Second hair transplant: why, when and how?

October, 16 2019 | By Dr. Sangay Bhutia (Hair Transplant Specialist in Delhi)

The fact that hair transplants are the best and only permanent solution to hair loss is widely known and acknowledged. And usually one procedure is enough for patients to get satisfactory results. However, sometimes people might not get the hairline they wanted, or the density is not as per their expectations. Often, patients also think that the surgeon could have harvested more from the donor areas and covered their bald spots with more grafts, making it look fuller. Some patients also find themselves dissatisfied with the crown coverage or the definition of the hairline.

During the first transplant, it can be difficult for surgeons to achieve complete natural density. Surgeons have a safe number of grafts that they can extract and place in a single procedure. Grafts need a blood zone around them to heal and grow; over-harvesting and placing too many grafts in one area can put the surrounding hair in danger of falling as well. Therefore, a second transplant might be necessary for achieving a more natural and fuller look.

Apart from not achieving satisfactory results, there are also cases of botched transplants or scarring, wherein patients may require a corrective procedure.



In cases, when patients are not happy with their first procedure and think that the results are not as good as they had imagined it, they should consult their surgeon, and ask them if there is scope for another procedure. Patients should, however, remember that full growth from a hair transplant takes about a year, so they should wait that long and then decide whether they are unsatisfied with the results. The transplanted hair also changes in terms of its texture and diameter, and the full results are only realised after a year at least.

There are also patients who are progressively losing hair after the transplant, since hair loss is genetic. Now, surgeons account for future hair loss, when they are planning the first procedure itself, but sometimes hair loss is excessive and patients develop new bald patches or experience more thinning. Follicles which are susceptible to falling, will continue to miniaturise (a process by which a hormone called DHT causes the hair growth phase to become progressively shorter) and fall off eventually. This leads to the results of the first transplant looking bad as new bald patches emerge making the scalp look spotty or pluggy.

The progression of baldness is measured on something called the Norwood scale, which is classified into eight stages. On the scale, baldness begins with some loss of hair on the temple and the crown, which can happen to men as early as in their teens and twenties. It progresses over time and eventually the two bald areas, the crown and the temple meet.

These patients will need a second hair transplant, sometimes years after the first one, but to be eligible they need to have donor hair, which is the loss-resistant hair on the back and sides of the head.

Another important factor that surgeons consider before a second procedure is skin laxity or elasticity, or the ability of the skin to stretch. Those with less-than-usual laxity are not good candidates for FUT or Follicular Unit Transplantation. A second procedure for such patients might result in excessive scarring. Surgeons measure skin laxity to determine how much skin they can strip off the scalp for a transplant. This is especially important in second procedures because the skin becomes tighter after the first time.

A second hair transplant is also a good option for those who need a corrective procedure. This is for patients who have had a botched transplant or excessive scarring. There are cases where inexperienced surgeons have executed the procedure poorly, or patients have got outdated procedures, which look ‘pluggy’ and do nothing for the person’s appearance. These can all be corrected with a second procedure.

Both FUE and FUT techniques are used for corrective procedures. FUE or Follicular Unit Extraction involves taking healthy hair follicles from a donor area of the scalp, and implanting it onto bald spots. While FUT involves taking a strip of scalp from the donor area, dissecting it into individual grafts, and implanting them.

For corrective procedures, surgeons will either use the camouflage technique, where smaller grafts are placed next to large ones to improve the overall appearance, or the plug removal technique which involves removing the problematic grafts, dissecting them and replacing them on the scalp. In some cases, both the techniques are combined together to correct a botched procedure. While performing a corrective procedure, the surgeon also ensures that the grafts are placed in the direction of hair growth, and their placement is done skillfully.

For fixing scars from a botched procedure, surgeons can use FUE to cover a donor scar caused by the strip method. They use grafts from around the scar and place them on the scar itself to camouflage it.

Second procedures are nothing to be scared of. Of course, the onus of finding a good, experienced surgeon who can deliver satisfactory results from the first procedure itself lies on the patient. But there are patients, who find surgeons in a hurry and under panic, and end up with results which are far from their expectations. For such patents second procedures are a good option, and can be done in most cases. However, the second time around, find someone with considerable experience on conducting hair transplants. You have to be more careful the second time around.