This patient had plug surgery 20 years ago. This method is outdated by today's standards. During plug surgeries, the hair is removed in 4mm plugs, about the size of a pencil eraser. The plugs are then transplanted to the front. Each plug for this patient included 3-6 follicular units and all of the tissue between the follicular units. Because of the bulk of the tissue, the transplanted area was raised, causing a ridge on each side of the frontal third. He also had widened scars in the donor area from where the plugs were harvested.
The options to this patient were to either add hair around the plugs to make the area look more natural or to remove the plugs and go for a bald look.
First, this patient came in for a test. We removed 4 plugs and placed them into the scar. Test sessions are especially useful because it allows the patient and the doctor to review the results before moving forward with a large session. Should the result of the test be unsatisfactory, the patient can decide against moving forward before they spend money or make large changes to their appearance. It also allows the doctor to adjust the future surgery based on the outcome of the test for optimal healing and results. Dr. Cole and the patient decided that the test was successful, so they did a larger session, removing 435 plugs in one day. The plugs were divided into smaller groups and transplanted to the scars in the donor. Another session removed 271 more plugs, divided, and relocated the hairs to the scar in the donor. This gave a total of 710 plugs removed and relocated to the scar.
Here are pictures of before, 1 month after surgery, and 1 year after surgery.