At the Seager Hair Transplant Centre, we frequently perform hair transplantation for patients who had already had hair transplantation elsewhere.
Some of their more frequent concerns are that the transplanted hair looks too sparse and/or too conspicuous (“pluggy”.) Sometimes hair has been transplanted into areas that would have been better not to be transplanted. Often there are donor scars and donor hair limitations to contend with.
Performing hair transplantation for patients who have had previous hair transplantation elsewhere can be the most challenging but can also be the most rewarding work in the field of hair transplantation.
Of course, an individual plan must be devised for each patient but there are some general considerations.
In the donor area, the goal is usually to obtain as much hair for transplantation as possible without causing additional scarring or leaving hair between two scars that would be unavailable for future hair transplantation (because it is needed to conceal the scar below). Where there are wider scars that are conspicuous or could become conspicuous, part or all of the donor scar could be excised as one edge of the donor strip. If there is a significant risk that scar revision would be unsuccessful or could make a situation worse, we can transplant hair into conspicuous donor scars.
If someone has had micrograft or minigraft hair transplantation that is mostly just too sparse we can improve it beautifully by performing follicular unit hair transplantation into the same area.
In almost every corrective hair transplant, follicular unit micrografts will be placed to surround and fill in between and camouflage older, larger grafts. We can thus increase the hair density in the transplanted area and make it look more natural at the same time. In the case of previous frontal work, where the previously transplanted hairline was fairly high, we can just create a new all follicular unit no-line hairline below the old grafts and can fill in the remaining area.
Often there are larger, conspicuous old grafts close to the hairline and the hairline is already too low or low enough that it should not be lowered further. Other times there may be isolated large grafts in the crown when there is not enough donor hair to transplant far enough back to conceal them. In these cases, camouflage alone may not be enough. Older grafts can be removed or reduced surgically and, with microscopic dissection, the hair that is removed can be recycled into follicular unit grafts. This can often be done on the same day as hair transplantation but occasionally it is better done as a two-step procedure. That is the old grafts would be removed or reduced and the recycled hair transplanted in one session then the main session of hair transplantation would be performed later, after the area had healed.
Occasionally, electrolysis i.e. destruction of some of the hairs within larger micrografts or minigrafts in conspicuous area can lead to a better result than removing and recycling the hair. This is only an option when the underlying skin is smooth and of normal colour.
The first goal of corrective work is to provide as natural a result as possible. The second is to provide as much density and coverage as is reasonable and the third goal is to preserve or restore the donor area as much as possible.
Previous punch graft transplantation performed elsewhere
After camouflage with follicular unit transplantation at the Seager Hair Transplant Centre