posted by ISHRS on August 23, 2012

Hair transplantation is, in the majority of cases, a cosmetic enhancement that serves a patient for life. Occasionally life situations can change and a hair transplant needs to be revised to meet the patient’s present and future needs.
Can this be done? Is this something that a patient can reasonably ask a physician hair restoration specialist to undertake?
The answer is Yes and Yes. Revising hair restoration surgery must be approached cautiously, however, with appropriate examinations and patient-physician consultations. Patient and physician must agree on reasonable expectations for what revision of a hair transplant can accomplish.
There are many situations that may lead a patient to consider seeking revision of a hair transplant. For example:
Surgical techniques and surgical instruments have steadily evolved and improved from the time when hair transplantation was a new procedure. The esthetic emphasis of hair transplantation today is on “naturalness”—making an area of transplanted hair look no different from an area where no hair has been lost (Click on Surgical Hair Restoration). Creation of “naturalness” became possible with newer techniques using tiny grafts of one to three or four hair follicles. The natural appearance was difficult to create with older techniques that transplanted “plugs” of multiple hair follicles containing up to a dozen hairs. The “pluggy” look characterized the older techniques of hair transplantation. Patients who had hair transplants a decade or more in the past may want to have their pluggy looking transplant revised to achieve a more natural appearance. Revision of a pluggy look can be accomplished for most patients—for example, by procedures such as (1) “filling in” between pluggy grafts with micro-grafts of one to a few hair follicles, (2) surgically removing pluggy grafts that are too large to be camouflaged by micro-grafts, and (3) revising the hairline to blend more naturally with the overall revision of the transplant. Every patient has individual characteristics that have to be considered in consultations with a physician hair restoration specialist. Patient and physician must agree on what outcome can be anticipated from a revision of the previous transplant.

An alternative goal in revision of a “pluggy” transplant may be to achieve greater hair density. Although plug grafts are relatively dense in themselves, areas between plugs may have little or no hair and the esthetic effect may be one of spottily thinning hair. Revision to achieve greater density has a different goal than revision that aims primarily to achieve naturalness, but some of the same surgical techniques of revision may be used.

Some patients with older transplants may have had some additional hair loss in addition to a transplant they now find esthetically unsatisfactory. The combined surgery for revision of the older transplant plus new hair restoration surgery in the area(s) of new hair loss may offer an opportunity to meet “natural” or “more dense” esthetic standards, but may also present challenges such as finding enough donor hair to accomplish both goals (Click onThe Donor Site: Savings & Loan for Hair Transplantation). New areas of hair loss commonly occur after initial hair transplantation. A physician hair restoration specialist is usually able to anticipate the progressive hair loss and tell the patient that additional transplantation sessions will be necessary in the future to address the problem of continuing hair loss. Continuing hair loss can frequently be anticipated on the basis of factors such as (1) age of hair loss onset, (2) rate of progressive hair loss, (3) hair loss type, and (4) history of hair loss in the patient’s family (Click on About Your Hair Loss).

Hair styles for both men and women change over time. People who are especially anxious to be current with style may alter hair styles frequently. Other people may be pleased to remain with a hair style that changes little over time—for example, the well-groomed look of a successful businessman or professional. Whatever the preference for frequency of change in hair styles, a person with a hair transplant may come to believe that the esthetic form of his or her transplant is out of step with current style mandates. For example, a transplanted hairline placed well forward in the frontal and temporal areas in a younger person may become cosmetically inappropriate as the patient ages. Unanticipated hair loss in the hairline area can also create cosmetic difficulties. Before revision of a transplant for “style” reasons is undertaken, the patient should be certain of the need for revision, and patient and physician hair restoration specialist should agree on a revision plan for goals for outcome.

A patient who experiences difficulty in styling hair after a transplant has been in place for some time may attribute this difficulty to factors such as (1) hair does not part on the side preferred by the patient, or (2) the patient’s belief that more hair density is needed in the transplanted area.

Esthetic concerns should be discussed thoroughly with a physician hair restoration specialist. Transplant revision should have well-defined esthetic goals that can usually be achieved.