Bad Hair Transplant

A hair transplant candidate expects dense and natural-looking hair after the surgery. Unfortunately, many doctors do not realize these expectations. A candidate feels more confident when the transplanted hair is not distinct from natural. Many doctors operate the procedure wrong which is very sad. We have many patients applying to us to fix a bad hair transplant. So, what are the reasons for the bad hair transplant? What is the solution for an unsuccessful hair transplant? In this article, you will find real patient cases with failed hair transplants who applied to Dr. Hakan Doganay for repair. You will also see the results of Dr. Hakan Doganay’s restoration operations.

What is an Failed Hair Transplant?

You can easily check whether the outcome is successful or not by a small test. When you talk to any person, you need to find out what he/she is looking at. If his/her attention is constantly on your hair, it means he/she sees the difference. Moreover, if he/she asked you whether you had your hair transplanted, be sure, the results of your transplant are not natural-looking.

On the opposite, if a person next to you does not look at your hair at all, the result is a complete success. You can tell him/her that you have transplanted hair, be sure, he /she will be shocked. This is the result we always pursue.

What are the Reasons for Failed Hair Transplant?

Failed hair transplants can be divided into five main groups, these are:

1. Hair transplant in unsuitable candidates
2. False promises
3. Grafts extraction mistakes
4. Bad grafts implant
5. After surgery mistakes made by patients

a) Hair transplant in unsuitable candidates

Remember that not everyone is suitable for hair transplants. An examination prior to the hair transplant can easily determine if a candidate is suitable or not. Here are the examination criteria:

• Age. Considering the hair transplant at a young age if there is an intense hair loss is not correct.
• Hair Loss in the Family. Hair loss in the family (father, brother, uncle)  should be analyzed. For example, if a patient’s father has Norwood 7 hair loss type, most likely, the same expects the patient. The candidate should be informed about this in advance.
• Hair Loss Type and Intensity. In an advanced hair loss like Norwood 6-7, there may be not enough grafts to cover the hairless area.
• Donor Area State and Capacity. This is a very important factor. How many hair roots can be taken from the donor area? How many square centimeters is the hairless area? How many hair roots are there per square centimeter? These moments should be analyzed before the surgery. Reckless hair transplants lead to disappointing results. 
• What is the Candidate’s Expectation? It is better to ask a patient about his expectations. Yet, it is not possible to do a dense transplant out of nothing. We transplant the hair from one area into another by the FUE technique. In other words, we just transfer existing hair from one zone into another. We are to tell the patient the real capacity.

In the picture below you can see a failed hair transplant made in one of the centers. Actually, the hair transplant itself was a wrong decision. It was clear from the beginning that there are not enough grafts on the donor area, achieving good results is not possible in any way.

b) Inappropriate Hair Transplant Promises

This problem is very common in hair transplant clinics in Turkey. Many centers forget that the procedure is medical and focus only on hunting for new customers. Unluckily, a lot of patients get into these promotion traps.

We transplant 10.000 grafts per session.

We transplant an unlimited number of grafts.

These sentences sound nice but the reality is different. Generally, the reason for the failed hair transplant is the wrong place selection.

c) Grafts extraction mistakes

There are two main graft extraction techniques: the FUE and the FUT. As far as the FUT method is almost replaced, let us take a look at mistakes in the FUE. Bad hair transplant does not only depends on implants but also sequences by an improper extraction chain. Grafts extraction errors are:

• Overharvesting. Withing the examination prior to the surgery a doctor should identify and an approximate number of grafts for transplant. Everybody has a unique donor capacity. Too many grafts taken from the poor donor area result in a bad hair ook in a few months after the surgery. Approximately 20-25% of grafts should be extracted out of one square centimeter. A bigger quantity causes the donor area to overharvest.
• Homogeneous graft extraction. An equal number of grafts should be collected from every square centimeter. Unbalanced hair extraction causes a moth hole look.
• A little number of grafts should be taken from the on-ear area. Comparing to the mid area the hair in the on-ear is rarer and thinner. Intensive extraction may result in gaps.
• Incorrect use of the manual and micro motored tools. Hair grafts length is important in adjusting manual or automatic tool. Extraction should be made under proper angle and direction to avoid graft destruction. The defected grafts do not grow, which is also considered as a failed hair transplant.
• Micro motor’s spin. In most cases, hair extraction in the donor area is made by a micro motored tool. Unfortunately, in many centers, the reason is to get the work done in as many patients as possible. In addition, they use a high spin. Hair roots get destroyed by the high temperature. We do not find suitable the extraction of more than 1.000-1.200 grafts per day. The true skill is not the extraction of  4.000 grafts in one hour. The true skill is to transplant all 4.000 hair grafts in a healthy way.
• Punch Width. Extraction with too wide or too thin punches is not appropriate. Everybody has diverse hair thickness. The punch’s width should be selected according to the hair root thickness. 0.7, 0.8, and 0.9 mm punches are ideal. Extraction of hair with wide punches leaves scars on the skin. On the opposite, if the punches are too small, transection occurs, that is hair cuts, or in other words, graft’s loss. 
• Roots number in a session. Another reason for the bad hair transplant result. We think that the transplant lasting more than 6-7 hours is not favorable. The roots remain outside for a long time and this destroys them resulting in rare hair growth. We do not transplant more than 2.000 grafts per day. If there are more grafts, it is better to divide the procedure into several sessions. 

d) Mistakes in grafts implant

Wrong hairline design and wrong implanting angle. These are the main complaints about failed hair transplants. The frontal hairline must be carefully planned and hair follicles in the area are to be the thinnest. We explained the details in our article about Natural-looking results in hair transplants and hairlines. We have loads of patients referring to us with the so-called ‘grass man’ results of the bad transplant.

• Root Implantation Depth. Hair roots implantation deeper than needed always causes problems. The majority of these roots just will not grow. Moreover, the hair that could grow deforms or causes folliculitis, inflammation. 
• Very Dense Hair Trnaplsnat. All patients want to have dense hair. The ideal proportion for a session is 30-40 grafts on one square centimeter. A denser implant during a single session is a big mistake because it significantly hurts the vessels. These capillary vessels nourish the implanted hair roots. They are not capable to supply for too many hair grafts, which is why some hair does not grow.  If a patient wants and is suitable, it is better to schedule another transplant after a year.
• Very Rare Hair Transplant. If a candidate maintains a wide hairless area but his expectations are high, it is better not to do a hair transplant. For instance, people with Norwood 7 have a hairless area of about 300-400 square centimeters. When 3.000 grafts are transplanted here, the ratio is 10 grafts per 1 cm2 which creates a rare hair look. The candidate will definitely be disappointed with the results. Another solution is to reduce the receiver area and increase hair grafts for a square centimeter.
• Tissue Necrosis and Infections. One of the worst complications after hair transplant is tissue necrosis. When the adrenalin is used improperly within the channel method, some cells are left unnourished and this causes their death. As a result, there are round or oval hairless gaps 2-3 cm in diameter. Additionally, nonsterile tools used during the procedure leads to infections. Sometimes,  inflammation occurs, and sequences in hair growth decrease.

e) Patients’ mistakes after the transplant

These mistakes are made by patients who underwent the transplant. Nobody wants to have an failed hair transplant. In most cases, mistakes are made accidentally. For example, a nob causes bleeding and popping out of the implanted roots. To restore these roots, another hair transplant is required.

A patient who had the hair transplanted should follow several simple rules. Such as protecting the implanted are from direct sunlight. Avoid hammams and saunas during a certain period of time.

How to Fix a Bad Hair Transplant?

Many people are curious about this question. It is worth mentioning that fixing a bad hair transplant is harder than transplantation from scratch. It requires a lot of effort, skills, and experience of the operation doctor. This is why we advise you to take time to search for the best doctor or center and then move on with the procedure.

Donor Area Restoration

Homogenization. The graft extraction mistakes were described above. Usually, when the number of extracted hair is big, the gaps in the donor area occur. These gaps can be covered (repaired) with another transplant. It is important to keep a homogenous look and hair distribution, carefully calculating grafts numbers on each square centimeter. The spoiled donor area can be fixed with beard hair.

Fixing Donor Area

There are many patients who apply to fix a bad hair transplant, which is a complicated procedure. They are very disappointed with ‘grass man’ hair and sensitive about their appearance.

• 3-4 rooted hair on the frontal hairline
• Rough and ‘grass man’ look. This look is called a Statue of Liberty in the United States. Hair becomes uncombed.
• Irregular Hair direction and upright roots
• The very direct hairline like a needle
• Very rare hair look
• Swellings or hole looking scars on the skin at the roots. Opened channel size must be the same as the grafts. Usually, this problem does not occur in the pen implanter method because of its thin needle tip.
• The hairline is behind
• The hairline is too low. A lot of elder patients bring pictures of themself at 18 years old willing to have the same hair. It is one of the most difficult operations to restore

There are several ways to fix a bad hair transplant.

1. Extraction of wrong angle hair roots or multiple roots
2. Camouflage method
3. Combine method (application of both extraction and camouflage)
4. Re-tightening transplant

Extraction of Multiple Wrong Directed Roots on the Hairline and Re-Implant the Line Backward

This procedure is complicated and requires experience.  The operation is the same as the extraction of hair roots from the back of the head by the FUE technique. However, since the multiple hair follicles were already transplanted, some of them are not suitable for extraction. Extraction can be divided into several sessions with 10-15 day intervals. Bad look disappears only when all multiple roots are extracted, they are split and re-transplanted again on the frontal hairline.

Once multiple grafts are split, they can be implanted in the gaps. This approach also covers the scars.

Grafts extraction is made by a micro motored or manual punch. It should be just a little bit bigger than the multiple roots. Otherwise, it will be hard to extract them.

If a candidate does not consider creating a hairline, these grafts can be transplanted to their old places one by one.

Camouflage Method

Sometimes, the extraction of hair roots one by one may not be enough. For example, extraction traces are left in brunets, this is why new hairline should be planned and implanted in that area. It can be placed 2-3 mm lower. Additionally, a new design should be made for temporal and hairline sides areas to achieve the natural result.

Combined Method (camouflage and extraction)

In some cases, it is not enough to cover the bad hair transplant or extract the wrong transplanted grafts. In this situation, the best solution is to apply to both. We usually prefer to operate extraction and camouflage simultaneously. If the hairline is implanted too low, the hair roots should be extracted one by one. Then, the new hairline is planned to achieve a natural result. A new hair extraction by the FUE is needed to create a new frontal hairline. The donor area should maintain sufficient hair reserve. Sometimes, the procedure needs to be divided into several phases with 8-10 month intervals.

Additionally, if a candidate considers not moving the hairline back, there is no need for graft extraction. Only the very bad-looking hair has to be taken out.

Additionally, if a candidate considers not moving hairline back, there is no need for graft extraction. Only the very bad-looking hair has to be taken out. Moreover, this area can be camouflaged. The results of bad hair implants are illustrated in the picture below.

Density Hair Transplant Restoration

A very rare hair transplant will never give a natural look to the hair. If the donor capacity is sufficient,  accurate planning should be made to cover the rare area. When there are not enough grafts on the head, hair from the beard or chest can be used as well.

In other cases, candidates who had the hair transplanted can loose their hair naturally in the time. They may consider it a hair transplant failure, however the process is natural. A second hair transplant surgery can be planned if the donor area capacity allows it.

Bad Hair Transplant Results

A candidate who considers hair transplant repair needs to study the topic well. He must get as much information about a doctor or center, their outcomes, and experience. Below you will find videos of bad hair transplant restoration by Dr. Hakan Doganay.

You can also visit forums where people share their personal experiences.

References

1. Controversies in Hair Transplantation J Cutan Aesthet Surg. 2018 Oct-Dec; 11(4): 173–181. http://www.jcasonline.com/article.asp?issn=0974-2077;year=2018;volume=11;issue=4;spage=173;epage=181;aulast=Kumaresan