People hear the term “hair plugs” and may grimace at the idea. The expression is used as a catch-all for any type of hair transplant that doesn’t meet aesthetic standards or a procedure done by an inexperienced surgeon.
The problem is that the definition of hair plugs varies depending on who you may ask, and the term is used in different situations depending on the context.
This article will break down exactly what hair plugs are, why they have the reputation they do, and some tips for clients with hair plugs to take corrective measures and improve their hair.
The first thing to understand is that hair plugs are not in an entirely different category from today’s methods. The doctors of the 1950s and 60s had a fairly strong understanding of donor regions and the techniques required for successful transplantation.
Although these doctors were on the right track, they were limited by the technology available at the time. Because their instruments were still somewhat crude and too large (sometimes up to 4mm in diameter), each individual graft’s size was much bigger than average compared to modern methods.
These old-school “punch graft” tools were used to remove sizable cylinders of skin from the donor area, each containing between 15 and 30 hairs. With so many hairs in each graft, doctors believed this to be the most efficient way to transfer large quantities of donor hair to the scalp or wherever it was needed.
While some of these procedures looked fine at first, problems emerged as the grafts contracted due to the tightening and scarring of skin on the recipient area. In addition to the growing space between grafts, the clusters of hair became tighter and unnatural looking, sometimes clumping together and becoming tangled or knotted.
These factors combined over time led to the “dolls hair” look that people now commonly call hair plugs, even though the hair was harvested from the patient donor area. Surgeries from many years ago may still have this look and it’s widely considered to be undesirable in the hair restoration community.
Nowadays, the term “hair plugs” is simply meant to describe a transplant of poor quality using antiquated techniques, rather than a specific type of surgery or treatment.
Thankfully, technology and methods improved steadily from the 1970s onward. Doctors first focused on ways to reduce the size of punch grafts to create tighter groupings of hair in the scalp, but the “pluggy” look persisted long after the initial recovery period.
The 1980s saw the introduction of minigrafts and micrografts – a step in the right direction that reduced the sparse and unnatural look of early plugs.
Rather than “punching” out large cylinders of hair from the donor area and inserting them directly into the scalp, doctors used more precise tools to take small slivers of hair-bearing skin and place them more deliberately along the hairline or throughout the scalp.
While this was slightly more labor-intensive than earlier methods, surgeons found the process to be more predictable and reliable, and hair would grow more naturally without the “dolls hair” appearance of the punch graft approach.
Compared to more advanced methods such as Follicular Unit Transplantation, mini and micrografting still do not appear completely natural, which is why many clients still feel that surgeries from the 80s and 90s had the “hair plug” look despite newer techniques.
Today’s procedures are planned with precise measurements to ensure that follicles are allocated the correct position for the most natural possible look. Modern techniques like FUT and FUE deliver high rates of success and satisfaction for patients on their first go-round or returning for repeat surgeries and multiple sessions.
FUT is accomplished by removing a long horizontal strip of skin from the donor area, containing the most resilient and dense hair available. With the help of technicians, the surgeon is able to single out the highest-quality follicle units (anywhere from 2 to 5 hairs) and organize them perfectly on the recipient area at a rapid rate.
This allows clinics to perform extremely efficient “mega sessions” that yield phenomenal results and avoid the “plug” look that clients want to avoid.
Since so many surgeries from the past several decades have resulted in an unfortunate hair plug aesthetic, it isn’t surprising to see clients coming to modern clinics to fix the look of their hair.
The good news is that there are several viable ways to address hair plugs, and skilled hair restoration surgeons will take a customized approach depending on a set of key factors.
In an ideal scenario, doctors will be able to excise healthy follicles from the highly concentrated “plugs” on the scalp without causing much damage to the hair and reusing them immediately. This allows the surgeon to dissect the follicle units with greater care and place them more deliberately throughout the recipient area to create a more natural look.
There are some instances in which a reduction of the grafts is the best route since they may be highly concentrated and look out of place on the scalp along with other healthy hair. In these cases, doctors must resort to techniques such as electrolysis, laser hair removal, or a precise excision of a segment of the follicle unit, each of which presents its own challenges.
What the surgeon decides to do with the available hair after excision depends on the client’s aesthetic needs. Some clients have a sparse hairline with clearly exposed plugs in need of extra coverage. It’s important to not build a “solid wall” of units in front of the plugs but rather to create a “transition zone” that more closely resembles a natural hairline.
These procedures require careful planning by clinical teams as they determine the availability of healthy hair from existing units, the likelihood of successful grafting vs transection, and other factors such as the hairline’s natural progression in years to come.
By planning and forecasting these different variables, surgeons can map out the ideal configuration of old and new follicles to reduce the appearance of plugs and create a natural look with minimal discomfort or difficulty for the patient.
More commonly, clients will return to the clinic for repeat procedures as the hairline is worked on and follicle units are allowed to heal over time without interfering with new excisions and grafts. Clients should realistically expect at least two separate procedures to get a sufficient level of coverage along the hairline if conditions are right.
Revisiting hair plugs with precise instruments and reallocation strategies is typically successful thanks to modern tech and highly skilled surgeons. However, some issues can arise if trauma is caused to the region and follicles are damaged or unable to take root after dissection.
For this reason, clients seeking hair plug repair or restoration surgery should work with a clinic highly experienced with methods such as FUE and be sure that doctors have strong track records of performing these types of restorative procedures.
Another problem encountered by many clinics in this process is the scarring and depigmentation of the skin, resulting from methods that can damage the area in and around the grafts.
Laser therapies can help fix these inconsistencies, but doctors do their best to preserve the scalp’s skin as much as possible to create a hospitable environment for the follicles as they readjust to their new positions.
In some cases, doctors may want to revisit the donor area at the back of the head to add coverage or camouflage to the area in need. In the best-case scenario, doctors will have access to strong and healthy hair from this section and proceed as usual with FUT or FUE harvesting methods.
However, the availability of great donor hair may vary, especially if the client has had repeat procedures in the past. Depending on the surgeon’s skill and the patient’s willingness, they may choose to extract a small quantity of remaining donor hairs to fill out sparse areas on the scalp, even if it doesn’t mean complete coverage.
Repairing hair plugs is a complex process that demands a lot of medical experience and expertise from the head surgeon and staff of the clinic. It’s important that clients put in extra research when looking for a clinic to perform these procedures and get at least a couple of opinions to make sure they take the right route.
Surgeons may have competing ideas about the right approach, and it’s up to the client to weigh their options and put their trust in the best person for the job.
Still, you have so many questions about hair plugs: Are they safe? Will they hurt? What kind of results can I expect? Are my expectations realistic? Hair transplants are not a common topic of discussion. So, who do you turn to?
A successful hair plug process starts with a consultation with a hair transplant expert who truly wants to understand your personal goals. Dr. Jae Pak of Jae Pak, M.D. Medical is a board-certified physician and a hair transplant artist with 15 years experience. With a complementary background in engineering, Dr. Pak uses precision-like skill to bring his patients a natural and balanced hair line they can be proud of.
Schedule a consultation with Dr. Pak today and discover what hair transplants can do for you.
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