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This is a non-commercial website. Please ignore any advertising you might see.
Ads are placed by Angelfire in exchange for providing free space on the web.Any statements I make on this website are my opinion.
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My case is not unique... Over ONE MILLION MEN have been subjected to crude punch graft surgery, with lousy results similar to mine. Many doctors care more about PROFITS than they do about their patients' well-being.Dr. Puig gave me a horrible "Dolls Hair" transplant, not the "natural" and "undetectible" transplant that I was promised.
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This section of the website discusses:
- Some of the corrective surgery approaches that are typically used.
- My personal experience with corrective surgery.
Techniques For Revising Bad Grafts
Graft revision is often the first step in corrective surgery. Bad grafts are usually too "tufty" (pluggy), so they need to be "de-bulked" and have hair follicles removed. Often the hairs in these grafts emerge at an unnatural angle, often straight up at 90 degrees. That is not how hair naturally grows, and it looks bizarre. Grafts can also be placed in innappropriate areas, for example too low on the forehead.Often the first goal in corrective surgery is to revise as many bad grafts as necessary, in order to "clean the slate" before adding new (and better) grafts to conceal the scarring and other problems. In some cases, bad grafts can simply be surrounded and hidden with new "good" grafts. But sometimes the best corrective results are seen when the bad grafts get revised first.
Here are three typical graft revision techniques: Coring, Line Excision, and F.U.E.
1. The pluggy graft before correction. Plug grafts get compacted by scar formation, which exaggerates even more the visual effect of too many follicles in a small area. So a plug can actually be denser in follicles, than hair normally grows in the scalp. When surrounded by ANY amount of bald scalp, these grafts look tufty and bizarre. Hairs are also angled incorrectly. And big grafts usually don’t lay flat, but resemble a “cobblestone” or bump.
2. First step: A center section of the plug is punched out ("cored"), leaving a large HOLE. Part of the old graft is left behind, often in a crescent shape. The pluggy graft has now been “de-bulked” and will lay flatter. Only a few hair follicles are left behind in the original plug, so the abnormal density has now been decreased.
3. The punched-out “core” section of the plug is divided up into smaller grafts. The goal is to recycle as many of the follicles as possible, after they are removed. Some of the follicles will get damaged by the punch tool, and they can’t be recycled. These follicles will get thrown away. Wasting hair follicles is one of the problems with this technique. Wasting precious donor hair is one of the cardinal sins in hair transplantation. The follicles that weren't destroyed by the "coring" will get inserted back into the scalp, in a place where they can be useful.
4. The remaining HOLE gets closed up, usually with a single stitch (green line = suture). This results in a small scar where the core was. By itself, a small scar like this is not too bad. But if you multiply this scar by hundreds of grafts, it turns into another added new problem! The scarring that this technique causes is another drawback. Because closing a hole this size creates some tension in the scalp, most doctors limit the number of "cored" grafts they will do per session. Tension in the scalp can cause puckering or less-than-perfect healing of the scars. In my case, I was limited to 20 to 30 "cores" per session. Since I have 300 plug grafts, this technique is TOO SLOW... progress takes too long!
Coring is a flawed technique because:
-The remaining hairs from the plug are still angled incorrectly.
-The technique is imprecise and destroys follicles
-A linear scar is created, when the hole is stitched up.
-It takes too long to make progress.
1. In many cases, bad grafts can be packed together in a row. A doctor may decide that the best (or fastest) way to correct a row of grafts is to cut out the entire row with a Line Excision.
2. A scalpel is used to cut around the entire row. The entire strip of scalp is removed. In some cases, this row can be 6 inches long or more (!) I had a Line Excision done on a row of pluggy grafts in my frontal hairline, that was about 4 inches long.
3. The hole where the strip was gets sutured together, and forms a scar. The strip of scalp containing the plugs is dissected into smaller grafts, which will get recycled. There is less waste of precious follicles with this method than the Coring method, because there is no randomness to the removal. Also, the entire grafts are removed, so no incorrectly-angled follicles get left behind, like the Coring method. This is a rapid way to revise multiple plugs at the same time.
The biggest drawback with this approach is that it creates a new long scar in the scalp. It solves one problem (pluggy grafts) at the same time it causes a new problem (long scar). In theory, there is supposed to be enough new grafts to cover the scar later. (In my case, that may not be possible. Read on.) The other problem with this technique is that it is usually impossible to use it on every bad graft. Many corrective patients have dozens (or HUNDREDS) of grafts that need to be removed. It's not practical or sensible to just "cut out" a patient's entire scalp, in order to remove the bad grafts.
FUE = “Follicular Unit Extraction”. It’s a new graft harvesting technique that uses microsurgical tools to isolate the individual follicular units (bundles) and removes these follicles while removing the LEAST possible amount of excess scalp tissue. FUE has proved itself to be especially useful for corrective surgery, with fewer drawbacks than other methods.
1. Plug grafts have several problems:
-Too many follicles in a small area.
-Hairs are angled unnaturally.
-Grafts are bumpy (cobblestoning)2. FUE isolates the main problem with bad grafts: the follicles themselves. Using specialized tools, the follicular groupings are ISOLATED and REMOVED. Correcting a graft with FUE conserves more precious follicles than the “Coring” method, which randomly punches out the center of a pluggy graft. Coring is TOO IMPRECISE. Because FUE targets and isolates each follicular unit individually, there is less waste of precious follicles. Any follicles that get removed with FUE are then recycled into other areas.
Because pluggy grafts are often distorted, graft correction via FUE "may" damage some follicles, resulting in some waste. However it is much more "precise" than coring techniques, and usually wastes less hair, when done by an experienced clinic.3. Unlike coring, there is not a big hole created. These holes are too small for even a single stitch to be necessary. There is scarring but the scars are much smaller and draw less attention than the line scars that result from Coring or Line Excision. A scar that is a line will get recognized more easily as a scar, than the tiny "dot" scars that FUE creates.
4. Some doctors (ex: Woods Clinic) prefer to "fill the holes" with tiny skin grafts, with donor tissue taken from inconspicuous areas. Other doctors (ex: Cole) have experimented with surrounding the area with a "running stitch" (green lines) that pull the small holes together like a drawstring purse. (Edit: Dr. Cole rarely uses this running stitch technique-- if ever-- any more). The purpose of skin-grafting (filling) the tiny holes, or pulling them closed, is to try to minimize the tiny final scar that will be there.
The goal with FUE graft revision is to recycle as much hair as possible, while creating as little scarring as possible.
FUE has all of the benefits and none of the drawbacks of the other methods (when done by an experienced clinic):
-It’s possible to remove ALL the follicles, leaving NO bad follicles behind. This may require multiple (additional) "passes".
-The resulting scars are tiny. FUE causes the least damage compared to Coring or Line Excision.
-FUE wastes less follicles than Coring, and conserves almost as many follicles as Line Excision.
-FUE "de-bulks" the graft and allows it to lay flat.
-Progress with FUE can proceed much faster than Coring. There aren't limits to how much hair can be removed each session, like there is with Coring.-Unlike Line Excision, it isn't unrealistic to use FUE on every single bad graft, if necessary.
I think the FUE approach is preferred, but every patient is different, and all three techniques may have their place. Corrective surgery patients are encouraged to KNOW THEIR OPTIONS and make informed decisions. A couple of OTHER OPTIONS are to "do nothing" or to wear a hair piece and forget about hair transplants.
For additional reading on repair techniques (especially coring), see the LINKS section.
I will probably never be able to have a completely normal appearance. There has been too much damage from previous crude punch graft techniques (see the Punch Graft section for information on how that technique was performed). For additional photos and more information on my bad results from Dr. Puig (BEFORE corrective surgery) see the section of this website called MY RESULTS.
My Experience with Corrective Surgery
Results of First Four Corrective Surgeries
My first four corrective surgeries were done over a two year period with Dr. Robert Bernstein at the "New Hair Institute" in New York City. These surgeries were spread out over two years because that's how long it took me to save up the 6000 dollars that these four surgeries cost. These surgeries were done using the Coring and Line Excision techniques (described above) which create more scarring than I believe is necessary.Most of the work was done using the Coring technique, which can be a slow process. Improvements can sometimes seem to take "baby steps" and not show obvious progress. The first two graft corrections were done with Coring only. See the difference after 2 surgeries? Me neither. The difference is subtle. I believe "coring" is often TOO SLOW and INEFFICIENT. However it is a common 'corrective' technique, unless the patient can find an experienced FUE surgeon.
This next photo shows the difference in the front hairline after 4 Coring surgeries, and one Line Excision in my hairline. Most of the corrective work was done in the front, and you can see that the pluggy hairline has been noticeably softened after 4 surgeries. There is still a lot of work to do, even in the hairline.
These are not perfect photos for comparison, because they were taken by different cameras under different lighting conditions, with slightly different angles.
These overhead shot show that after four corrective surgeries and 6000 dollars spent, my terrible appearance has only changed slightly. There is still a lot of corrective surgery needed. I am still in terrible condition.
During the third surgery, Dr. Bernstein decided to do Line Excision at the last minute, on a row of grafts in my hairline. While this was effective at removing the grafts, it created a scar in my hairline. The problem with Line Excision is that it creates a linear scar that needs to be hidden later with new grafts. However, I have very few available grafts to conceal this scar. This scar is going to dictate how I proceed with additional surgeries. I will need to put grafts in front of and around this scar, whether I want to or not.
A good corrective procedure should NOT create new problems, while it solves other problems. A good corrective procedure should NOT limit a patients' options, like this Line Excision does for me. I worry that Dr. Bernstein made an error in judgement when he created this scar in my hairline. The scar isn't that obvious in photos, it is easier to see in person. Look for the scar in the other photos, because it is noticeable.
Corrective Surgeries #5 and #6
The two most recent surgeries were done with Dr. John Cole in Atlanta, with his variation on the F.U.E. technique that he calls "F.I.T." (Follicular Isolation Technique). These two surgeries accomplished much more rapid progress than the previous four Coring surgeries, and also caused much less damage than the Coring did.Dr. Cole donated all of his time on these surgeries (as well as his staff's time) based on my financial hardship and my desperate need for corrective surgery. I estimate that Dr. Cole donated over 10 thousand dollars worth of surgery to me. I am grateful that Dr. Cole has taken an interest in my case.
The next photo shows my hairline before undergoing work with Dr. Cole. The pluggy hairline has been softened and improved by Dr Bernstein.
The next photo shows a top view before undergoing my surgeries with Dr. Cole. You can see that there is still a tremendous amount of corrective work to do.
The next photo shows me in the surgical chair, shortly after beginning Day 1 of two corrective surgeries with Dr. Cole. Dr. Cole did two full consecutive days of surgery, and also a third day of light touch up and clean up work (approximately an hour or two). I am not counting this as a full day of surgery.
The hairs are shaved down, in preparation for corrective surgery. There is so much work to do. Graft correction has already started on the back row of plugs, and you can see "running stitches" to pull the tiny gaps closed.
The next photo shows me after two full days of corrective surgery. You can see that Dr. Cole has used his F.I.T. technique (similar to FUE described above) to remove hundreds of individual follicular bundles. Graft correction using these methods results in TINY scars.
Dr. Cole has laid a running stitch around the holes, which he draws tight, to make the tiny hole close up as much as possible. This was done to potentially speed healing and reduce the size of the resulting scars. (I believe that Dr. Cole rarely uses the running stitch technique any more, as the benefits are marginal at best when the holes are already so small.) The follicles that he removed have been recycled and moved to the sides, and we attempted to build a "bridge" between the two "parietal" (hump) areas.
Look where my frontal hairline should be, on the left side of the photo, and you can see the white scar from the LINE EXCISION that Dr. Bernstein did. This scar is NOT in a good place, and will need additional steps to hide, that I might not had to take if Dr. Bernstein had used a different method for hairline correction. A line is more recognizable as a SCAR, than a bunch of small dots are.
Corrective surgery is traumatic. It is very hard to wake up and see this in the bathroom mirror. The running suture is only left in for a day or two. Healing with this method is fast, but the days surrounding surgery can be difficult.
Patients should not underestimate that it is hard to undergo surgery like this on consecutive days.
Any red dots NOT surrounded by running sutures are recycled follicles, which should begin growing after a short dormant phase. Healing was the fastest and easiest of any hair transplant surgery I've ever had. The redness in the post-operative healing phase was gone by about 2 or 3 weeks. After about a month, it was impossible to see that I had recently undergone surgery.
UPDATE: I underwent five FUE surgeries at The Woods Clinic in Sydney Australia. These surgeries were successful and some good progress was made. This was the best surgical experience I have ever had at any clinic. I hope to add new pictures soon, however the improvements have been incremental and not drastic (which is what I expected). So much damage has already been done to me by previous surgeries with Dr. Puig, that I estimate another 10 to 15 additional surgeries will be necessary, which will cost me roughly 75,000 to 100,000 dollars, depending on the details yet to be determined. Even after spending all that money and undergoing dozens of surgeries, there is no guarantee that I will regain a totally normal appearance.
There are several heart-warming stories on the internet about guys who were damaged by hair transplant doctors, who went on to regain a fairly normal appearance. I'm not convinced that I can have a similar result, because of my hair characteristics, amount of hair loss, and the extensive amount of damage that has already been done.
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