Reconstructive hair transplantation

Reconstructive hair transplantation: the treatment of patients who have been through prior treatment

A hair transplant is a highly complex and demanding form of surgery. Unfortunately not all treatment is performed using state-of-the-art techniques and technology. There are many possible reasons for this:
 
Example of patient with a ‘pluggy’ hairline from a previous surgery (performed ex domo)


The choice of the right hair surgeon is of crucial importance

A hair surgeon needs to possess a wide range of characteristics and abilities. These include utmost care, the right professional qualifications and knowledge of all hair restoration surgery techniques and methods, along with the right sense of the principles of aesthetics and harmony. Correcting or repairing a hair transplant that has gone wrong is therefore a treatment placing extremely high demands on the physician. It is not just a case of correcting the bad results and consequences (for instance, scars or an unnatural appearance) of a previous transplant, but also of achieving a result looking completely natural.

The team supporting the physician is also a crucial factor, for a hair surgeon's employees need not just to fully master the techniques used and have years of experience, but also need to be able to work for a period of 8 - 10 hours - the duration of a hair transplant - in full concentration and without making any mistakes. A well-established surgery team working flexibly as a team represents a key success factor for any hair transplant.
Another factor is membership of an internationally recognized association such as IAHRS; Members of this association are always experts in the field of corrective hair transplantation.
Dr. Feriduni has already successfully performed hundreds of corrective hair transplants in his clinic and therefore has the necessary experience and know-how. This is confirmed by the fact that some 20% of all hair transplants involve correcting previous transplants.


Example of patient with ‘punch grafts’ from a previous surgery (performed ex domo)



Reasons for correcting a previous hair transplant

The reasons for a previous hair transplant needing to be corrected are mostly associated with the usage of out-of-date methods, the wrong advice and/or treatment or a lack of knowledge about the aesthetic and harmonious design of hairlines and how to achieve a natural look. The most common reasons why patients want to have a previous hair transplant corrected involve an unnatural appearance or too much scarring. Further reasons include:
 


Remedial options available to reconstructive hair surgery

With the hairline forming part of a face's frame, achieving a natural hairline is an art needing to be mastered by any good hair surgeon. An unnatural or unaesthetic hairline can be greatly improved by an expertly performed FU transplant. This will optimally design the hairline, taking into account natural hair density and achieving optimal harmony through expert fine-tuning. The possibilities open to corrective surgery are however not just dependent on the competence and know-how of the surgeon, but also on the availability of appropriate donor hair. The corrective methods used to repair an unnatural hairline include completely removing any disturbing grafts, removing individual undesired grafts or placing follicular units between the mini-grafts.
 


Correcting hair transplants performed using the strip or flap technique

The flap technique was developed as an alternative to the then usual punch graft technique. In the strip or flap technique, a strip of the scalp is removed and transplanted to the bald patch on the head. Negative results of a hair transplant performed using the strip or flap technique are visible scars, unaesthetic or unnatural hairlines, or unnaturally high hair density. Another consequence is that the transplanted hair often grows in the wrong direction, other than desired.
Though not immediately, the flap technique often leads over time to an unnatural appearance, as the hairs belonging to the transplanted strip often greatly contrast with the surrounding hair which falls out due to natural ageing. This in turn leads to baldness appearing behind the transplanted strips, making the scalp look very unnatural.
Correcting hair transplants performed using the flap technique is a difficult process generally requiring a combination of different corrective methods to achieve an aesthetically pleasing result. These include follicular unit transplantation (FUT) and follicular unit extraction (FUE), as well as various strip and scalp reduction techniques:
 


Methods for correcting existing scars

Unaesthetic and/or unduly wide scars can be corrected, though there are certain factors needing to be taken into consideration:
 


Trichophytic Closure

 
Reconstruction of a linear scar from a previous surgery (performed ex domo)

Unaesthetic and often unpleasant scars in the donor area are often the result of the use of outdated techniques or even the wrong ones. A further problem involves the wound not closing properly, meaning that the scar gets overstretched. One of the main reasons for this is that no account is taken of the different levels of scalp elasticity in the different areas.
Where there is sufficient elasticity in the area of the scar, the existing scar can be removed. A combination of scar removal and the concurrent use of trichophytic closure is often appropriate here.
In cases where the scalp lacks elasticity, we recommend massaging the scalp daily for several months prior to the corrective hair transplant. Such stretching exercises are a proven help, directly increasing scalp elasticity and having a positive influence on the treatment.



Follicular Unit Extraction (FUE): transplanting individual FUs

FUE is an option used successfully to make scars practically invisible. The method involves extracting individual hair roots, the so-called FUs, and implanting them in the scarred area. By doing so, the affected area - including the scar - will later be covered by own hair.

Reconstruction of a linear scar from a previous surgery (performed ex domo)


Combinations of different techniques

Not all scars are fully suitable for an FUE. In certain cases a renewed scar correction with a subsequent FUE, generally within 6 - 8 months, is the method of choice.

Whether FUE alone is appropriate for a hair transplant is to a certain extent dependent on the size of the scar, the consistency of the scalp and the hair, and also on how long the patient wants his or her hair to be. Hair normally grows very well on scarred tissue.



Tricopigmentation

In cases where scars in the donor area are too pronounced, scar correction can be very difficult or even impossible. A medical tattoo matching the patient's hair colour is in certain cases an appropriate long-term solution for reducing scar visibility. Make-up can also help, though needing to be regularly renewed. Summing up, there are five different corrective methods:
  All five methods are complementary and can be combined. It should however be borne in mind that in certain cases several different forms of treatment will need to be performed concurrently. Any decision on which method(s) to use needs to be taken on a patient-by-patient basis.
An in-depth personal consultation is an absolute “must” and always the first and most important step in correcting previous hair restoration surgery. 

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