Episode 18
Common Hair Transplant Issues and How to Fix Them

Common Hair Transplant Issues and How to Fix Them

The following is a transcript of Episode 18 of the Hair Restoration With Dr. Daniel A. Danyo podcast. In this episode, Dr. Danyo shares five reasons why a patient may require hair transplant repair after a previous transplant procedure. He discusses the solutions he offers in each of these scenarios and stresses the importance of finding an expert you can trust when seeking a hair transplant.

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Dr. Danyo: It’s kind of like having an old car and you clean it and you buff out the paint and somebody thinks it’s a new car. So that’s kind of my vision when I repair something.

Clark: That’s the voice of Daniel A. Danyo, M.D., founder, and physician at North Atlanta Hair Restoration, a boutique medical practice solely dedicated to the diagnosis and treatment of male and female hair loss. And you’re listening to “Hair Restoration” with Dr. Daniel A. Danyo. I’m your host, Clark, and all season long, we’re speaking with Dr. Danyo about how he and his team at North Atlanta Hair Restoration are helping his patients transform their everyday lives for the better. In this episode, Dr. Danyo discusses five different situations when patients come to him for hair transplant repair, whether someone has had a transplant done poorly by another doctor or they have new hair loss and need additional grafts. Dr. Danyo explains how he approaches each of these common issues. There’s a lot to talk about. So let’s dive right in. Dr. Danyo, it is great to be back. Looking forward to our conversation today, but first, how are you doing?

Dr. Danyo: I’m doing great and looking forward to it as well.

Clark: There’s been a lot going on. I know you continue to be super busy and I appreciate just slipping us in here at the end of your workday and to talk about this. I know it’s your passion. I know how much care you put into the work you do. You are the doctor here. With everybody you’re dealing with, you are helping them from start to finish, bringing out great results. And it’s a great way, this show. We love it because it gives you a chance to just kind of talk, you know, just you to be you and to share some examples and continue to share with me all the different types of procedures you do. And it’s really informative, you know, because this is important, how someone feels about themselves, and that’s what it’s all about.

Dr. Danyo: Well, there’s a lot of information on the web, and it’s really hard for people to kind of consume the information and kind of believe what’s true and what’s not because people have different philosophies, different techniques. So I’ve come at it from a different angle than most just doing all the extractions, all the placing and, you know, just how I address either concealability. You know, we’re gonna be talking about fixing a hair transplant, previous hair transplant issues and just trying to make it fun.

Clark: Well, you make it fun, but you also, you’re serious at this. You really are, you know, you’re backed out. Your schedule is packed out. People come back, they have great results. What I mean by that they come back and then when you do your visit with them, you get the high-fives and the hugs because you’ve seen that change, they’ve seen that change in their lives. So that being said though, not everyone takes the amount of care you do on this. Sometimes people maybe farm it out. Maybe, you know, other hair restoration practices are, you know, maybe they’re just trying to max out the amount of money they can make and they’re maybe cutting corners. Who knows? There are all sorts of things I can speculate on, but what I do know though is you see people for hair transplant repair and maybe they’re coming to you for different reasons. What are a couple that you think of, of why someone might hit you up to repair their hair transplant surgery?

Dr. Danyo: There are about five main reasons somebody would come for a repair. The first one would be they just had bad outcome from a previous hair transplantation, whether it’s FUT or from FUE. And so FUT would be the strip where there’s a linear scar in the back. The other would be FUE, which is follicular unit excision which I do where you take random hairs. So one of the common things that I see is frontal hairline is done and the frontal hairline angulation is poor. It’s either too flat. You know, I have a lot of different examples. A guy recently that I saw that looked like a female hairline design, which was more like a rainbow instead of having kind of a little bit of temporal recession, kind of arcing back to the middle part of the hairline and then back into the temporal recession.

And so we had talked about taking out some grafts and kind of redoing the hairline. Another thing with the hairline is sometimes there are big, chunky grafts upfront and it’s just really flat. The standard practice that I do where I typically have about 300 to 400 singles that I’ll pack in up at the front in very random distributions to create a very soft hairline, it will never look plug it’s a single graft. So we fix that. And in a lot of times they just say got 2,000 grafts and it looks like they had 1,000 and the hair can have a poor texture, just does not look good. And so a lot of times we just have to make it more bonafide.

Clark: You know, I feel like after our conversations, I do look at this stuff differently. I do look at hairlines differently just because you don’t know it until you really looking for it, but then once you see it and you’re thinking about it, it can kind of get in your head.

Dr. Danyo: Absolutely. And, you know, the hairline is key because somebody is looking at you and you wanna have a nice framing of the face and if it looks fake and it looks kind of, you know, hair transplant-ish, you know, it’s not…

Clark: Yeah. You might not be able to put your thumb on it, but you know there’s something off. This is the way the human nature works.

Dr. Danyo: Well, and people are very, you know, it’s a psychologically purging, you know, exercise that people go through. I’ve seen people that we’ve kind of redone some frontal hairline work where they had a big case but they still wear a hat. They’re almost embarrassed to take their hat off. And that’s a terrible situation, but easily correctable.

Clark: Right. Well, that’s a optimistic message here. You know, someone comes to you and they’re frustrated. And I can’t imagine you go and you take the time and you spend the money, you make the investment to feel better, and then you don’t get the results. It’s really disappointing.

Dr. Danyo: It’s very disappointing and costly. But again, for people that are out there that aren’t happy with all aspects of their hairline, and it can be little things. A lot of times it’s very common for the hairline and guys to just be like a U-shape and there’s no return back into the side temporal areas. And that looks almost like a diving board. So a lot of times I’m just adding, say 300 or 400 grafts on each side to kind of make two more curves going from the side temporal kind of up to create some temporary recession then back down into the frontal hairline. And that can take this kind of awkward, you know, diving board, looking hair transplant with just that single u, it can make it come alive again. And it creates a much more youthful look when you have three curves.

Clark: Okay. That makes sense. So when you were saying it’s costly earlier, I guess all of this is gonna be based on case by case, but do you find that doing repair, maybe there’s not as much you have to do to kind of just get it to where it needs to be, or is it really, you just don’t know until you can take a look?

Dr. Danyo: You don’t know. I mean, the good thing is people that have had… And I’m gonna focus more on the hairline. People have had grafts placed. So a lot of times we don’t have to do as many grafts to fix it, but we just have to do it right, use the right amount of singles, get the curving of the hairline in the proper position, you know, kind of building it into the side temporals. So the good thing is there are previous grafts there, which help and, you know, we’re just making it look better. It’s kind of like having an old car and you clean it and you buff out the paint and somebody thinks it’s a new car. So that’s kind of my vision when I repair something.

Clark: That’s great. Bringing life back into it and making those small changes, they have a big impact on how someone feels and if someone feels better about themselves, good things happen.

Dr. Danyo: Absolutely. And it’s such a terrible scenario when somebody has hair transplant and they don’t even wanna take a hat off to have people look at them straight in the face.

Clark: No. No.

Dr. Danyo: It’s a terrible situation

Clark: That’s not what you want.

Dr. Danyo: No. so the second thing that we work on a lot are previous strip scars. You know, a lot of times…

Clark: Strip scars?

Dr. Danyo: … Which would be, you know, the FUT, the linear strip excision. So sometimes these scars go from ear to ear, you know, in the back of the head and oftentimes you can’t…

Clark: Oh, no. That sounds painful.

Dr. Danyo: Well, it can be. But, you know, oftentimes there’s, you know, there’s a scar. Sometimes you can barely see it, but the people that I’m obviously correcting, they have issues. I’ve seen strip scars that are almost an inch wide from ear to ear that I’ve had to place 1,400 to 1,500 grafts into the back of the head to conceal it. I’ve seen other people where there may be one or two rows of hair and it really limits how long they can keep their hair in the back of the head because if they cut it too short, that usually lessons, say, a number four guard on a razor, then that scar is unearthed and it just limits haircut styles.

And then other people, there’s almost like a divot there. So what I do with these scars, there are a couple of things you can do. For one, I take a very small sharp punch and I actually core out a lot of the scar to help make a contract. And then because scar tissue can be firm and have less kind of blood flow, you don’t wanna just stick straight into the scar, you know, these grafts because, you know, you can kind of pinch them off and there’s not as much blood flow support. So kind of going in with a small punch, kind of coring out where you’re gonna be placing grafts, you get the contraction, you get more blood flow, and you also decompress the amount of pressure that’s on the graft so you have better results.

Clark: Interesting. So you can take a scar and sort of, comes back to that word, concealment. You can try your best to help hide it, really. As simple as that.

Dr. Danyo: Yes. And, you know, oftentimes we use a hair from the head but, you know, there are a lot of patients that their donor site is pretty thin. We don’t have a lot of options to use head hair. So oftentimes I use beard hair. And the nice thing with the scars, you don’t have to just, you know, pummel it with really dense grafting in the scar. An analogy I use with my patients is if you look at like a deer that has a few white spots, those few white spots make it invisible to predators instead of it being just an opaque animal. And so when you break the opaqueness of that scar by adding grafts in there, it conceals it immediately.

Clark: Wow. You’re right. Because it doesn’t take much to camouflage an animal like that. That’s a good visual. I can really see that.

Dr. Danyo: Yeah. The typical strip scar even from ear to ear, if it’s one to two kind of hairs, you know, thick, can be kind of a row of single or double hairs. I mean, the number is usually about 500 grafts can conceal it and as it gets thicker, that number can go up. I brought up the 1,400 to 1,500 graft case that they did, but that was just a massive scar and it just needed a lot of work just from a volume perspective. The other thing it can do with scars, which is great, in combination is just a little bit of micro-pigmentation where we do some sub epidermal tattooing. And again…

Clark: Wait. What is this?

Dr. Danyo: It’s called scar micro-pigmentation. So we can play some small dots in and around the scar. And, again, we don’t wanna, you know, kind of bring attention to the scar. And, again, back that baby deer analogy with the small white dots, we just want to add a little bit of contrast to break up the opaqueness of the scar and that in combination with the grafting is really, you know, just awesome. I can just completely blank it out where people can wear short haircuts again and even less than a two-guard oftentimes. Now, if you, you know, were to shave the head or take it to zero gaurd, most scars, even if they’re close to perfect, are still visible. And that’s the main reason I don’t do FET because I just feel that these scars are always an issue and just pose too much of a challenge and limitation in how you wanna style your hair to where, you know, FUE is what I do.

Clark: That makes sense. Okay. So we’ve talked a little about working around the strip scars, we’ve talked a little about some people who just have…they’ve had a bad outcome, poor results with the frontal hairline, we’ve talked a little about some of the other techniques. What are some of these other reasons someone might wanna come to you?

Dr. Danyo: Yeah. The third one would be people that have had previous plug transplants. Now, a plug is different than a graft. Plugs were done in the ’80s and ’90s, a little bit in the early 2000s, and then as FUT and FUE with these single follicle grouping grafts became more popular, the plugs where you would take a 5-millimeter full-thickness skin punch, punch out the skin where you’re placing and say, along the forehead and then, so in that full-thickness graft, and what would happen is you almost have like a dolls hair appearance where you have this really dense, you know, packed, you know, 5-millimeter know circle and then no like zero hair just bald skin and then a little bit from that would be another patch. So it’s very easy to correct and what we do is I just literally graft a portion of those groupings. I mean, generally, they’re usually about 6 to 10 grafts, you know, follicle groupings within those 5-millimeter punches and maybe I’ll take three, possibly four of those and just scatter them in it immediately breaks up the plugginess.

Clark: There’s no reason that anyone after the ’80s, ’90s, 2000s, no one else is doing this kind of work, right? I mean…

Dr. Danyo: No. Plugs are gone.

Clark: That’s ancient technology.

Dr. Danyo: That’s ancient technology. I don’t know of a single physician that’s doing it and I don’t think patients as consumers would actually search that out. So it’s just not done, but it’s a great option for, you know, it’s usually older patients. I mean, they’re usually at least in their ’50s. Now, some have maybe had a little bit younger than that, but that really kind of dealt with it and actually did well. And maybe things that thinned out around where they have the plugs and then they become a lot more noticeable. So it’s a very easy solution. It doesn’t leave any scarring when you extract the hair. You know, within those groupings, you know, the plug groupings and we just move around similar to what we do with the modern technique. They usually also do some grafting from the back to make some singles so that we can kind of make a more natural hairline with like 300 to 400 singles upfront to just make it nice and soft.

Clark: Got you. What else do you got? Any other things that have been over the years, common themes?

Dr. Danyo: Yeah. The last major one, and I don’t see it very frequently, but I’ve had two patients recently that went overseas and I’d rather not comment on where they had it done, but they were both extremely over-grafted. In one procedure, one patient recently…

Clark: Over-grafted. What does that mean?

Dr. Danyo: Where you take too many grafts at one time from the donor site. So most people can have up to, like men can have, I would say Caucasian men usually have around 4,000 even up to 6,000 grafts that you can take before the donor site looks thin. But if you were to take 4,000 grafts one time, what happens when you do a graft, there’s a small hole that’s formed, that hole will contract, but if you have too many holes that are too close to each other to get that number of grafts at one time, you don’t get the contraction. And so the donor density doesn’t kind of pull back in as it heals and it stays, you know, static, and then it looks thin. So if you have the need to do over 2,500 grafts, it’s best to do smaller cases. You know, oftentimes I do 2,500 grafts up front in 2,000 and back to get coverage from the frontal hairline to the crown and you just have to separate out those numbers or even grab somebody hair, especially from the beard.

A lot of times I’ll do 2,000 from the head and 500 from the beard, knowing that I’m going to, you know, I have a big canvas to fill and it just kind of preserves that donor site. So recently I saw an African-American female. Now, with my African-American patients for the men, I’ll only extract a maximum of 2,000 at one time because the hair is coarse and curly, they make up for actually less density in the donor site. So you have to be really cognizant not to over-harvest even though you may need more than 2000 at any one time. And again, you just have to space these procedures out. For the women, usually, the donor site is a little bit smaller and the head is a little bit smaller. And I limit that for African-American females to 1,500. So recently I saw somebody who had well over 3,000 grafts placed…I mean, extracted at one time from the donor site and she had a great result upfront. They did, you know, the edges on the side and the frontal hairline and she’s happy upfront, but the sides and back of her head look extremely thin and it almost gives it a look of somebody who’s sick or went through chemotherapy.

And it’s a very tough situation. And what we’re planning on doing is she has some areas of the donor site that I can still extract from what we’re looking to do, probably two to three small cases of 500 grafts where we’re going to go back into the donor site and repopulate and, you know, try and build that donor site up again. And the other thing we’re gonna be doing is scalp micro-pigmentation to kind of colorize the scalp to make it less obvious and less opaque. And that combination should help the situation. Recently had a patient as well who had over 4,000 grafts extracted at one time that also had the same situation, just extremely thin donor sites. He actually, because he’s got thinner hair, he’s Caucasian, really looked almost unhealthy, the way the hair looked. And the unfortunate thing is if he would have done 2,000 and then 2,000 or possibly taken some beard hair to save the donor site, this would not be an issue at all and he would have had the same results.

So I think with my patients, on the internet, there are tons of videos and pictures of people getting these massive procedures and I’ve even had patients say, “Well, if you can’t do 4,000 grafts at one time, then I’m gonna go somewhere else.” And I said, “That’s fine.” Professionally, it’s backed up by science and experience that this needs to be broken up at least in two separate procedures separated by six months and you’ll be happy, but now it’s a tough situation.

Clark: It really is. All of these situations are so upsetting, but I know you’re able to make it work though and turn a wrong into a right.

Dr. Danyo: And the last a bit would be, you know, I’m seeing more and more patients that have full hair loss that actually want full coverage. And, again, I’ll use another example. Had a patient that had two previous strip procedures with two separate scars but has pretty severe alopecia around each scar. I mean, it’s like an inch, maybe a half-inch above and below, both scars from ear to ear where the donor site actually from the stress of the procedure, developed scarring alopecia. So his donor site is just not an area that I can pull more grafts from. And so we are going to be doing 3,000 grafts. We’re taking 1,500 from his beard and then we’re gonna take 1,500 from his chest on two separate days, but to total 3000 grafts and I’m just gonna spread that throughout and that should complement the previous grafting. Now he’s got a very large head and just a large area and a really give him the results that he’s looking for.

Clark: I always love how people feel after they… For the first time would see you, but if you’re able to help someone who’s had a bad experience elsewhere, that’s special. And all of these examples, they all make sense why somebody wouldn’t come get that hair transplant repair. Is there anything else, any other reasons why you’ve seen?

Dr. Danyo: Well, when I do these repairs, I’m never accusatory on who did the procedure. I wasn’t part of the procedure.

Clark: That’s a good point.

Dr. Danyo: And, you know, I just… And sometimes I have to calm patients down because there’s a lot of anger. You know, I think it’s kind of ethical and more professional to say, “Listen, we’re gonna build on what’s been done and we’re just gonna make it better.” I think that goes a long way with just settling people down and just getting them, you know, back in the mode and getting them excited again.

Clark: That’s great. You’re an optimistic, friendly guy. That said, that it’s important because this kind of work, I mean, there’s a lot of emotions in this and it’s important to have that kind of attitude.

Dr. Danyo: Absolutely.

Clark: Well, I think this answers all the questions I’ve had and, you know, we often will talk about the feeling people get afterwards after, you know, there’s… You know, someone might come back and visit you six months, usually, is that right? Is that typically the time it takes to do your first big checkup or your only big checkup?

Dr. Danyo: Well, I do two big checkups, one at 6 months, and then one at 12 months. And for the out-of-town people, we oftentimes will do either a video call or we’ll have them kind of send some pictures in for our charts. There’s no reason to kind of fly back in and get checked. But for the local people, obviously, we love having people come back, but six months. Generally, there’s about 50% to 75% growth and then at 12 months, there’s usually about 90% growth. And, you know, at those follow-ups, it’s important because we can form a timeline and if there are things that need to be added, sometimes people do their frontal hairline. They may not think about doing the crown, but they come back and say, “You know what? I wanna do my crown now.”

Or sometimes we just have to add a little bit more, and a lot of that depends on how coarse the hair is, the colorization. If you have kind of thin, dark hair, sometimes it takes more grafts compared to somebody who has course, blonder, even salt and pepper hair. You know, oftentimes it doesn’t take as many grafts to get the desired effect. But the follow-up is just so vital for me to, you know, do the consult, the procedure, and then do the follow-up to really get the best results.

Clark: Well, Dr. Danyo, as always, I really appreciate the time. It really helps hearing directly from you. Because I know we’ve talked about this before, but you are the person going from start to finish through all of these steps. And I know some people are on the kind of, you know, they’re on the fence of, “Hey, do I wanna do this? Do I wanna spend the time and the money to do this?” This provides them some great opportunities to hear directly from you on all of this. So this is the first time we’ve talked about this particular topic on the show, but I appreciate you taking the time for it and I’m looking forward to our next session together.

Dr. Danyo: Likewise. Thanks, Clark.

Clark: Thanks for listening to “Hair Restoration” with Dr. Daniel A. Danyo. Book your free consultation today with Dr. Danyo by simply calling 678-845-7521 or visit them online at nahairrestoration.com. And be sure to subscribe, rate, and review the podcast wherever you listen to your favorite podcasts.