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Hair Plugs

Picture of Author: Dr. Victor Hasson

Author: Dr. Victor Hasson

Medical Doctor & Hair Restoration Surgeon

What Are Hair Plugs?

Older hair transplant procedures from as early as 1952 up until the 1980’s were commonly referred to as hair plugs. Large round punches were used to harvest groupings of hair that would commonly consist of up to 30 hairs per unit or graft. This now outdated approach to hair transplant surgery resulted in an unnatural outcome resembling the appearance of doll’s hair due to large graft size and spacing between plugs. The donor area was also negatively impacted as the harvest of these large grafts left a considerable amount of potentially noticeable scarring and damage that would also limit further harvests. With advancements in technology and surgical techniques, such as follicular unit transplantation (FUT) and follicular unit extraction (FUE), the era of hair plugs is thankfully behind us. These modern methods involve the transplantation of individual follicular units, resulting in more natural-looking hairlines and improved aesthetic outcomes, while minimizing scarring and at the same time enabling a faster recovery for patients.

hair transplant patient with hair plugs before repair

Hair Plugs vs Hair Transplant

  • Natural Result: Both FUT and FUE provide much more natural-looking results compared to the outdated hair plug method of extraction.
  • Reduced Scarring: Modern techniques in the right hands leave minimal scarring, making it difficult to detect that a hair transplant was performed.
  • Improved Aesthetic Outcomes: The smaller grafts which therefore require smaller and more precise incisions enable better graft placement and integration with the existing hair, creating a more cosmetically pleasing outcome.
  • Enhanced Recovery: Patients experience quicker recovery times and less post-operative discomfort and side effects with these newer more modern methods.

Hair Plugs Repair

When adopting a plan for a hair plug repair, the surgeon carefully evaluates the patient’s scalp to determine the best course of action. This includes determining whether the location of the plugs is appropriate and if the angle and direction is acceptable. If they are, the repair can be easier if the surgeon can eliminate the negative appearance of the plugs by transplanting the necessary number of grafts in front of and around the old work to completely camouflage.

In more difficult scenarios, removing the outdated plugs is necessary for the best outcome. Removed plugs can be broken down into the correct units and repurposed elsewhere on the scalp. After a period of healing, the newly created landscape, usually the hairline and frontal zone, can then be reconstructed using the modern techniques mentioned above to achieve the desired natural result. As long as the previous work has not severely compromised the donor hair and there remains a sufficient number of grafts available in reserve, outcomes can be very good.

In those cases where donor hair is very limited and there is not enough in reserve to adequately repair the previous work, removal without reconstruction is also an option. No hair or a bald appearance will be more natural than the doll hair/plug look. Ultimately, hair plug repair offers a transformative solution for individuals dissatisfied with the unnatural results of previous hair transplant procedures. By combining surgical expertise with modern techniques, patients can often reclaim a natural-looking, full head of hair and regain confidence in their appearance.

Hair Plugs Before And After

This patient learned the hard way that choosing a surgeon based exclusively on price is likely going to be a poor decision. Opting for a very low-cost procedure in a foreign country did not achieve the expected results, leaving him in worse condition than before. After experiencing this very disappointing outcome, he conducted further research and discovered that Hasson and Wong were far superior to his previous doctor, and he hoped we could correct his earlier mistake. Fortunately, he still had enough donor hair for a significant transformation. However, due to the poor quality and location of the previous work on his scalp, additional steps were necessary to ensure the best possible, natural-looking result.

Removal Of Existing Plugs

The hairline is not only placed too low, especially in the corners but the hair direction is also incorrect. To properly repair this patient, many previously transplanted hair plugs needed to be removed.

hair plugs bxeing mapped out for a repair surgery

Mapping Out The Plug Repair

These mapped out plugs in the old hairline were targeted for removal. In addition, the first row of plugs in the temples needed to be excised.

hair plugs patient after hairline was raised

Raising The Hairline

After phase one, the hairline was affectively raised and the most offensive plugs were removed to pave the way for the new hairline.

patient showing hair plugs repair two weeks after corrective surgeyr

2 Weeks Post Hair Plugs Repair

2 weeks after the final reconstruction, the transplanted hair effectively blends with any old plugs making them now a non-issue.

Post Surgery Results

After removing all of the old hair plugs deemed necessary, 3,170 grafts were used to reconstruct the new hairline and frontal zone. The extra steps taken by Dr. Hasson and his team, including an additional removal session, ultimately paid off. The results speak for themselves, and although the process was costly and time-consuming, it was a life-changing transformation for this patient.

post surgery hair plugs results
hair plugs post surgery left temple repair

Before And After Plugs Repair #2

This patient also had large, unsightly grafts from a previous procedure. Despite issues such as poor angle and direction, the previous surgeon did not place the hairline too low or advance the temples. Therefore, removing the previously transplanted grafts was unnecessary. Dr. Hasson could design and reconstruct a lower hairline to effectively camouflage all the old grafts.

Redesigned Hairline Effectively Hiding The Hair transplant Plugs

With the new lower hairline and significantly higher density compared to the previous work, the old, unnatural-looking frontal zone is completely concealed.

BEFORE

patient showing his results after a bad hair transplant

AFTER

Correct Angle And Direction

In many repair cases, previously transplanted grafts are placed at incorrect angles and directions. If these misalignments are not too extreme, they can be overcome with a lower hairline and sufficient density. By placing enough new grafts in front of and around the old ones, the new hair can influence the appearance of the old grafts, allowing them to blend in seamlessly with the new grafts.

patient showing plugs in right temple before repair surgery

BEFORE

AFTER

Final Results

The top priority was to restore a natural appearance to the front, using any remaining donor reserves necessary to achieve that goal. Often, in cases like this, donor reserves are compromised, limiting what can be done. However, this patient was fortunate to have a good remaining donor supply. As a result, Dr. Hasson and his team could not only restore the hairline, frontal zone, and mid-scalp, but also completely cover the entire balding areas, including the crown, achieving a remarkable transformation.
top of head of patient with hair plugs before hair transplant repair

BEFORE

hair plug repair after photo of patient showing top of his head

AFTER

patient with hair plugs showing hairline before corrective surgery

BEFORE

patient showing hair plug repair results in his hairline

AFTER

Hair Plugs Cost

In such a case as referenced above where old hair plugs are appropriately placed with correct angle and direction, the cost can be similar to a typical reconstruction on a virgin scalp. However, in cases that require hair plug removal, costs can be greater. In addition to the removal phase or phases, some cases will require not only one but perhaps two sessions to reconstruct.

A few scenarios and how they may affect cost:

  1. No need for old plug removal: The cost will be similar to a hair transplant procedure on a virgin scalp.
  2. Some removal of plugs required and one session to reconstruction after removal: 25 – 50% above the price of scenario #1.
  3. Extensive removal of plugs requiring two removal sessions: closer to 50% above the price of scenario #1.
  4. Extensive removal of plugs requiring two removal sessions and two sessions or more required after removal: 100% or more above the price of scenario #1.

Hair Plugs Scars

Scars from hair plug procedures are more noticeable when hair is cut to shorter lengths on the sides and back. In addition to an unnatural hairline, the resulting donor area scarring can also be an issue. In the best possible outcome, both the recipient area and the donor area can be improved. In a typical case, as much of the scarring from the hair plug harvest will be excised reducing the total area of scar tissue. The extent of the scarring among other factors can influence the best approach but because a hair plug harvest usually leaves a large area of scarring creating areas of lower density as well, FUT can be the preferred method of extraction provided the scalp has sufficient laxity. By removing as much of the scarring as possible, its impact on the appearance is reduced. At the same time, grafts harvested within the strip are used to reconstruct the new hairline. FUE can also be considered to add hair into the pencil eraser sized scars. However, in these cases the patient will need to have enough remaining donor hair. We’ll need enough grafts to completely reconstruct the hairline and any other necessary areas in addition to having enough to fill in the donor area scars.

Hair Plugs Summary

With the arrival of more advanced techniques like FUT and FUE, the transition from hair plugs marked a significant improvement in hair transplant surgery results. These modern methods are not only superior to older methods of the past but also reduce the negative impact on the donor area. Thankfully, hair plug procedures are mostly a thing of the past, but unfavorable techniques and procedures can still be found today. While it is far less likely you’ll receive a procedure that achieves a result more typically found decades ago, choosing a clinic or surgeon with extensive experience in modern techniques to ensure the best possible outcome is still important today. A “repair” patient is the last thing you’ll want to be considered because of a bad hair transplant decision.

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