Rejuvenating bad hair transplants

Abstract

Objective To share the experience of corrective surgery for bad hair transplants. Patients and methods This study was carried out at the Aesthetic Plastic Surgery, Rawalpindi, from January 2007 to December 2008. All the male patients having unsatisfactory results after hair transplant surgeries were included. Patients having problems with front hairline were included in group A. Patients having problems in mid-scalp were placed in group B, whereas patients with problems in donor area were placed in group C. In all patients, the corrective procedures were performed under local anesthesia, with a single dose of sedative (diazepam 10mg) and first generation cephalosporin. The donor area was infiltrated with a mixture of normal saline, lidocaine and epinephrine (1:100,000). The strip was harvested in prone position. The donor area was closed with single 3-0 non-absorbable running suture. Undermining of the wound margins was performed in almost all the cases to avoid the stretch on the suture line. Slits were made according to the preoperative plan. Large hair plugs were removed/excised/extracted. The defects were closed using very fine sutures. Hair plugs were also removed in cases of very low hair line. Only single follicular unit grafts were used to reconstruct the anterior hairline. The remaining follicular unit grafts were distributed according to the preoperative plan. Transplanted areas were left open without any dressing. The first wash was started after 48 hours. The donor area stitches were removed on 12-14 days. Results A total of 26 patients were included who had previous surgeries at other centres and were not satisfied with the results. The mean age of the patients was 30.8 years. Majority of the patients (42.5%) belonged to younger age group 20-30 years. 69.2% patient complained of a prominent unnatural hairline and 46.2% of these patients had multiple hair plugs in the anterior hairline.  80.8% patients had unnatural angles of the hair. Donor scar problems were also seen including wide scar (69.2%) and poor positioning in 26.9% patients. Conclusion Presented with significant cosmetic problems and severely limited donor reserves, the surgeon performing restorative transplantations faces distinct challenges. Meticulous surgical techniques and optional utilization of a limited hair supply will enable the surgeon to achieve the best possible cosmetic results for patients requiring repairs.