does mini-graft removal leave scars?

[multiplier]

My first surgery (MHR) was ten years ago and I'm considering doing another one with a reputable surgeon.

 

One issue I've spoken about to various top surgeons is improving my hairline, which looks pretty transplant-y if you look at it very closely, due to the mini-grafts used.

 

What I've discussed with some of the surgeons is the idea of removing them and planting them further back to blend with newer transplanted hair, OR to place grafts around them to minimize the look.

 

Has anyone had luck with this scenario?

 

Also - when mini grafts are simply removed altogether, is there not a pinhole or scarring left in its place? Or can they be pretty cleanly removed?

[RCWest]

I would imagine it would look similar to a FUE donor site?

[Janna]

Hi Multiplier,

 

Either removing the mini-grafts or transplanting around it are both viable options. Generally, there really isn't much of a scar remaining after a punch out session if done correctly. Which course to take depends on several factors, such as, the size of the mini-grafts, how prominent they are in the hair line and how high or low the current hair line is. If your hair line is low, the recommendation will likely be to remove as many mini grafts as possible and replant them further back. I would imagine you'll still need some fine single hairs to make it look natural.

 

If your current hairline is high, then planting around the mini-grafts will likely be favored. The existing grafts will help with the density. Make sure you have good "before" pictures to send for thorough consultations if the consultations are not in person. Best of luck!

[multiplier]

If your hair line is low, the recommendation will likely be to remove as many mini grafts as possible and replant them further back...If your current hairline is high, then planting around the mini-grafts will likely be favored.

 

That's good info, thanks Janna. I'm 35 and my current hairline is receded in a way that matches my age, and I'm comfortable with. I will ask Dr Shapiro about implanting around the old mini-grafts. I'm happy to know that can be done convincingly. Also pleased to know removing them is common.

 

That makes me wonder, for people like The Edge from U2 - he has bad plugs in front, why not just get them removed?

[Dr. William Lindsey]

I would respectfully disagree with Jana. (Assuming the hairline is at an appropriate level)

 

Growing up on a farm I am a planter, not a digger-upper and re-planter. Those minigrafts that you have are likely growing perfectly well, but are either too clumpy, too organized, in too straight of a line, or all 3. Just like driving by a Christmas tree farm as seen from the street.

 

My suggestion is to simply plant lots of individual hairs amongst the organized minigrafts that you have. You'll likely not kill any of the good growing hairs you have already paid for, and they certainly won't go through the shock of replanting. Try digging up 100 tulips in your front yard and moving them to the neighbors yard and see how many die....

 

Here's an example I recently put up. http://www.hairrestorationnetwork.com/eve/158631-9-month-check-750-fue-plug-repair-dr-lindsey-mclean-va.html

 

Plus, having practiced facial plastic surgery for 16 years, I have not yet seen the excision of anything that doesn't leave at least some scarline.

 

Now if your hairline is too low, moving grafts becomes a perfectly viable option.

 

 

Dr. Lindsey McLean VA

[wb280]

Dr Lindsey, i somewhat recalled a question answered by Dr Feller who mentioned the same as u. The idea is to plant many single hairs among the minigrafts. Obviously, i cannot fathom the reasoning ( i din look into it as i am not experiencing such an issue ) but the end results were perfect. The hairline looked so natural with the newly implanted SINGLE hairs among the minigrafts.

[multiplier]

Thanks for your input, Dr Lindsey. Even though my hairline was done at age 25, it looks like the hairline of a 35-year old, which I've been fine with because I'm not looking to look like a high school kid. So, planting amongst existing mini grafts sounds viable.

 

You'll likely not kill any of the good growing hairs you have already paid for, and they certainly won't go through the shock of replanting.

 

This touches on something I posted earlier, which I'd love to get feedback on -

 

http://www.hairrestorationnetwork.com/eve/158601-does-transplanted-non-native-hair-get-shockloss.html

[Janna]

Good analogy Dr. Lindsey. We use the trees and forest analogy quite often. I'm not quite sure what part of my response you disagree with since I wrote if the hairline is high grafting around the grafts would be favored and if the hairline was low then likely a punchout and graft session would be recommended. I addressed the high and the low hair lines where as you addressed the appropriate hairline and low hairline. You mentioned that if the hairline is low then punch out is a viable option so it seems to me like we're saying the same thing.

 

Each repair patient will certainly get a better assessment if seen in person or provide good pictures.

 

Punch out sessions aren't ideal since you do risk the follicles, and in a perfect world there wouldn't be a need for punch out sessions. But fact of the matter is that there are too many patients with inappropriately low, pluggy hairlines that don't have much of a choice. For these patients the outcome can be remarkable. I don't believe I've encountered a repair patient who regretted having their plugs removed in the last 15 years I've been at SMG.

 

On a side note - thanks again for taking care of our patient's sutures - very nice of you. Our patient had nothing but good things to say about you and your staff.

[scar5]

The question is about scarring, not about survival of transplanted hairs.

In my personal experience, I have had hundreds of hairs punched out my NW 2-3 zones and I cannot see one single scar, even with 2mm punches. For those who don't undersatnd this, consider that 1mm punches in the donor will leave spots. This concurs with what I have been told my more than one doc, that the NW2-3-4 zones scar much better than the horse-shoe donor zones. As far as strip scars go, the same applies. I had a frontal strip and the scar is very fine, almost like 'pencil thin' (pardon the cliche) As for survival, yeah I have heard , and I beleive, that casualties are high. There is sheathing of the hair graft shaft. I don't understand this intuitively, because it seems that those dumb storks planted at 90 degrees to the scalp should be the easist to punch out, yet when you see the way the skin buckles to actuate the 'break-and-punch', then it make more sense, becaues the hair follicles come out like umbrellas through a jammed door. But the key point is scarring and generally no, the scars are good, however the casualties are higher than suggested by the breezy tones of the doc, 'Let's replant them'

[Janna]

The question is about scarring, not about survival of transplanted hairs.

 

Yea, ok. And it's certainly okay to disagree on whether it leaves scars or not. Not all patients are the same so you may not get one definative answer. For those who have pitting around the mini-grafts, remnants of scarring from the punchout session is not their main concern. Until I started seeing results of repair patients after punch outs, I wondered what type of scarring would be left behind but it's always been a pleasant surprise and the hairline looks so much more natural. As I said before, it's not ideal to punch out grafts but for those who have no choice, it's a viable option.

[Dr. William Lindsey]

Yes, my disagreement was mainly on scarring. I have yet to see the excision of anything that doesn't leave at least a little scar. Now sometimes that little scar is almost undetectable, but often it shows at least a little. Having seen lots of good and awful scars on faces for 16 years, I can say that one persons "scar is ok" could actually be terrible; while another person's virtually undetectable scar can be a huge issue to them.

 

But its ok to disagree. This is a great forum and lets patients see multiple sides of potential solutions.

 

Dr. L

[gillenator]

Usually when threads like these come up, it's usually an either/or discussion. When dealing with repair, I have become more and more convinced to have both methods available in the repair surgeon you are considering.

 

I know of a very talented plastic sugeon in the Mid-Atlantic area who does HTs and does not practice FUE whatsoever. Albeit well respected, he is limited to excising any large grafts in repair scenarios. Some have to be sutured closed. It's hard to argue improved cosmetic appearance when trading off a plug for a scar. It's very possible that some of the larger grafts could be thinned with extractions thereby minimizing any "visible" scarring since there is no excising of the entire graft or plug. Some larger grafts are better to be excised; it all depends on the condition of the individual graft/plug. I think it is a judgment call by the surgeon. My point is that if the doctor at hand cannot perform FUE, he is limited.

 

Some of the best repair results that I have seen post-op utilized a combination of excision and extraction techniques.