What can be said about the skill of the technicians if many double-hair grafts are placed on the frontal hairline? (photo)

Question

My hair transplant failed of 2,000 grafts (1500 front + 500 crown). There has been poor growth in the crown, frontal area and there are bald patches in temples. Donor area is destroyed also. I also see many double-hair grafts in the frontal hairline giving it a completely pluggy look with very low density. What can be said about the skill of the technicians if they filled that area with double-hair grafts instead of single hair grafts. And can single hairs be extracted from these double hairs?

Bernardino Arocha, MD, FISHRS · Answer

fuepatient212,Thank you for the question. I am so sorry to see this! Unfortunately, it is happening very frequently. Research is vital to prevent this from happening. An expert has no shortage of evidence of the great work they perform. Experience is a database of having done something, it permits the expert to navigate difficult situations. It looks like your donor has been over harvested in certain areas. I would recommend that you seek a consultation with an expert to thoroughly examine you and devise a short and long term plan. This is vital, no one has donor to waste! The hair transplant network has many carefully screened providers,another source might be    The American Board of Hair Restoration Surgery is a good reference with many Diplomates that you can search for the necessary before and after photos and videos.Best of Luck,Sincerely,Bernardino A. Arocha, MD

Jae Pak, MD · Answer

A successful hair transplant surgery is a reflection of the surgeon and the team.  Double hair grafts should never be placed on the hairline.

Ali Emre Karadeniz, MD · Answer

The problem you mentioned about double-haired grafts being placed at the hairline seems to be the least of the problems they caused. If placed at proper angles, directions and density, double-haired grafts at the hairline may not look unnatural. The graft harvesting wasn't done evenly and punch holes were created too close to each other, probably a very high transection rate which also explains the poor growth rate. The hairline design is not done professionally and the angles/directions of the hairs placed are wrong. The density is insufficient. You are strongly advised to consult a professional that could do repair surgery by removing the previous grafts and looking for a way to improve the donor area.

Cory S. Goldberg, BSc, MD, FRCS(C) · Answer

Hello in Gainesville,Thanks for posting so many photos.  I'm sorry to see the poor result of your transplant.  If done properly, at 13 months you should be able to see a much better result than that.  As you've said, typically you want to see single hair units used to reconstruct the frontal hair line, and then doubles and triple further back to provide density.  The graft take at the frontal hair line and the fronto-temporal angles is rather poor.  It is possible that such poor graft take and growth is due to technical problems with the grafts, such as poor harvesting technique causing trans-section of the follicles, but it would be unusual to lose so many grafts. Poor growth could also be due to other health issues such as smoking or poor blood flow, or the presence of skin disorders and autoimmune disease (rare).  Before you consider paying for another transplant, make sure you see a dermatologist to make sure you do not have a medical disorder or skin condition that interferes with hair growth.  It may be worthwhile to have a scalp biopsy.  You may also want to consider using Minoxidil and Finasteride for 12 months (minimum) to see if that can improve things.  As for the donor site on the back of the scalp, consider growing your hair a bit longer, and that should mask the visible thinning.

Baubac Hayatdavoudi, MD · Answer

Being that you are unhappy with the yield, density and appearance of the result and it being pluggy, you should look in to some of the top clinics in the U.S. for repair work.Rather then choosing your hair restoration doctor based on who is close to you, you should research the top clinics and go with who's results you like the best. Many of today's top clinics will reimburse you for travel cost, and you can leave for home the very next day after the procedure, so travel and location should not be a top consideration when choosing your doctor. The result you receive will be permanent and there for life, so don't be afraid to take a short trip to go with your favorite clinic.

Brian Goertz, MD (retired) · Answer

Hair transplantation is a very specialized procedure and done best by full time hair restoration physicians and there team. The International Society of Hair Restoration Surgery is explicit about who should extract donor material, the physicians. Grafts needs to be extracted and handled with care to avoid transection and cell death. The scarring you have and poor growth should be investigated a by a full time hair restoration physician, there are less than 100 in the USA. Get to know your doctor, do your research well. Double hair grafts should never be placed in the frontal hairline. The surgeon is responsible for his/her work and their team. Good research helps to avoid bad results.

William Rassman, MD (retired) · Answer

The placement of two hair grafts in the frontal hairline is something that should not be done because it makes the hairline detectable. What you need is a no-hairline hairline, something I discuss often (see below for a typical example). This can be corrected in the right hands as shown in the photo of the blog post

What can be said about the skill of the technicians if many double-hair grafts are placed on the frontal hairline? (photo)

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Answers (7)

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