Authors : DR. VISHAL KHURANA , DR. GEETANJALI KHURANA .
 

INTRODUCTION

A hair transplant surgery that is used to repair bad or deterred results of previously performed procedures is referred as Corrective or Repairing hair transplant surgery. This is usually done on patients who are dissatisfied with their results usually because having had poorly performed hair restoration procedures or out-dated hair restoration procedures done in the past such as mini-grafting; strip harvesting; or scalp reduction surgery and getting unnatural results, hair plugs, or scars. Other reasons might be of a poorly performed surgery or inappropriate candidates. All these problems can be fixed under a corrective surgery with intelligently planned procedures and technology.
 

REASONS OF BAD HAIR TRANSPLANTS

1. Outdated Hair Restoration Procedures- Traditional hair transplant surgery is now outdated. This was done with mini-grafting technique in which 10-12 hairs were taken from the patient’s back of the scalp by only one way that is called strip harvesting. A linear strip of skin is cut off from the back of the scalp with numerous hair follicles stuck in it. The hair follicles were dissected from the skin by cutting the skin into tiny pieces and each piece contained 10-12hair follicles, quite irrelevant of the naturally occurring follicular units. The dissected hair is called a hair graft, which is then planted with a needle into the bald area of the scalp. As this is the basic idea of the whole procedure the hair would grow normally covering the bald patches. However, despite serving the purpose of covering the baldness, the results appeared a dense patch or plug of hair as if glued with gum paste, it was obvious and unnatural.

2. Scalp Reduction- is another outdated procedure in which the skin from part of the bald scalp taking from the crown area is just removed and the edges of a more hair bearing skin is stretched to close and sutured thus technically reducing the bald scalp, partially. It is nonetheless subject to many complications like stretching back of the hair bearing skin; unwanted scarring; unnatural look of the scalp; infection; hemorrhage. These procedures are hardly in use now a days.

3. Poor operator skills- Hair transplant can be great if performed correctly. Lack of operator’s skills leading to disastrous results accounts for more than 10% of the hair restoration surgeries worldwide out of which majority happen in india itself. Patients needs to be careful and research before they get a hair transplant. Going bargain hunting leads to disastrous consequences. Rushing into a hair transplant without doing thorough research just based on cost has emotionally and in the long run, financially, hurt many patients.
 

VARIOUS CORRECTIVE HAIR TRANSPLANT MODALITIES:

1. Modern Corrective/Repair Surgery-

1. Graft Excision- A corrective surgery is done by ideally removing the larger grafts with FUE technique and re-dissecting them according to the hair follicular units that can be retrieved and replanted to the area in a more natural looking pattern, if there is transection of hair grafts in the process, then more hair grafts are extracted freshly from the patient’s back of the scalp. This process is called hair graft excision, and the larger holes which had the larger holes are closed and sutured as finely and any scar tissue is also removed, conclusively meaning a more naturalistic appearance.


2. Hair Camouflaging- Sometimes, the results of a previously done hair restoration is not as bad, and the larger grafts that are otherwise are planted in proper direction, a hair camouflage can be a less costly affair to fix the problem. In hair camouflaging, small-1, 2 and 3 hair follicular units or micro grafts are used to transplant in front and subsequently in order to camouflage the larger grafts and thus improve their look to a more naturalistic appearance, without taking off all the hair grafts and this can limit the time and cost of the overall procedure. Hair Camouflaging is a very affable procedure that saves time and cost than a complete graft excision, and also saves more grafts from transection in the process. This lead many surgeons to believe that this procedure can completely replace the graft excision procedure, however, this is not true, because despite being affable with smaller grafts with larger grafts camouflaging will obviously make it more dense and unnatural hence, both graft excision and hair camouflaging is important for a corrective hair transplant surgery.


3. Combined Repair- Depending on the actual condition of the bad hair transplant, a corrective surgery can also be done in combination of camouflaging and graft excision to attain the best possible result. In this not all grafts are removed, only the ones that cannot be camouflaged. A combined repair needs a skilled hair transplant surgeon who can strike a proper balance between graft excision and camouflaging.

2. Fixing Scar- Scarring is a regular complication with old hair restoration procedures of strip harvesting and scalp reduction, and with the newer innovation of Follicular Unit Extraction, these scars can be fixed or camouflaged beyond recognition. While a scalp reduction procedure often deplete the quality of donor hairs and make the scalp very tight, making a corrective surgery extremely difficult; a strip harvesting technique leaves a widened linear scar from behind the ears one end of the scalp to the other. The scars can be fixed in with scalp micropigmentation technique or the FUE technique.

3. Scalp Micropigmentation(SMP)- Scalp Micropigmentation (SMP) is a permanent cosmetic ‘tattoo’ that mimics the very short hairs of a closely shaved scalp. It creates the appearance of a close shave or a short buzz cut over the entire scalp. The process reduces the contrast between scalp and hair color. SMP can be used for a variety of scalp conditions that include: common pattern baldness, scarring alopecias, and alopecia areata. It is also used to improve the unnatural appearance that is associated with outdated hair transplant procedures and those that have left widened donor scars.
 

hair-transplant-surgery

 

GOOD CANDIDATES FOR HAIR TRANSPLANT REVISION SURGERY

Ideal candidates for hair transplant revision are people who have aesthetic issues with their previous hair restoration procedure or who have experienced cosmetic complications with the procedure for a variety of reasons. These patients should be in relatively good health and have realistic expectations about the nature of the revision procedure and the healing process.
 

HOW HAIR TRANSPLANT REVISION SURGERY WORKS

Each surgery is different and carefully customized to the needs of the patient. In general, the revision procedure will combine the removal of bad hair follicles from the previous procedure, the placement of new hair follicles in order to make the necessary aesthetic corrections, camouflaging of large or sparse grafts using modern techniques, and other kinds of carefully planned revisions. Changes in hairline angle and hair density can both be done through this approach.
 

Corrective Hair Transplants

 

THE EFFECTIVENESS OF HAIR TRANSPLANT REVISION SURGERY

More than one sessions may be required to achieve the desired results in some cases, though the effects of a revision procedure can be quite dramatic. A number of patients who have undergone hair transplant revision note a greater sense of confidence and self-esteem about their revised and corrected hairline.
 

CONCLUSION

Hair transplantation has changed dramatically since the first cases were performed. We have now gone beyond the “Wild West” days of the old hair plugs and there is new hope for people who have been harmed by bad hair transplants. Most importantly, with adequate research in finding the proper hair restoration surgeon, now there is a much better chance to get it right the first time around.