’t go to any events, social gatherings, funerals and wakes are a nightmare, weddings forget it, my kids events. I’m tired. It’s changed me. I find I can’t concentrate on anything.My self worth is zero bacause I see what I did to myself. My career is halted. Go where I can wear a hat. I am a member of SAG-whose going to hire an actor with lines going across his head. That’s another career that’s been halted. Can I send you some pix. I don’t think FUES are out of the question. The problem is sending photos with substantial growth since I cant’ grow it that long w/o looking like a freak. This sucks! Sorry but it totally consumes me. It’s easy for a friend or wife to say-” who cares, don’t worry about it” ” you have kids to worry about”- it’s not that easy. I want my life back. The Joe Penny article fueled this email. I hope I don’t sound angry but it seems like no one listens or can understand the pain. Why even live if you look like a freak, have no career, debt, scattered thoughts ect. Can you help?

Actor Joe Penny has been kind enough to share his experience with the repair process and some of what you are describing is just what Joe went through. Joe’s experience is a success story, while others who we have seen over the years have not been so fortunate. We’ve published the stories of many patients that just wanted to be bald again, with one example being that of a local doctor who fell victim to the process. Although his results seem to work for him, his solution was far less than I would have accepted (but one way to avoid a huge wig).

I am ashamed of the history in this profession where the old deforming type of surgeries created work like you are complaining about. It has impacted the lives of so many men and most of the doctors who did the worst type of this surgery are nowhere to be found today to solve problems like you have. Believe it or not, some of this surgery is still being performed today. You made a decision to improve yourself, and fell victim to an industry that was at best naive and at worst malicious by offering such surgeries. I wish you much success and good luck.

As you are in NY, Dr. Bernstein (with offices in NY and NJ) may be the best route to other solutions. Both Dr. Robert Bernstein and I have spent a great deal of time with patients like you. If you’re planning a visit to California, I’d be happy to see you.

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

Dr. Rassman,

Hi doctor. I wish I could be writing to you under different circumstances, but I’ve got a major problem that I need some advice on. I had a hair transplant with a doctor here in Canada about 10 months ago and I really, really hate the results. This doctor completely ruined my appearance. I’m considering legal action due to what I feel are unethical practices. A couple thousand dense-packed grafts were placed in the hairline (some of them were placed at the wrong angles), and many 2-hair grafts were also placed there. My hair is dark and coarse, so it just does not look right! I’m considering electrolysis to try to undo this and maybe start over elsewhere. I need help!

It is quite hard to remove hair by electrolysis and lasers without creating hypopigmentation (loss of skin color) in the area where the grafts are taken out. Surgically removing the hairline could work, but it would require real expertise in doing this. Hairs transplanted in the wrong direction / angle should be a real concern and some of the solutions can be as difficult to achieve as the actual problem you are trying to solve.

I always tell the patients I see to talk with their doctor. Most doctors care about the results you got and the doctor should be able to address your problem in detail. I always tell patients that the good news and the bad news about a hair transplant is that it is permanent. It is very hard to undo them if they are not done properly. I couldn’t tell you if legal action is the way to go — what I can do is try to help get you back to normal looking. You do have a very real problem, but I would have to see you in-person to determine what can be done to help your particular case. Whatever happens, you must know and set realistic expectations on what can be achieved with any ‘repair’ that you undergo.