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This 59 year old patient came to us to repair his pluggy looking hair transplant. His goal was to have a more natural appearance and slightly better coverage.
As you can see in the pre-operative photos, his transplant was very pluggy. He had numerous vertically directed two and three hair grafts in a perfect row along the hair line. Behind this he had numerous full size 4mm plugs.
When we perform repair cases, we like to ask our patients whether their goal is to have more hair or to be naturally bald. Of course there are numerous degrees of coverage that one can attempt in between this. In this case, the goal was to have slightly more hair and to have a more natural result.
When someone wants to have hair and be natural, the best way to transform them is to add hair without taking out hair. Once the new grafts have grown in, we can selectively remove grafts that are very unnatural or we can try adding a little more. You can think of it as trying to hide a school bus that someone left in your front yard. You can either plant trees and bushes in front of the bus or you can pay someone to tow it away. Either way works. If you don’t want trees or bushes in your yard, you pay someone to tow the bus away. If you prefer trees, the best way to hide the bus is to plant more trees. Then if one part of the bus is still visible, you can spray paint that part green.
Taking hair out is a little risky because you never get a 100% return on the removal process. If you take out 100 hairs, you might get only 85 to 90 back. If you don’t care about loosing 10 to 15 hairs and you don’t want to appear hairy, you can simply remove the grafts by FIT and appear naturally bald. If you prefer to be hairy, it is best to add hair and then selectively remove anything that is still noticeable or add more hair.
In this case, we added many single hair grafts to the hair line and then several rows of two hair grafts. In a single procedure performed 17 months prior to these photos, he achieved his goal, which was to be more natural result. This procedure consisted of only 1800 grafts. His goal changed with a more natural result. He now wants a fuller head of hair.
When someone looks like they have a hair transplant, they are willing to do almost anything to look natural. Once they look natural, they often alter their goal and want to have more hair, as well. This is one of the risks associated with just taking out grafts and I’ve seen it happen before. I have had patients who wanted to be naturally bald. Once we go through the laborious process of taking out hair and making them look naturally bald, I have seen patients come back and suddenly have a desire to have more hair that looks natural. Therefore, I strongly encourage patients to come to grips with their ultimate goals before we begin. If you want hair and you want to appear natural, it is usually better to add first and take out later if required because you will usually find that you do not need to remove that much hair. There are a few problems though. A young patient who has plugs and is a class 5 headed to a 6 or a class 6 already in his 20s or 30s will require a tremendous number of grafts to make them look natural. Therefore, it is a very good idea for these guys to consider the long term consequences of trying to have more hair. In these instances, the on going financial commitment can be huge and it can exceed the budget that many young men have. |
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Wow! Huge difference! Very nice
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