Hair Transplant Procedures In Patients With Old Plugs


It is not unusual for me to see patients presenting for consultation who have plugs from the old way of performing hair transplant surgery. The plugs were groupings of 5-15 hairs that were punched out of the back of the scalp, and subsequently punched into the areas of thinning. They were very unnatural and looked like “dolls hair” because hair does not naturally grow in clusters of 5-15 hairs. Natural hair follicles are typically 1-4 hairs per follicle, with only single hair follicles present in the hairline. These plugs were harvested using a primitive version of the harvesting procedure we now call follicular unit extraction or FUE. The major difference is that the punch tool used to harvest the plugs measured between 2mm-5mm in diameter, while the new tools I use to harvest my FUE follicles measure between .8mm-1mm in diameter. Besides the unnatural look that these plugs left in the recipient zone, they also caused a huge amount of scarring in the donor zone. Often times these patients donor density can be decreased up to 50-75% from their original density. For these patients wearing their hair very short is not an option as their donor density has been so depleted that they must wear their hair longer in order to cover up the thinness. In most cases the best way to treat these patients is to perform a strip harvest procedure and go right through the old plug zone. If there are areas that are unscathed (sometimes the sides are untouched) the patient will have more yield from these regions. Regardless, depending on the amount of scarring and door depletion, we can often harvest between 1500-2000 grafts from these individuals by taking a maximum safe sized donor strip. In some cases, this procedure may be performed more than once. We can then transplant single hair follicles into the hairline, camouflaging the plugs, and transplant follicular units into the pluggy areas throughout, creating a much more natural look. In some cases we can also perform FUE to plugs in the hairline to remove them completely or to reduce the number of hairs in the plug, and then recycle the follicles further back on the scalp.

The technology in hair transplant procedures has come a long way since the days of the old plugs. The good news is that using the latest technology at our disposal we can improve the look of the old hair transplant plug procedures.

All the best,

Marc Dauer, MD