Today I want to demonstrate a bad hair transplant in young patient from another Doctor. The patient came to me requesting more density and this is what I saw. The patient is now in his mid 40’s and had his first hair transplant in his late 20’s by a local Southern California physician. The physician who performed this patient’s hair transplant placed his hairline extremely low, and did not take into account the fact that the patient would experience much more hair loss over time. This is a cardinal rule in Hair Transplant planning, that we as physicians must treat the patient not just for the way they look when they present to us initially, but for the amount of hair loss to the extent that we can predict over time. This is even more important in young patients who can be expected to experience a significant amount of additional hair loss over time.

In addition, the hairline that the physician created is not irregular enough and from a distance looks too much like a straight line. It is always important to create significant irregularity in the hairline in order that it does not look like a straight line from a distance as this is a dead give away for a hair transplant. Hair does not naturally grow in straight lines.

Finally, as if the above was not enough, if you look closely as the photos, you can see that many of the grafts appear as if they are growing out of a small crater in the skin. They are not flush with the skin, as they should be. This is because the grafts were placed too deeply. When this happen a phenomenon called “pitting” occurs and the grafts appear as if they are growing out of a hole in the scalp. When they are placed too high it can also cause small bumps which is called “cobble stoning”.

Unfortunately once the wrong has been done there are not many great options to correct it. In this case the patient’s options are to have the low hairline grafts removed via FUE and recycled further back (this would leave tiny white spots where each graft is removed). Another option would be to have a plastic surgeon raise the entire hairline but undermining and cutting out a large piece of skin posteriorly. This would require extensive scalp surgery. The last option would be the soften the hairline with single hair grafts and place additional grafts in the frontal and mid scalp, ignoring the crown as this patient will never have enough donor hair to fill the entire area of balding if we transplant up to this low lying hairline.

The bottom line here is that it is of the utmost importance that when seeking a hair transplant procedure you throughly investigate your physician in order to ensure that you are going to a competent Doctor. Years in practice do not always translate to good technique, as many physicians continue to make the same mistakes over time and never change their techniques. Beware of the “lowest price” or “over promising” physicians. Find a competent, kind, and compassionate physician, who is an artist, and loves their work.  Spend the time, and do the research, and hopefully things will turn out right.

All the best,

Marc Dauer, M.D.

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