Hair Transplant Correction
In an ideal world, hair transplants should be done perfectly, creating natural and dense results that last a lifetime for all patients. The reality is that not all transplants are created equally, and there is a wide range of hair loss in patients and skill sets in surgeons around the world. A patient’s transplant may look unnatural or thin and can result from a few different reasons. It is important to know what can be done to improve a less than “perfect” transplant.
Common Reasons for Correction / Repair
There are a few reasons that lead a patient to repair work.
- Patients who had an adequate initial result may over time, lose more hair from genetic alopecia that may necessitate needing more surgery. The hair loss around the transplanted hair may eventually leave an unnatural pattern.
- Also, repairs may be desired because the transplant was poorly done in the first place. Hair transplants from years ago were often done with larger grafts and some of these patients still live with this coarse and “pluggy” appearance.
Even today, for multiple reasons, low-quality work by inexperienced providers is still being done. These results can leave low-density, very unnatural results. Beware of work done by the Black Market Clinics.
Some poor work is being done by physicians not experienced in hair loss or hair restoration surgery and they use non-licensed hair technicians to perform most, if not all of the work. It is important to choose trained and experienced hair restoration surgeons.
Correction for Poor Work or Continued Hair Loss
There is hope for patients suffering from unnatural results from continued hair loss or poor-quality surgery. Many experienced hair restoration surgeons have the skillsets necessary to improve the cosmetic appearance of patients in need.
As discussed, there is a limited number of hairs available to use as donor. If there is not enough of this donor, then correction of more loss or bad transplants may be challenging or even impossible.
You should seek the advice of an experienced hair surgeon near you to go over your options. Thankfully, much more help is available to patients in need through current advances in techniques and technology.
Characteristics of Transplants that may Benefit from Corrective Work
Genetic hair loss is a relentless disease that affects many patients for a lifetime. Those patients who had good work done initially may continue to lose more hair over time around and behind their transplanted hair. This continued loss can occur because the patient does not want to be on hair loss prevention medication, the medications don’t work as well over time, or just the general passage of time. If a proper plan was established prior to the first surgery, then additional surgeries should greatly improve the situation for the patient.
Those patients with poorly done work can have various “problems” with the results. Common issues are hairlines that are placed too low or too straight on the patient’s forehead. Younger patients, especially, often push the surgeon to give them an overly aggressive and low hairline.
In addition to the hairline, grafts can also be put in inappropriate areas and at the wrong time in a patient’s life. Hair put into a person’s crown (vertex) at a very young age can be inappropriate and use up too much of their valuable donor hair.
Other examples include poor surgical techniques where grafts were placed at the wrong angle or in the wrong direction. These mistakes, especially in the hairline can create a very unnatural appearance. Just as in the past, large grafts placed too close to the hairline can become problematic.
The donor area handled incorrectly can also become a problem for the patient. With the FUT technique, the scar can become widened or put in the wrong area due to poor surgical skills. Harvesting grafts with FUE can also be done poorly and overharvesting can create very thin or “moth-eaten” appearing areas.
Techniques Used in Repair and Revision
Corrective surgery is often unique to each individual patient as no two patients and their surgeries are identical. An experienced surgeon should give you a detailed plan for approaching your individual goals and desires. The goal of most corrective cases should always be improvement.
Oftentimes, depending on the case’s complexity, it may take many procedures to reach one’s goals of a more natural result. With the use of modern-day FUT and FUE, much can be done to improve poor work.
Some techniques involve first removing completely or partially some of the unnatural grafts. After that, depending on donor availability and the plan, more grafting may be done to increase density in various areas that need it or to help camouflage other areas.
The advancement of FUE has allowed surgeons to selectively remove unnatural grafts and oftentimes move them to a more appropriate area. In addition, FUE for some, has increased one’s total donor supply by allowing us to use body hair (beard, chest, abdomen) for use as a donor.
Camouflaging Techniques
Sometimes surgery is not an option or not desired by the patient. Depending on the issue, Topical powders and coverups may be used to help disguise the area. A more permanent, but non-surgical technique involves the use of scalp micropigmentation (SMP).
SMP is a permanent or semi-permanent solution that uses specialized tattoo pigment to help visually improve areas of the scalp. Very small dots in varying patterns and distributions are spread over areas of thin scalp. This can be used in low-density areas or scarred areas from prior FUE or FUT procedures.
SMP should only be performed by experienced providers who work with hair loss patients. SMP can also be used in conjunction with surgery to help improve areas of the scalp that would otherwise be too thin. Often SMP is used when the donor hair are limited and there is still a desire to improve visual density.
Complications of a Revision Transplant
Corrective work must be planned and executed by an experienced hair transplant physician. The patient and physician must understand the limitations and goals associated with the procedure.
A poorly planned corrective surgery can result in more scarring and worsening of the donor and recipient areas. This can further limit the hope of patients to find a more natural final result.
There are also occasions when no corrective work should be done. Lack of donor hair is one good reason for not performing surgery.
In addition, if the goals of the patient are too ambitious or aggressive for the amount of donor hair still available and the severity of loss, a procedure should not be done. The patient’s goals should be realistic and in line with what the physician feels can reasonably be accomplished with one or several corrective procedures.
Patient Case Studies
1. This young male was treated with a very low-density hair transplant. The patient was later repaired with an adequate density procedure.
2. The patient had surgery done in the frontal region with a poor surgical technique. The patient developed necrosis, which is the death of the skin and some grafts in the area. The photos show the normal healing of this complication. The patient may require another repair surgery later.
3. This is another young male with an inappropriately low-placed hairline. The grafts are also much too large and placed too far apart from each other. This patient will require multiple sessions to correct this.
Choosing the Right Surgeon
Many times, inexperienced surgeons create an unnatural or poor-quality transplant for the patient. It is especially important that when one is interested in corrective work, they do their due diligence in finding an experienced physician to do the repair work.
Years of experience performing hair restoration surgery is an important characteristic to look for when choosing a doctor. Repair surgery is unlike routine “normal” hair transplantation. It is unique and almost a specialty in and of itself. It is critical to locate physicians who work extensively with these types of cases.
It is recommended to see results and examples of their repair work. While no two patients are the same, this will give you a good idea of the quality of work they perform.
If possible, try to get recommendations for these surgeons from other patients who have had good repair work done by them in the past.
For a consultation with a hair restoration surgeon, access our Find A Doctor tool where you can search for an ISHRS member by location.
Expert Opinion
As a surgeon who frequently does repair work, I know that there are a wide variety of different types of patients that exist. As previously discussed, there are similarities with some hair transplant errors, but all patients require an individual treatment plan. This type of work needs much patience and dedication. This is important on the part of both the surgeon and the patient.
A good surgeon requires an artistic eye and a listening ear. It is very important to hear what the patient desires and to translate that into a realistic goal. Both the physician and patient need to be ready to make small improvements over multiple procedures to make a good overall improvement in the end. Not all patients can be helped.
Surprisingly though, there are many patients who are currently suffering from bad work who are either afraid to do more work or are unaware that anything can be done. I recommend talking with an experienced hair restoration surgeon and seeing what your options are.
FAQs
Can unnatural hair transplants be corrected?
Oftentimes, an experienced surgeon over one or multiple procedures can improve unnatural results. With modern-day techniques, it is possible to correct mistakes made in the past
How do they fix a bad hair transplant?
There are multiple techniques available today that allow the surgeon to either remove poorly placed grafts or use more donor hairs in a way that can improve the unnatural situation.
How do you hide a bad hair transplant?
Sometimes, growing the hair longer or changing one’s hairstyle can help improve the look of a bad hair transplant. Other times, a non-surgical method like SMP or a surgical repair is necessary to improve the situation.
What does a bad hair transplant look like?
Bad transplants can be those with unnatural hairline shapes or heights. Often, the grafts that are placed are done in an unnatural way. The donor area can also be harmed by scarring or overharvesting and can look very sparse.
With modern-day devices and techniques are bad transplants today less common?
No. With the advent of FUE, many physicians and non-physicians have started to perform surgery with little or no formal training. Patients are being offered cheap hair transplants by unlicensed and inexperienced practitioners. Poor results are still occurring around the world.
Do you have to do surgery to fix a bad hair transplant?
No. Sometimes, creative hair styling or specialized tattooing called SMP can improve the transplant enough that surgery is not needed. Many times though, surgery is the best option to improve the hair to a more natural appearance.
References
Harris JA. Approach to Repair Cases. Practical Guide to Hair Transplantation (eds.) True, Garg and Garg: Thieme, 2021; 563-575.
El-Maghraby S, Chaudhry M. FUE in Repair Cases. Hair Transplant 360 (eds.) Lam S and Williams K. Jaypee Brothers, 2022; 871-910.
[starbox id=2572]