In the early years of hair transplant surgeries, plug grafts were the most commonly performed procedure. These large circular grafts were extracted using a much larger version of the punch tool used during modern FUE micrograft procedures.
These larger grafts are now considered to be cosmetic failures due to the unnatural appearance of the transplants. This old style of grafting looks unnatural because the surgeons did not respect the natural growth patterns of the patient’s hair. The grafts were inserted facing the same direction, which limited styling options and created the unnatural appearance of hair that only grows in a forward direction.
Another cosmetic issue with the plug grafts was the appearance of “doll hair” or hair that grows in unnaturally tidy rows. These cosmetic flaws created transplants that were clearly unnatural and ultimately embarrassing to many patients.
Today, modern techniques can be used to repair cosmetically unappealing plug grafts. FUT and FUE transplant procedures can be used to improve the natural appearance of the patient’s hair. The plug grafts can also be removed or recycled depending on the patient and his or her cosmetic needs.
The “doll hair” appearance of the plug grafts can be altered by filling in the spaces between the plugs with new micrografts. This works best in patients who have retained large areas of donor hair and who have plug grafts that are not placed too closely to the hairline.
For many patients, removing the plug grafts is the best option. The plug grafts are removed in much the same way as they were originally harvested from donor sites. A large punch tool will be used to remove the plug grafts from the patient’s scalp. Sometimes small portions of the plug grafts will remain to serve as smaller, more natural grafts, but this is generally not the case.
The old style plug grafts were much larger than what hair transplant surgeons use today. Extracting the plug grafts often requires stitches at the removal sites.
After removal, the plug grafts will be divided into a number of smaller grafts. These smaller grafts will be inserted into the scalp in a more natural pattern of hair growth. For most patients, additional grafts will be necessary to create a completely natural appearance. These additional grafts will be removed either through FUT or FUE procedures.
In some extreme cases, scalp surgery may be required to create a truly natural appearance. This usually occurs when the original procedure placed the hairline too low on the patient’s forehead. In order to raise the hairline, a strip of tissue will be removed at the front of the scalp. This tissue will be used to harvest additional hair grafts to fill any thin areas with healthy hair.
The skin on the patient’s forehead is then pulled up and sutured to the newly formed hairline. This results in a more natural appearing hairline. A side effect of this procedure is a brow lift, which may or may not be desirable to the patient.