Appearance of Hair Transplants

What makes a hair transplant bad is that everyone can tell it is a transplant. The uneven, patchy effect of the large pluggy grafts occurs when large grafts are used and the spaces between the grafts are wide. This causes a contrast between the bald skin and the islands or clumps of hair and creates a "dolls-head" appearance. Traditional hair transplants also produce small subtle deformities in the skin. Skin abnormalities with larger grafts occur for two reasons. First, the surface of the transplanted skin may not be aligned with the surface of the surrounding scalp (this is seen in larger hair grafts where the transplanted skin has enough mass to produce the problem). Second, scar contraction and/or skin dimpling occurs at the recipient site from the healing process. As the grafts increase in size, these abnormalities occur with increasing frequency. When the grafts are smaller than the critical size, these problems rarely exist.

The natural hair mass is composed of hair groupings of one to four hairs that are close together (follicular units). In nature, only single-hair follicular units appear at the leading edge of the hairline. To appear natural, a hair transplant should simulate that look as closely as possible. An ideal hair transplant consists of follicular units placed closely together with naturally occurring single units placed at the frontal edge of the hairline. When follicular grafts are placed into small sites, skin deformities are rare, or nonexistent.