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Today hair transplant surgery can achieve results that are so natural they are undetectable, even by a barber or stylist. However, many early hair transplant techniques that used hair “plugs”, large grafts, or mini grafts that are not aesthetically acceptable by today’s standards. Many who have had these older hair transplant techniques can now complete or repair their previous hair transplants using today’s very refined hair restoration techniques. After hair transplant repair patients can typically achieve a natural look that they can style in any manner.
Some physicians will simply attempt to mask the old plug-grafts by surrounding them with today’s smaller and more refined micrografts. This can be effective if the older grafts are not too close to the hairline. A patient must also have a sufficient number of micrografts available to surround and mask these larger grafts. However, if a patient’s large grafts are too low on the hairline or if there are not sufficient micrografts available to mask them they should be carefully removed. Often a patient’s previous hair transplant grafts cannot simply be masked by surrounding them with smaller and more refined micrografts. These large grafts should be surgically removed and recycled into small micrografts that can then be retransplanted.
To do plug reduction and recycling a physician begins by removing the large round plug-grafts. Typically a round punch instrument is used to excise these obvious larger round grafts. This punch graft is normally the same size or smaller than the one used to originally create and place these round punch grafts.
Sometimes a small part of the large graft is left in the scalp, thus leaving behind a smaller graft. Often the round holes left after the round grafts are punched out are then stitched closed.
The hair plug or part of the hair plug that was removed is then carefully dissected into tiny micrografts that contain one, two, three, and sometimes four hair follicular units. These refined micrografts are then retransplanted into tiny incisions around the excised punch grafts. Often a surgeon will harvest additional tissue from the donor area to create additional micrografts. When these tiny micrografts grow out they will recreate a natural and refined distribution of hairs in place of the previously unnatural “pluggy” grafts.
In extreme situations where the hairline was placed unnaturally low or the temple areas are blunted with no natural recession, scalp surgery may be required to raise the hairline.