Plug repair - camouflage or removal/recycle?

[albatross]

I am looking for advice from the forum on how to resolve my terrible pluggy appearance (2 sessions from the mid 90s) and frontal hair loss. The two Coalition doctors from my area I have consulted with in person have recommended polar opposite approaches:

 

1) linear excision of row of plugs along hairline + 2000 grafts over 2 sessions

OR

2) camouflage in front, in between and behind existing plugs with 1,000-1,200 grafts

 

One doctor is convinced the camouflage is the best approach and will produce a desirable result (A grade). The other says it is like planting grass among the trees and will still be very noticeable (he's had clients come back to him with poor results).

 

I can see the camouflage working with smaller mini-grafts but I am concerned if my plugs are too thick for them to be shielded adequately. However the prospect of major surgery with the linear excision and scarring is fairly terrifying given all I've been through, making the more conservative approach desirable. I can't help but think I'll be one of the 1% who has problems.

 

My overall goal is to restore a naturally looking appearance. It doesn't need to be perfect but I don't think I'd be happy if I can still see the plugs, or scars (i.e. noticeable as a transplant). I'm trying to determine if I can achieve a "very good" result (B+ / A- grade) with the camouflage as opposed to the major reconstructive surgery and higher risk with the linear excision that likely would produce an A+ result eventually.

 

Does anyone have knowledge of good repair results of large plugs leaving them alone and grafting around them? Or the opposite if this has produced unsatisfactory results?

 

Who are considered the best repair doctors in the States?

 

I feel completely confident that both doctors I consulted with are the best I can choose in my area. FWIW, I did email pictures to Dr. Konior and he recommended the linear excision of the hairline technique for the best result.

 

Both doctors agree I have a very good supply of donor hair. I even have fairly thick hair from the top of my head back through the crown. It is really just the front I need to deal with.

 

Thank you for your assistance in helping me sift through the information in making a decision. This will truly be life-altering in a good way, as I have had this "hanging over my head" for 20+ years.

Edited November 16, 2015 by albatross
fix title

[Al - Moderator]

There is a hairline plug graft repair that was just posted by True and Dorin. They filled in the areas around the grafts rather than extracting any. The link is here:

http://www.hairrestorationnetwork.com/eve/181550-dr-dorin-revision-case-2139-fut.html

[NewHare]

Albatross, I am currently researching this myself as I am in a similar situation. There is a procedure called the 'Lucas' technique that might be of interest to you. Several coalition doctors offer this. Just one more approach for you to consider.

 

Good luck...

 

 

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Edited November 15, 2015 by NewHare
added search link

[albatross]

Thanks BeHappy. An impressive result for sure. If I could count on this result I'd jump in with both feet. Good to see this is a possibility.

 

NewHare, yes I didn't mention this plug removal/recycle approach ("Lucas" technique I believe) as the one doctor recommends the complete excision over this due to the number of sessions required/slower process and better yield from taking all out in a strip. My other doc also recommended against it as the yield can be low. Dr. Konior through an email exchange also indicated a preference for the linear excision of the hairline vs debulking the existing plugs as he called it.

 

Still very torn having been told I would have good results by one doc and I wouldn't by the other.

 

Anyone else have very favorable results (or poor?) with the camouflage approach?

[wylie]

If you are happy with the hairline placement, you are the perfect candidate for camouflaging the plugs with additional grafts. However, debulking the plugs, allowing the areas to heal, and then adding additional grafts is a lengthier process. It would likely yield a more positive result, knowing that the plugs are no longer there, in effect.

 

If you can find someone to FUE the plugs to debulk them, that would probably yield the optimal outcome.

[NewHare]

 

NewHare, yes I didn't mention this plug removal/recycle approach ("Lucas" technique I believe) as the one doctor recommends the complete excision over this due to the number of sessions required/slower process and better yield from taking all out in a strip.

 

 

Albatross could you share some before and after photos of the 'excision' technique. I am not familiar with it, however I would be concerned with having a scar running across the frontal area.

 

Here is a case by one of the coalition doctors where the plugs were debulked/redistributed over two sessions. How many sessions were you told the excision process would take and how well will the plugs be camouflaged then thereafter? Also could you elaborate on the 'better yield' you mentioned in percentages between the two procedures ?

 

 

 

http://www.hairrestorationnetwork.com/eve/166773-old-pluggy-grafts-made-more-natural;-3738-grafts;-dr-beehner.html

 

 

 

 

[albatross]

NewHare, here's a link to a linear excision of the hairline (also called a brow-lift?) from one of the docs. To clarify, the whole line(s) of plugs are taken out in a strip just like an FUT strip in the back donor. The plugs are trimmed down into FUs and replanted in front of the sutured incision along with new grafts from the back. So all plugs along the hairline are completely removed in the initial procedure. Then in a second procedure once the incision has healed (I'm told in about 6-8 weeks for my case) and blood supply reestablished, a second procedure is done to fill in behind the linear scar back to the existing hair. A doctor or long-time member of the forum could definitely better describe it but I think that is the gist of it.

 

https://www.drvogelplasticsurgeon.com/gallery/corrective-hair-transplants/case-1#galleryNav

 

I don't see any appearance of a scar in the final results but the pics might be a best case scenario. It all depends on your situation too. In my case, this is what is recommended for me due to quality of donor and intensity of plugs. I believe this will yield the best result for me but it is most certainly the most invasive, which I am apprehensive about.

 

From my research I've gathered that the individual extraction of the plugs can cause damage and some percentage don't survive the process.Hopefully others more knowledgeable than me can chime in on % yield from punching out grafts vs a strip.

 

Good luck in your research, I'm interested to hear what you turn up.

[albatross]

If you are happy with the hairline placement, you are the perfect candidate for camouflaging the plugs with additional grafts. However, debulking the plugs, allowing the areas to heal, and then adding additional grafts is a lengthier process. It would likely yield a more positive result, knowing that the plugs are no longer there, in effect.

 

If you can find someone to FUE the plugs to debulk them, that would probably yield the optimal outcome.

 

wylie, oh that is an interesting technique/idea to FUE the plugs to debulk them. I wonder if that is a possible back up strategy if I go through the camouflage process and am unhappy with the coverage of the plugs (still noticeable). I'll look into this more. Thanks!

[Bill - Seemiller]

Both camouflage and plug removal have their place. In order to adequately camouflage a pluggy hairline, grafts would have to be placed in front, in between and behind the pluggy grafts. That said, if you don't want to lower the hairline at all, you may have to excise at least some of the plugs and re-distribute them wherever they are needed.

 

That said, I highly recommend discussing your concerns with one of our recommended physicians and seeing what he or she recommends.

 

Best wishes,

 

Bill

[Garageland]

I do have some examples of both procedures that you mention and will try to dig them out for you to see. Planting around the grafts to hide camouflage them will require many more than 1200 in my opinion. As you say placing around mini and micro grafts is easier you can take a look at my blog as that is what I had done nearly 10 years ago.

 

As for your situation I would like to see the height of your hairline it is much easier to camouflage if you can bring the hairline forward in your case for some reason I am guessing your hairline is already low enough but photos would help. There is a lot of scarring around the plugs and hairs are growing in all sorts of directions you would need to place quite a number of grafts around them to influence the direction. My gut feeling is to take them out with the linear excision and recycle what you can further back.

[Garageland]

Here's a video of a patient that had the same procedure that you are considering.

 

Repair of plug grafts

[1978matt]

Plugs tend to have hair at the wrong angle to the head so they could stick out like a sore thumb when you implant new hairs (at the proper angle) around them, hence it is preferable to take them out completely.

 

It's also 2 for the price of one because you get a free brow lift in the process.

[albatross]

Here's a video of a patient that had the same procedure that you are considering.

 

Repair of plug grafts

 

Garageland, unfortunately I wasn't able to find a video for the camouflage approach on the site. Do you have a direct link? I did happen to find a truly an amazing result with the browlift procedure that is being recommended for me by the other doctor. Quite a transformation

 

 

 

Do you know how long Dr. Hasson and Wong wait after the initial browlift before coming back to perform the transplant? The doctor I have spoken with says I am a candidate for a fast-track approach 8 weeks after the surgery. I have seen Dr. Konior wait 3 months.

[albatross]

Plugs tend to have hair at the wrong angle to the head so they could stick out like a sore thumb when you implant new hairs (at the proper angle) around them, hence it is preferable to take them out completely.

 

It's also 2 for the price of one because you get a free brow lift in the process.

 

Hahahah I wish that part was free but I gotcha on knocking out a few wrinkles while taking care of the plugs.

 

Good to know about the hair direction. Amazing transformation for yourself by the way. I've been emailing with Dr K. He's definitely on my short list, just considering the 6 month wait and travel.

Edited November 18, 2015 by albatross

[NewHare]

Interesting approach albeit a little too invasive for my taste. I suppose one of the trade offs might be losing some hairs via the FUE approach, though no one has actually shown that be true. A study would be most helpful.

 

Whatever your decision I wish you all the best. Having plugs myself I fully empathize with your position. Do let us know how you make out.

 

 

 

 

NewHare, here's a link to a linear excision of the hairline (also called a brow-lift?) from one of the docs. To clarify, the whole line(s) of plugs are taken out in a strip just like an FUT strip in the back donor. The plugs are trimmed down into FUs and replanted in front of the sutured incision along with new grafts from the back. So all plugs along the hairline are completely removed in the initial procedure. Then in a second procedure once the incision has healed (I'm told in about 6-8 weeks for my case) and blood supply reestablished, a second procedure is done to fill in behind the linear scar back to the existing hair. A doctor or long-time member of the forum could definitely better describe it but I think that is the gist of it.

 

https://www.drvogelplasticsurgeon.com/gallery/corrective-hair-transplants/case-1#galleryNav

 

I don't see any appearance of a scar in the final results but the pics might be a best case scenario. It all depends on your situation too. In my case, this is what is recommended for me due to quality of donor and intensity of plugs. I believe this will yield the best result for me but it is most certainly the most invasive, which I am apprehensive about.

 

From my research I've gathered that the individual extraction of the plugs can cause damage and some percentage don't survive the process.Hopefully others more knowledgeable than me can chime in on % yield from punching out grafts vs a strip.

 

Good luck in your research, I'm interested to hear what you turn up.