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Note from Dr. Vogel: I have published this article for my colleagues so that they may learn from my techniques and experience. The article may be a bit technical for those not in medicine, never the less, it does provide the lay reader some idea regarding my general approach to correcting problems that can occur in Hair Transplants. The article appeared in the April 2000 issue of the medical Journal Plastic and Reconstructive Surgery.

Hair on the top of a man’s head is an important emblem of health, youth, and vitality. As in all areas of cosmetic surgery the refinements of surgical technique and instrumentation have improved the results of hair transplantation. The state of the art in hair grafting today is to produce a result that is undetectable as a surgical hair transplant. Many earlier techniques of plug hair transplantation are not aesthetically acceptable by today’s standards. This is especially true in the face of progressive hair loss which can unmask previously camouflaged corn row plugs. A technique to reduce the plugs and recycle the grafts into smaller grafts is described. The recycled hair grafts can be combined with scalp lifting, scalp reductions, and occipital harvesting of grafts to improve the results of corn row appearing hair transplants and other problems of surgical hair restoration.

A basic tenant of plastic surgery is to restore form and function. This tenant holds true for the practice of hair restoration surgery as well. Thus within the constraints of available supply and demand the ultimate goal of surgical hair restoration is to naturally restore form and function of scalp hair. For example, the result of a hair transplant using a combination of hair grafts should be to produce a hairline and overall result that is natural and not noticed as a surgical hair restoration. (Fig 1) New advances in the efficient procurement of occipital donor tissue and microscopic dissection of individual hair grafts permit this degree of advanced reconstruction. (1-5)

CLICK IMAGES FOR CLOSER VIEW			Fig 1. 45 year old man who underwent hair transplantation using a combination of graft sizes to achieve a natural restoration of his hair bearing scalp . Grafts containing 1-2 hairs were placed anterior to grafts containing 3-4 hairs to provide a transition from thin to thicker coverage. A total of 2100 grafts were transplanted. A mature hairline was created at 9 cm from the glabella and symmetric bitemporal recessions are present.
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Orentreich (6) first popularized the use of plug grafts in the 1950’s.. The practice of using plug grafts is uncommon today but the technique was widely used until 5-10 years ago. For those who have undergone previous transplants using round hair plugs or other techniques that do not produce a natural result, current corrective methods offer an excellent solution for reconstruction as well.

The purpose of this report is to describe the most commonly seen problems in clinical practice and describe a practical approach to their correction. The majority of patient complaints seen clinically concerns a straight, pluggy, or cornrow appearance of grafts or the malposition of their anterior hairline. In addition, patients frequently complain about

the progression of the their own alopecia and the resulting separation of the previous transplants from the receding hairline. In the majority of patients a clinically significant improvement in appearance can be achieved after one corrective procedure. However it is not unusual to perform two or more staged operations to maximally improve the results of previous hair restoration procedures.

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