How can I fix a pluggy hair transplant? (Photo)

Question

I had a hair transplant in 2016 that was done in the North West of England and I feel it looks unnatural. I had multiple hair grafts (3 hairs coming out of each graft). The angles and directions are wrong which makes the front of my hairline look noticeably gappy and spacious. I was thinking of having SMP put in to make it look more natural and add density. I've had SMP to over the scarring as I was badly over-harvested. Alternatively I am considering another hair transplant.

Amir Yazdan, MD · Answer

Hello, thank you for your question. In my professional opinion I would not get SMP into the hairline, most likely it will just make your hairline stand out more. I would recommend consulting with reputable surgeons to see what they suggest. Generally, for patients such as you I would recommend another corrective procedure to mask the pluggy looking grafts with single hair grafts and implant them at the correct angles. If you decide to undergo another procedure I would advise that you make sure to consult with well experienced surgeons who are actually doing the procedure and involved in every aspect of the surgery. It is possible that you may need to use other donor areas as well since you mentioned that your donor zone is not in great shape.

Hope this was helpful, if you need further help you can feel free to reach out to us at (949) 374-2563.

Hope this was helpful, if you need further help you can feel free to reach out to us at (949) 374-2563.

Marco Barusco, MD · Answer

You have a few options, based on your pictures. Some of the course hairs can be removed from the hairline, refined and re-inserted as singles for a softer look. You may have to have some grafts removed from the corners of the hairline (fronto-temporal angles) to make them more natural. The density you achieved is good and can be used to your advantage. Recycling the grafts preserves your donor area, since no more grafts have to be harvested from there in order to correct your results. There is not much that can be done with the angle of the grafts that were placed in your hairline, though. Hope this helps.

Anna Chacon, MD, FAAD · Answer

Addressing the issues you've raised with your hair transplant requires consultation with a specialist. However, I can provide some general advice that might help you understand your options.

1. **Scalp Micro Pigmentation (SMP):** As you mentioned, SMP is a non-surgical treatment that uses detailed micro-needles to deposit pigment into the scalp. It can create the appearance of tiny hair follicles that help thicken and restore the look of fuller hair. If you're considering this procedure, it's important to consult with a professional who is experienced in this area.

2. **Revision Hair Transplant Surgery:** Another option could be having another hair transplant. This could help to correct the angles and directions of the hair grafts. However, this would depend on your donor hair availability, as you mentioned you were over-harvested previously. A skilled surgeon might be able to extract grafts from other body areas (like beard or chest) if scalp donor hair is insufficient.

3. **Combination of Both:** A combination of SMP and another hair transplant could also be an option. This could potentially give the most natural-looking result, with the SMP providing the appearance of density and the hair transplant correcting the unnatural angles and directions.

4. **Non-Surgical Options:** There are also non-surgical treatments such as Minoxidil (Rogaine), Finasteride (Propecia), and Low-Level Laser Therapy (LLLT) that could potentially help improve the density and health of your existing hair.

Remember, it's crucial to consult with a hair restoration specialist before making any decisions. They can provide a thorough evaluation of your situation and guide you on the best course of action.

Taner Karahan, MD · Answer

For sure it can be fixed.Just my personal view as a hair transplant surgeon,unnnatural look is NOT only because of multiple hairs in frontal hairline zone but also not an artistic shape of hairline design applied such as man hairline should have had ''inverted V'' pattern at frontotemporal corners,midfrontal point should be lower than fronto-temporol point in vertical dimension,and there is no accordance with hairline and temporal triangle(peak).and your hariline seems flat (should have been a bit trianguler shape)...SMP does not seem to be capable to fix all these ,revision hair transplant would work very well ..I hope it helps.

George Abrahamian, MD · Answer

Hello, Dr. George Abrahamian MD here, La FUE Hair Clinic in Pasadena, CA.
Hairline structure is extremely important to the final appearance of a hair transplant. The design of the hairline should be suitable for you at your current age, but also should be suitable for you as your face matures over the subsequent years of life. The grafts on the hairline itself should be single haired follicles to give it a soft and natural appearance. If double and triple haired grafts are implanted along the hairline, it can give an unnatural and hair-plug like appearance. 
You do have a few options, though. I highly recommend against SMP in the area as it currently stands, it will make it look even more natural. If you have the patience to do so, you can pluck the multiple hair follicles on the hairline to only have 1 hair showing per follicle, but that would be something you will likely need to do frequently and likely for the rest of your life, and would be quite time consuming. Another option would be to have electrolysis done on the front few rows of grafts, which will raise your hairline, and set the stage for a second transplant to repair the design of the first transplant. This option, however, will cause you to lose a medically significant number of hair follicles that were previously grafted. The 3rd option would be to micro-punch out the existing front row of hair, and implant those hairs somewhere else, and then down the line have a 3rd transplant to create a more natural appearing hairline. This option will leave you with FUE micro-punch scarring across the hairline, which is not ideal either. The fourth option would be a repair transplant, to reconfigure the hairline with single haired follicles, and add some density between the grafted follicles you currently have. This will lower your hairline a few millimeters, but should soften its appearance. This option will lower the hairline, which may not be ideal, as the location of the hairline is just as important as its structure/design, and the follicular density of the grafts on the hairline. In my opinion, option 4 is the easiest option if your donor provides the necessary number of grafts, and if you're agreeable to a very slight lowering of the hairline (likely 2-3 millimeters).
I hope this helps, and best of luck on your hair restoration journey!

Wipawan Vathananai, MD · Answer

I'm sorry to hear that you are having this problem. What can be done are1. Removing the multiple-hair grafts from the hairline - this can be quite difficult but still possible2. Probably have to lower the hairline around 0.5 cm a bit more using all 1-hair grafts but the direction of the transplanted hair cannot be fixed
I hope this help

Jeffrey Rawnsley, MD - Account Suspended · Answer

The hairline should be created with the subtle features that make it unique. These include the height from the eyebrows, the shape as it ties into the recession area toward the temples. The doctor that created this hairline was a little ambitious in how low it was brought down. There are no temporal recessions, so it looks much like a adolescent hairline. The element that could be relatively easy to improve is to create a softer look of the hairline. Naturally, hairlines have significant micro-variations. In addition, instead of the multiple hair follicular units that I see in the frontal hairline of this patient, there should be all single hairs along the border, as is seen in nature. So the fix is to add single hair units, in an irregular line, to visually soften the hairline. This would improve the naturalness.

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