How to fix the pitted hair and hair roots? (Photo)

Question

I have an FUE HT three years ago and ended up with pitted hair transplant on the top and sides of the hair line and the roots of the growing hair is bigger than usual and it shows under the back light and sun ,Can something like Fraxel laser or other treatment help to remove the pitting and roots .

Ken Anderson, MD, FISHRS · Answer

Dear bob2020,Thank you for writing in with this question.  Grafts with pitted scars around them are a result of not trimming enough epidermis (eg: skin) from each graft prior to implantation and/or placement of the graft too deep into the scalp.  Bottom line is that it’s a result of poor surgical technique.  The skin around the top of each transplanted follicle wants to heal to other skin when implanted.  If any significant epidermis remains on the transplanted graft, it will heal into it’s new site, and if it’s not exactly lined up with surface of the skin it will heal at whatever level the graft was placed.  The more skin left on the grafts, the larger the scarred pits at the base of the transplanted follicles.To correct this issue the grafts will have to be removed.  It’s akin to an FUE procedure, but the previously implanted grafts themselves are the “donor area.”  A consultation with your physician is important to assess the number and depth of the follicles.  Removal by an experienced hair restoration surgeon with a 0.9, 1.0, or 1.2mm punch is indicated, depending on the size of the follicles.  It will leave a tiny scar, but in experienced hands it should be negligible compared to what you have there now.  FUE is a technique I’ve been performing since 2003 when I began my hair restoration career in Beverly Hills, California, and I published the results of the first FUE megasession in the medical literature.  See the paper on the link below.  I hope this information is helpful to you.

Jae Pak, MD · Answer

It is difficult to removed pitted scalp from a bad hair transplant. Some may advocate removing (cutting out) the pitted area.  This may work but it you still have some form of scarring.  It is best you consult with a few doctors in person for a proper examination and options.

Jon E. Mendelsohn, MD, FACS · Answer

Bases on the pictures you provided, it appears the combination of the grafts being placed deep and or the size of the device making the recipient sites could be the issue.Have you made contact with the Doc that performed your procedure?

John Peter Cole, MD · Answer

The only solution is to punch out the grafts.  These are the hardest grafts to remove because they are so deep.   I would recommend a punch at least 1 mm in diameter to do this.  The wound will heal with minimal scarring that you most likely will not see.  You can relocate the graft to a new location.  It takes tremendous skill to remove pitted grafts.  I've been removing such grafts by FUE method since 2003 and developed the method; however this is a very challenging procedure.

Brian Goertz, MD (retired) · Answer

It is an all to common a problem. It is from planting the grafts too deep, either with placement by a Neograft machine or due to inexperience. It is best camouflaged with more hair planted appropriately. See the doctor who did your procedure and ask what they would do to fix it. Thanks for sharing your results, I hope it will help others avoid bad hair transplant results.

Sara Wasserbauer, MD - Account Suspended · Answer

Pitting can be the result of a graft being placed too deeply, and also can be seen in some patients who are particularly prone (if you have very active sebaceous glands this may make you more susceptible).  Whatever the cause, your surgeon can take out some of those individual grafts if they are very deep, and I have seen fractional resurfacing help smooth out the appearance as well.Good luck!

William Rassman, MD (retired) · Answer

This is probably the result of faulty placement of grafts. This is a real problem for those that have it. Go back to your doctor and ask him what he is going to do about it.  You can always seek a second opinion.

Omeed Memar, MD, PhD (license suspended) · Answer

Pitting can be seen if the hair graft moves to deep in the pocket created.  The treatment is fractional lasers.  In fact,  fractional erbium glass is being shown to help smooth out pitting in the skin and also stimulate hair growth.

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