Incremental improvements in medicine lead to big results for everyday patients. This goes for disease prevention, longevity, and especially cosmetic procedures like hair transplantation.
It seems like just a decade or two ago, hair plugs were the norm in the hair restoration field, but standards changed quickly — now, plugs are known as a thing of the past.
We’re left wondering what qualifies as hair plugs, how they differ from today’s transplants, and what patients can do to avoid the “plug” look that appears so unnatural.
In this article, we’ll walk through a brief history of hair plugs and what has changed in the hair restoration field over time, giving you key info to help you steer clear of plugs and get the lasting, natural results you want.
Since “plugs” is not a technical term or an intentional procedure, it’s more of a case-by-case assessment. However, a few key characteristics signal hair plugs to the untrained eye and tell us a story about the quality of the surgery — or lack thereof.
Hair plugs are known for the following attributes that put them in a distinct category:
To properly identify and define hair plugs, we must take a trip back to the origins of hair transplant surgery. Let’s look into the origins of this procedure and find out why “plugs” were so common back in the day.
From a technical standpoint, plugs were the result of the best practices and technologies at the time, so we can’t blame surgeons working with limited instruments and knowledge.
Considering that hair transplantation for baldness first caught on back as recently as the 1950s and 60s, it’s not surprising that hair plugs were the norm for many years, despite their shortcomings.
What did early hair transplant tools and procedures look like, exactly? Early schematics suggest that instruments were relatively crude, only able to harvest large clusters of donor hair follicles and failing to preserve cohesive units prior to implantation.
In short, doctors could not be precise with their extraction process, and much of the hair they gathered from patient donor areas was lost along the way. This is known as transection rate and was a persistent issue in the first decades of hair transplant techniques.
Equipment and technology form the basis of any successful procedure, and even the most skilled surgeons are limited by the tools in their arsenal.
However, early hair plug treatments also fell short in terms of artistic execution. Physicians not only struggled with the technology available at the time, but they lacked an understanding of the artistry required to implant individual hair follicles in an orderly, aesthetic way.
This explains why hair plugs were not only deficient on a technical level, but also left much to be desired in terms of visual appeal. The “dolls hair” look resulted from a “one-size-fits-all” approach to implantation, done without acknowledging the natural flow and distribution of actual human scalp hair.
That’s why we’re able to detect hair plugs fairly quickly, even if we aren’t able to put the reasons into words. The human eye can tell when hair growth appears natural, going with “the grain” of the skin instead of sticking straight up from the scalp.
The combination of inadequate technique, technology, and personalized surgical approach led to many unsatisfactory procedures in early hair transplant methods, despite the best intentions of surgeons to recreate natural hair flows and distributions.
It’s safe to say that the worst hair plug treatments are behind us, as tech and medicine advanced quickly around the turn of the century. Nevertheless, one might still spot hair plugs from time to time, especially among older generations who received treatment for their thinning hair in the 80s or 90s.
Of course, hair transplantation is not an automatic process, even with the best technology at our fingertips. A focused and personalized approach to planning and execution is required to achieve the highest transplantation standards, particularly in high-volume cases and long-term outcomes.
In short, hair plugs may indeed still exist, and it’s up to patients to navigate the field with knowledge and caution.
What changed in the world of hair restoration that did away with the outdated hair plug looks of the late 20th century?
Let’s examine some of the key advancements that brought us out of the dark ages and into the golden era of hair transplants.
While we might tend to focus on how hair is implanted in the recipient area of the scalp, the follicular extraction process from the donor site is of equal, if not greater, importance.
A fundamental shift in transplantation focused on the size and scope of follicular units, whereby surgeons prioritized extracting cohesive grafts. This helped ensure that the extracted hair was stronger, more cohesive, resilient to transection, and ultimately more natural looking.
Counterintuitively, larger batches of smaller grafts yielded better results for patients, allowing surgeons to implant hair in an organic, high-density distribution.
Rudimentary tech limited hair transplantation early on, but superior instruments were soon invented and standardized throughout the industry.
Thanks to innovations from Dr. Jae Pak and others, equipment has improved by nearly every metric, allowing surgeons to extract and implant follicles with greater precision and consistency. Among the greatest advancements is the follicular unit excision “punch” tool designed to extract follicles with minimal scarring, forming the basis of follicular unit extraction (FUE) surgery.
Additionally, surgical standards and supplies have improved with time, helping physicians process and preserve healthy hair follicles in the crucial window of opportunity before implantation. Fewer lost follicles and reduced transection means better results for all.
Hair restoration pioneers soon discovered that a holistic, aesthetics-based approach to transplantation was necessary to fill gaps that technology could not accomplish.
Surgeons began to experiment with variables like implantation angle, density, flow, and other aspects of arrangement to recreate more natural hairlines without the “pluggy” appearance.
Now, look no further than a clinic’s before and after photo gallery to see if they set a high bar for aesthetic standards and execution and if they approach their work with an eye for artistry and personalization.
The completion of hair transplantation procedure is only the beginning of the restoration journey. Old-school hair plug methods were focused solely on the surgery itself, and didn’t always address key areas like post-op care and long-term maintenance.
Today’s top hair surgeons know the importance of proper recovery protocols in the days and weeks following the procedure. This typically involves the use of medication, bandaging, stress avoidance, and other instructions outlined by the clinic.
Closer adherence to these best practices on the part of both patient and surgeon help get more mileage out of an FUT or FUE hair transplant, as grafts remain in place for longer with minimal scarring or new hair loss.
It’s unlikely for a patient to encounter an outdated form of hair transplant or transplant surgeons without 21st-century medicine in their clinics. However, natural-looking results are the goal, and you want your surgeon to go above and beyond when paying good money for your procedure.
Apart from reading reviews and browsing online galleries, the consultation process will give you clues about a clinic’s standards and practices. During this meeting, be sure to discuss realistic expectations and express your unique vision for how you want your hair to look.
The best doctors will walk you through the steps of a modern hair transplant and weigh options including follicular unit transplantation (FUT) strip surgery, FUE procedures, and alternative hair loss treatment options you may want to consider.
Get as much detail as possible, including the target areas of the scalp, number of hair grafts, potential side effects, and the exact type of hair transplant you intend to undergo.
Avoiding hair plugs and maximizing results is a matter of research, due diligence, and a willingness to work alongside hair experts that understand your unique hair loss case and goals.
From prospective patients to leading researchers and surgeons, we can all agree that hair plugs will not be missed.
Medicine and tech have advanced considerably in a short period, and modern practitioners practice with an emphasis on aesthetics to elevate hair transplantation standards in every aspect.
From pre-op consultation and planning to the operating room and recovery process, today’s hair transplants are meant to deliver personalized, lasting results that look authentic and inseparable from your natural scalp hair.
Get the process underway with a trusted hair restoration expert like Dr. Jae Pak and make your lifelong commitment to real, healthy, and great-looking hair.
Hair Restoration Surgery Challenges | NIH
Review of Surgical Hair Restoration Techniques | NIH
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