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Avoiding the “Pluggy” Look


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When some people hear the phrase “hair transplant,” they immediately picture an older, balding man with visible hair plugs. In the early days of the surgery, several decades ago, the methods used by surgeons created an unnatural appearance, similar to the way the hair on a doll’s head gathered together in clumps or plugs.

Hair restoration surgery has come a long way since then. These days, the methods used by surgeons create a more natural appearance. Few people will know if someone’s had a transplant, unless, of course, you tell them. Whether you’ve had poor results from a transplant in the past or are considering the procedure today but are concerned about a pluggy look, you can rest assured that modern techniques produce a much better result.

Why Plugginess Happens

Older hair transplants look pluggy because of the size of the grafts used. The process of transplanting hair involves taking a graft from one area, usually the sides or back of the head, and moving it to the desired location, such as the top of the head or the beard area.

While today’s grafts are tiny and involve just a few hairs, older grafts were particularly large, up to 4 mm in diameter, which is similar in size to the diameter of a pencil or pen. It wasn’t until the 1980s that techniques were introduced that used much smaller grafts. No surgeons use the older, larger graft methods today. But there may still be past patients out there coping with the results of a bad hair transplant.

Follicular Unit Extraction

Follicular unit extraction (FUE) was introduced in the 1990s as a more advanced method of hair transplantation. Unlike the surgeries performed in the 1950s through 1980s, it used micrografts containing just a few hair follicles. It also eliminated the strip scar at the back of the head. During FUE, the surgeon removes the hair grafts using a special punch tool.

The results are a more natural look in the area where the hair is transplanted. Compared to follicular unit grafting techniques, which remove the hair from the donor area in a strip, the procedure doesn’t leave a large scar at the back or side of the head. FUE is often ideal for people who wear their hair short, as a long scar isn’t visible.

FUE has a number of other benefits when compared to FUG. Since the surgeon isn’t cutting a strip of hair follicles from the head, there is no need for sutures or stitches, which eliminates the need for an immediate follow up appointment. The lack of a large of incision also speeds healing and recovery time after the surgery.

But FUE isn’t for everyone. The surgery is considerably more involved than the strip method, which  means a surgeon is typically able to transplant fewer grafts. It’s often only recommended for patients who need 1,500 or fewer grafts. If a patient does need more hair transplanted and really wants FUE, he or she might need to undergo multiple surgeries to get the hoped for results.

FUE grafts are also more likely not to regrow. The regrowth rate for FUE is around 80-85 percent, while the regrowth rate for FUG is around 90 percent.

Repairing a Bad Transplant

Patients who have had a bad hair transplant in the past or who remain unhappy with the results of their transplant do not have to continue to live with those results. A trained hair restoration surgeon can repair the area or perform an additional procedure that conceals the undesirable results.

One way to repair unwanted results is to remove the larger grafts and divide them into much smaller units. The divided grafts can then be placed back on the head in a more natural-looking position.

Another repair option involves camouflaging the larger grafts with smaller units. Single follicles can be positioned around the larger, pluggy grafts, covering them up or filling in empty areas around them, so that the big grafts look less obvious. Camouflaging is only an option if the patient has an adequate amount of hair left to act as a donor hairs.

If you are considering a hair transplant, you can rest assure that the techniques used today will provide a natural result. If you’ve had a transplant in the past that you’re unhappy with, you don’t have to be stuck with it. To learn more about today’s hair restoration methods and what your options are for repairing a “pluggy” transplant, contact Dr. Kyle Choe, a hair restoration specialist, at the Choe Center for Hair Restoration in Virginia Beach. To schedule a consultation, call (757) 389-5850 today.

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The Choe Center for Facial Plastic Surgery offers state of the art cosmetic and reconstructive surgical care in a private, comfortable and safe setting. Our center is an AAAHC Accredited Office Base Surgery Center staffed by board certified anesthesiologists and experienced nurses. Quality and highest standards define medical staffs at the Choe Center.
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