Many patients from throughout the world choose Dr. Epstein and the Foundation for Hair Restoration to repair previous, inferior quality hair restoration results. There are few surgeons that have performed more reparative procedures over the past 18 years then Dr. Epstein who probably has more experience in these challanging cases then any other surgeons in this specialty. He has been performing hundreds of these procedures every year, with patients coming to him from all 50 United States and more than 75 countries. He has also authored hair replacement articles and taught his techniques at national and international meetings.
For most patients seeking revision work, the result of the initial hair restoration is a “pluggy” or “doll’s hair” look. This is usually from the transplanting of grafts that were too large, either performed years earlier or more recently with old-fashioned, outmoded techniques. Often times, these grafts need to be removed and dissected down (FUEplug punch removal), then replanted in a more aesthetic pattern to achieve a much more natural appearance. Some of these grafts can simply be reduced in size (FUE plug punch reduction), and the removed portions replanted. Additional hair grafting can also be a very effective way to improve appearances, capable when performed aesthetically of creating a more irregular, natural appearance. Sometimes, patients prefer to “just be bald”, having all the grafts simply removed and the scalp allowed to heal and become as smooth as possible, while the hairs from the removed grafts can be either discarded, or replanted into prior donor site scars.
Fat Transfer in the Treatment of Scarred Scalps
The use of fat in treating scarred scalps
In some patients in whom old plug or similar large-sized grafts were performed, there can be some scarring of the scalp that results in the loss of the transplants, and prevents future hair growth of transplants. Dr. Epstein and Dr. Kuka have developed a two-stage approach to these cases, where the first stage involves the injection into the scarred scalp of the patient’s own fat along with PRP- what they have named autologous fat transfer. Three months later, once the fat has caused new blood vessel growth and healthier scalp skin, a hair transplant procedure can then be performed- in this case, resulting in a rather unexpectedly high percentage of hair regrowth. Here the patient is shown 10 months after the transplant procedure of 1400 grafts. This was the topic of an article they had published in the Hair Transplant Forum.
Repair of Donor Site Scars
One of the most common- and challenging- problems faced by surgeons who specialize in reparative procedures is a widened or visible donor site scar. There are a variety of reparative techniques, and one of the most effective is the excision, then closure of the scar. In rare cases, the scalp is so tight that it must be stretched out to permit the removal of the entire scar, which is achieved with the use of tissue expansion.
Another way to repair donor site scarring is to plant additional grafts into the areas devoid of hair. In order to avoid making additional incisions to obtain these grafts, the FUE technique involving the individual removal of grafts can be utilized. Like the other reparative techniques he performs, Dr. Epstein has extensive experience with these procedures. While this scar tissue is at risk for supporting a lower percentage of hair regrowth, through careful techniques it is possible to achieve as much as an 80% rate of hair regrowth, excellent for the transplanting into scar tissue, and thus allow for moderate to significant improvement after one, sometimes two procedures.
Endoscopic Ridge Reduction
of FUE grafting placed into prior donor
site scar, the result of a strip
procedure performed elsewhere.
The endoscopic ridge reduction is a procedure personally developed by Dr. Epstein, designed to remove the ridging (thick tissue) usually along the hairline in areas of prior placed plug grafts. Recognizing that the ridging was due to the buildup of thickened scar tissue at the level of the galea and deep subcutaneous tissue (deeper levels of the scalp), Dr. Epstein was able to apply his plastic surgery experience in performing various endoscopic (tiny scope) facial procedures to the scalp, and through several small incision, able to remove much of the scar tissue that is causing the ridging. Like the surgical hairline excision, the endoscopic ridge reduction takes less than 2 hours to perform, and patients are usually presentable in 2 to 3 days.
Surgical Hairline Excision
The surgical hairline excision involves the removal of the entire or part of the frontal hairline. The hairline is removed—as wide as 4 cm (1 ½ inches)—including the prior unaesthetic grafts and all the scarred skin. The scalp is then brought back together with plastic surgery suturing.
This scarred skin is often a result of not onlypoor healing from prior placed large grafts (which leave thick scarring), but also from prior attempts by other surgeons to remove these grafts through individual punch techniques, which can heal with scar tissue.
The entire scarred area where there are
large plug grafts as well as whitish scar
tissue was completely excised,
leaving a fine line scar in its place.
This procedure is usually performed under local anesthesia and if desired an oral sedative, and take less than two hours to complete. Recovery is usually a week, after which sutures are removed and the patient can return to most activities. Most times, the area where the sutures are placed, in the area of prior unnatural hairlines, were already concealed by the patient due to the unnaturalness, so return to the public eye can be as soon as 2 or 3 days later.
Seek an Expert
Note that most surgeons will recommend against the surgical hairline excision and endoscopic ridge reduction, convinced they are not appropriate, however, most of them have likely never even done one, let alone even seen the results of these procedures when performed properly. Dr. Epstein is a specialist in hair transplantation.
female can be corrected, in this case
with a procedure of 1100 grafts to
create a softer, more natural hairline
that conceals the abrupt scarring.
Repair of Prior Scalp Flaps
While rarely performed today, in the past, several different scalp flaps (Juri, Fleming Mayer, TPO) were popular, mainly due to the very dense hairline and near immediate results produced. However, there are a variety of problems with these flaps. Learn more