Bad Hair Transplant

A hair transplant candidate expects dense and natural-looking hair after the surgery. Unfortunately, many doctors fail to meet these expectations. A candidate feels more confident when the transplanted hair blends seamlessly with natural hair. However, many doctors perform the procedure incorrectly, which is very unfortunate. We have many patients who come to us seeking correction for a bad hair transplant. So, what are the reasons for a failed hair transplant? What is the solution for an unsuccessful hair transplant? In this article, you will find real patient cases of failed hair transplants who sought repair from Dr. Hakan Doganay. You will also see the results of Dr. Hakan Doganay’s restoration operations.

What is a Failed Hair Transplant?

You can easily check whether the outcome is successful by conducting a simple test. When talking to someone, observe where their attention is focused. If their gaze is constantly on your hair, it means they notice a difference. Moreover, if they ask whether you had a hair transplant, it’s a clear sign that the results of your transplant are not natural-looking.

On the other hand, if the person next to you doesn’t look at your hair at all, the result is a complete success. You can tell them that you had a hair transplant, and they will be shocked. This is the result we always strive for.

What are the Reasons for a 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. Mistakes in graft extraction
4. Poor graft implantation
5. Post-surgery mistakes made by patients

a) Hair transplant in unsuitable candidates

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

• Age.Considering a hair transplant at a young age when there is significant hair loss is not advisable.
• Hair Loss in the Family. Family history of hair loss (father, brother, uncle) should be analyzed. For example, if a patient’s father has Norwood 7 hair loss, the patient is likely to experience a similar pattern. The candidate should be informed about this in advance.
  
• Hair Loss Type and Intensity.In advanced hair loss stages, such as Norwood 6-7, there may not be enough grafts to cover the hairless areas.
• Donor Area State and Capacity. This is a very important factor. How many hair follicles can be taken from the donor area? How many square centimeters is the balding area? How many hair follicles are there per square centimeter? These factors should be analyzed before the surgery. Reckless hair transplants can lead to disappointing results.
• What is the Candidate’s Expectation? It is important to ask the patient about their expectations. However, it is not possible to create dense hair growth from nothing. Using the FUE technique, we transplant hair from one area to another. In other words, we are only transferring existing hair follicles. We must explain the realistic potential to the patient.

In the picture below, you can see a failed hair transplant performed at one of the centers. In fact, the hair transplant itself was a wrong decision. It was clear from the beginning that there were not enough grafts in the donor area, making it impossible to achieve good results.

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 attracting new customers. Unfortunately, many patients fall into these promotional traps.

We transplant 10.000 grafts per session.

We transplant an unlimited number of grafts.

These sentences may sound appealing, but the reality is different. Generally, the reason for a failed hair transplant is the improper selection of the transplant area.

c) Grafts extraction mistakes

There are two main graft extraction techniques: FUE and FUT. Since the FUT method has almost been replaced, let’s focus on mistakes in the FUE technique. A bad hair transplant is not only due to improper implantation but also results from errors in the extraction process. Graft extraction mistakes include:

• Overharvesting: During the examination prior to surgery, a doctor should determine the approximate number of grafts needed for the transplant. Each person has a unique donor capacity. Taking too many grafts from a poor donor area can lead to a bad hair appearance a few months after the surgery. Approximately 20-25% of grafts should be extracted from one square centimeter. A higher quantity can result in overharvesting of the donor area.
• Homogeneous Graft Extraction: An equal number of grafts should be collected from each square centimeter. Unbalanced hair extraction can result in a “moth hole” appearance.
• A small number of grafts should be taken from the outer ear area. Compared to the mid-area, the hair in the outer ear is rarer and thinner. Intensive extraction from this area may result in visible gaps.
• Incorrect use of manual and micro-motor tools: The length of the hair grafts is important when adjusting manual or automatic tools. Extraction should be done at the proper angle and direction to avoid graft damage. Defective grafts do not grow, which is also considered a failed hair transplant.
• Micro-motor spin: In most cases, hair extraction in the donor area is performed using a micro-motor tool. Unfortunately, in many centers, the goal is to complete the procedure for as many patients as possible. Additionally, they use a high spin speed. The high temperature generated by this can damage the hair roots. We do not consider it suitable to extract more than 1,000-1,200 grafts per day. True skill is not in extracting 4,000 grafts in one hour; the true skill lies in transplanting all 4,000 grafts in a healthy and effective way.
• Punch Width: Extraction with punches that are too wide or too thin is not appropriate. Everyone has varying hair thickness, so the punch width should be selected according to the hair root thickness. Punches of 0.7, 0.8, and 0.9 mm are ideal. Extracting hair with wide punches can leave scars on the skin. On the other hand, if the punches are too small, transection occurs, resulting in hair cuts or, in other words, graft loss.
• Number of Roots in a Session: Another reason for poor hair transplant results is the number of grafts extracted in one session. We believe that transplants lasting more than 6-7 hours are not favorable. When roots are exposed for too long, they are damaged, leading to sparse hair growth. We do not transplant more than 2,000 grafts per day. If more grafts are needed, it is better to divide the procedure into multiple sessions.

d) Mistakes in grafts implantation

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: Implanting hair roots deeper than necessary always causes problems. The majority of these roots will not grow. Moreover, the hair that does grow may become deformed or lead to folliculitis and inflammation.
• Very Dense Hair Transplant: All patients want dense hair. The ideal density for a session is 30-40 grafts per square centimeter. A denser implantation in a single session is a major mistake, as it can severely damage the capillary vessels that nourish the implanted hair roots. These vessels are unable to supply enough nutrients for too many grafts, which is why some hair may not grow. If a patient desires greater density and is suitable for it, it is better to schedule another transplant after a year.
• Very Rare Hair Transplant: If a candidate has a large bald area but high expectations, it is better not to perform a hair transplant. For example, people with Norwood 7 have a bald area of about 300-400 square centimeters. When 3,000 grafts are transplanted into this area, the density is 10 grafts per 1 cm², which results in a sparse hair appearance. The candidate will likely be disappointed with the results. Another solution is to reduce the recipient area and increase the number of grafts per square centimeter.
• Tissue Necrosis and Infections: One of the worst complications after a hair transplant is tissue necrosis. When adrenaline is used improperly during the channel method, some cells are left without nourishment, causing them to die. As a result, round or oval hairless gaps 2-3 cm in diameter can appear. Additionally, non-sterile tools used during the procedure can lead to infections. Sometimes, inflammation occurs, and the rate of hair growth decreases.

e) Patients’ Mistakes After the Transplant

These mistakes are made by patients who have undergone a hair transplant. Nobody wants to experience a failed hair transplant, and in most cases, these mistakes happen accidentally. For example, rubbing or scratching the scalp can cause bleeding and dislodge the implanted roots. To restore these roots, another hair transplant may be required.

A patient who has had a hair transplant should follow several simple rules, such as protecting the implanted area from direct sunlight and avoiding hammams and saunas for a certain period of time.

How to Fix a Bad Hair Transplant?

Many people are curious about this question. It is important to note that fixing a bad hair transplant is more difficult than performing a transplant from scratch. It requires significant effort, skill, and experience from the operating doctor. This is why we advise taking the time to research and find the best doctor or clinic before proceeding with the procedure.

Donor Area Restoration

Homogenization: The graft extraction mistakes have been described above. Typically, when a large number of grafts are extracted, gaps in the donor area can occur. These gaps can be covered (repaired) with another transplant. It is important to maintain a homogeneous look and even hair distribution by carefully calculating the number of grafts per square centimeter. A damaged donor area can be repaired by using beard hair as a source for grafts.

Fixing Donor Area

Many patients seek help to fix a bad hair transplant, which is a complicated procedure. They are often very disappointed with the “grass man” look and are highly sensitive about their appearance.

• 3-4 Rooted Hair on the Frontal Hairline:
• Rough and ‘Grass Man’ Look: . This appearance is often described as having hair that stands up unnaturally, resembling grass. In the United States, this is sometimes referred to as the “Statue of Liberty” look, where the hair appears uncombed and unnatural.
• Irregular Hair Direction and Upright Roots: When hair roots are not implanted at the correct angle or direction, it leads to an unnatural appearance, with hair growing in different directions and upright roots, which is not consistent with natural hair growth patterns.
• Very Direct Hairline Like a Needle:
• Very Rare Hair Look: This occurs when there is insufficient graft density, resulting in a sparse, unnatural appearance.
• Swelling or Hole-Like Scars on the Skin at the Roots: Swelling or visible holes around the implanted hair roots can occur if the size of the opened channels does not match the size of the grafts. This problem is less common with the pen implanter method, as it uses a thin needle tip, which minimizes damage to the skin.
• Hairline is Behind: If the hairline is placed too far back, it can create an unnatural, aged look.
• The Hairline is Too Low: Many older patients bring pictures of themselves from when they were 18, hoping to achieve the same youthful hairline. Restoring this type of hairline is one of the most difficult operations to perform, as it requires careful consideration of the patient’s age, facial features, and natural hairline progression.

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.

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