Repair of Older Techniques

While state-of-the-art hair transplantation can now create results that are so natural looking that they are virtually undetectable, not every patient has received such high-tech surgery. For the unfortunate patient who has been the recipient of poor technique or hair transplantation from the past, there are an array of surgical treatments at Dr. Konior's disposal.  These techniques provide permanent relief from artificial looking looking results:

Repair of Pluggy Hairline Using Direct Graft Excision and Ultra-Refined Grafting

Graft Camouflage

The strategy with camouflage is to use hair transplantation, either FUE or FUT, to implant follicles to surround and disguise the pluggy grafts.  In the most simple terms, Dr. Konior implants a number of single hair follicles among the pluggy grafts. With a number of small grafts placed in the spaces between the plugs, a natural appearance can be achieved or at least the pluggy appearance can be softened.  Many men cannot pursue this strategy.  A factor more unique to this strategy is that poor donor resources may not exist and mass implantation may not be possible.  If inadequate donor resources are a limiting factor, another solution or combination of solutions may be needed.

Simple Graft Excisions

The excision of a number of awkward or pluggy grafts can sometimes be the best answer to cosmetically unappealing grafts.  Patients who present with little or no viable donor resources and with pluggy grafts can sometimes benefit the most by simply excising all of the grafts.  These individuals typically are victims of old plugs distributed haphazardly through the front with nearly complete baldness behind.  Some of these men even wear hair systems to hide the embarrassing plugs.  Dr. Konior has found that these men can often be happy with the simple removal of the grafts and a bald look.  The patient can then take off his hat or go without a hair system without fear of looking like he has had a bad hair transplant.  Pluggy crown grafts commonly result from young males undergoing hair transplantation and then losing much of the surrounding hair.  These men have learned by experience that crown restoration may not a good idea for young men.  Because these men want to preserve limited donor resources or because they do not have enough donor hair to fill the crown, they can be very content with excising the plugs and relieving themselves of the unnatural appearance.

Simple Graft Excisions plus Reimplantation

This techniques includes the excision of a number of awkward or pluggy grafts, plus their subsequent dissection under microscope and then reimplantation into the scalp.  The removal and recycling of unsightly plugs may be necessary, especially when the plugs are located in the area of the hairline or the crown. In this process, Dr. Konior removes the older, disfiguring plugs and divides them into natural, follicular unit grafts. Large plugs can often yield several natural follicular unit grafts. These follicular unit grafts, which are recycled from the old plugs, are then implanted into areas of need. When implanted between pluggy grafts, for example, the new follicular unit grafts may make reduce the pluggy appearance of the old grafts.  In the frontal region especially, modern follicular unit grafts will soften harsh lines and create an improved hairline. Besides repairing aesthetically displeasing plugs, the recycled plugs can also improve upon previous less-than-ideal hair restoration results, such as hairlines that were placed too straight, too low, or at an inappropriate angle.

Staged Graft Excisions

A common scenario in our office will typically involve a middle-aged man who has undergone numerous previous plug surgeries and now needs a great number of them removed.  Camouflage and simple excision and reimplantation may not be worthwhile options, especially if the sheer number of plugs and their sizes make them impossible to disguise.  One session or more of pluggy graft excisions followed a few months later by a session of dense hair transplantation can often be the solution.  As long as the patient can afford the graft removal sessions as well as the subsequent hair transplantation surgery, he has the benefit of removing and recycling the old plugs and has best chance of a natural appearance.

Graft Excisions plus Hair Transplantation

It would not be fair to categorize the existence of old plugs as being a complete impediment to undergoing "normal" FUE or FUT hair transplantation.  With old mini-grafts especially, many men can undergo a single session of hair transplantation with the simultaneous excision and removal of only the most offensive grafts.  In other words, simply removing the ones that absolutely need to be removed.  This, of course, is an ideal situation because the patient is able to achieve the goals of eliminating plugginess and adding natural density at the same time.  With this strategy, the key concept is the size of the offending grafts and the ability to remove them without affecting the overall hair transplant goals.  If one has a large number of large, pluggy grafts along an unnaturally lowered hairline, there is a real risk that this approach will not achieve patient satisfaction.

Forehead Advancement

This type of approach involves the direct, linear excision of one or more rows of pluggy grafts.  The fine line that results from this surgery is then hidden with one or more sessions of dense hair transplantation to recreate a natural, dense, well-placed and age-appropriate hairline.  A successful candidate for this approach is typically a male whose past surgery placed the hairline unnaturally low with a number of plugs.  Some of these patients may at first request camouflage as a solution or have been told that this was a reliable option.  However, while the placing of single hair grafts in front of the plugs may soften the pluggy hairline, it will at the same time be lowering the hairline even further and making the inappropriate hairline issue more obvious.  It can make the unnaturally low hairline even more aesthetically displeasing to the patient than it was prior to surgery.  Forehead advancement is designed to raise the hairline to a more natural position while at the same time removing the plugs and recycling them to areas of need.  At a later date, hair restoration surgery is performed to add the needed density to achieve density goals and to hide any visible scars.

Correction of Sagittal Grafts

Sagittal grafts are ones that are placed perpendicular to the skin.  If one pictures a forest where the trees grow straight up and the lower trunks are entirely bare, one can imagine that see-through effect.  While the tops look full, the bottom areas look sparse and peculiar.  This effect occurs when the hair grafts are implanted straight up by the surgeon rather than at a proper angle.  In short, sagittal grafting is responsible for the unnatural, see-through effect that one can sometimes observe in hair transplantation patients.  An effective solution for this issue is to surround the sagittal grafts with the implantation of deeply angled grafts. These grafts push down the old, sagittally growing hair grafts and provide a more natural appearance for the patient.  The new grafts have the added benefit of boosting density because they lay lower to the scalp and cover thin areas more effectively.

To contact our Chicago area office in Oakbrook Terrace for a preliminary assessment of your hair loss, complete the virtual consultation form or call us at 630-932-9690. 

Dr. Raymond J. Konior, MD, FACS

Chicago Hair Institute

Dr. Raymond J. Konior and the team at the Chicago Hair Institute offer world-class treatment backed by over 30 years of expertise in the field of hair restoration. Our doctors are nationally affiliated with professional associations including:

  • International Society of Hair Restoration Surgery
  • American Board of Facial Plastic and Reconstructive Surgery

To learn more or to schedule an appointment at our Chicago, IL, hair restoration clinic, contact us online or call (630) 932-9690.

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