Expert Doctor

Hair Transplant Revision

James Vogel, MD

Owings Mills, MD

Hair Transplant Revision

While hair restoration procedures are common surgeries, not every procedure lives up to the wishes of the patient.  In cases where a hair transplant is less than successful, either in its look or the overall satisfaction of the patient, a hair transplant revision is a surgical procedure that can help a person attain more favorable results.



There are various reasons a person gets a hair transplant revision. The main common denominator is that they have had a hair transplant that resulted in unsatisfactory results. The patient did not get what they asked for or what they expected. Another possible reason is the procedure was done before any state of the art techniques were available to create a natural looking hair transplant. The patients’ results looks like they have a strange hairline or strange hair transplant.

The need for hair transplant revision is mostly due to older techniques not currently being used today. One of the problems associated with a bad looking hair transplant is that when the transplant was done 10-15 years ago, almost all of the patients had more hair at the time of the procedure than they have currently. One of the primary factors involved with hair transplant revision surgery is the ongoing nature of progressive hair loss. The progressive hair loss unmasks a lot of the problems that were previously hidden at the time of the initial procedure. Their hairline and their own hair masked the pluggy appearance or the unnatural way the hair transplant was performed. Now that they have had progressive hair loss, the problems are apparent.

It is also important to remember there are still some people performing hair transplants in an inferior manner.  This means there are still people needing a hair transplant revision as a result of a transplant done in current time. It’s not all due to past procedures.



When a hair transplant surgery is performed, new hair is not created. It is just a rearrangement of what is already there. How it works depends on exactly what the problem is. Some people are not happy with their hair transplant results because they have a pluggy unnatural hairline that looks like a Barbie doll. Another big problem is the hairline was placed too low because the hair transplant surgeon placed the hairline at a level that existed when the patient was 12 or 13 years old. The patient now has progressive hair loss on the sides. If the hairline in front is placed too low then it looks very unnatural. A mature male’s hairline is much higher than a 12 year old’s hairline.

If someone has a pluggy appearance, an appearance of too many grafts in one spot, one of the main ways to address that is by removing 85% of the plug. This procedure, known as plug reduction, leaves behind a small amount of very natural looking and delicate groupings of hair. The hair that is removed is recycled, put on the reduced plug, and redistributed into an area that needs the hair.

When a male patient’s hairline is too low and does not have the normal male hairline recession, that entire row of hair is surgically removed in order to elevate the hairline. Stitches are placed and the removed hair is moved into an area that changes its position and appearance. The majority of hair transplant revision is about rearranging the transplant.  Sometimes it is necessary to harvest new hair from the donor area if the person has enough donor hair to use.  Sometimes the patient is severely depleted in the donor area.  In that case, there is no choice but to move the existing transplants.  There are limits to the work that can be done. Sometimes beard hair can be used as well as hair from other areas of the body.



The most difficult hair restoration revision is when a person has a hairline that is too low because that requires major reconstruction and rearranging. An older technique for performing hair restoration was to take a flap, which is an entire segment of the scalp, and twist it on its axis from above the ear to the hairline. The problem was those hairlines were almost always too low and the hair direction went backwards instead of forwards. Also, people will lose their hair back behind the flap for the crown. These are some of the most difficult cases, but the most difficult is when the hairline is too low.



Both the surgeon and the patient have to be on the same page and have good communication. Some patients feel taken advantage of by doctors who do not have experience and put the hairline too low, or do not do a good job with the hairline design. Also, the patient has to have realistic expectations.  Sometimes patients expect one thing but in reality they cannot get it. The patient has to understand that new hair is not being created. All that is happening is rearranging what they currently have. They have to understand what can and can’t be done. Realistic expectations are the key.



While a hair transplant revision cannot make it look like nothing ever happened in cases with badly done work, it can make the final product look a lot better. A hair transplant revision cannot prevent hair loss. One of the main problems is the ongoing nature of hair loss. That is why doctors use medication, like Propecia, to prevent progressive hair loss.



The cost for a hair transplant revision depends on the number of procedures necessary to complete the surgical plan. The overall reconstruction plan usually involves 2-4 stages to complete.  A patient has normally had a couple procedures before the hair transplant revision; so one operation may not change everything. The cost ranges anywhere from $5,000-$12,000.  It’s about the same cost as getting a hair transplant.



There should be no reason for a hair transplant revision if the patient goes to a qualified hair transplant surgeon.  The surgeon should devise a plan in the patient’s best interest and not in the doctor’s best financial, or ego, interest. The patient has to do his or her homework and go to a doctor who’s going to create a surgical plan that is in the patient’s best interest in short and long terms.



A hair transplant revision is intended for patients who are unhappy with previous results. Although hair transplants don’t prevent hair loss, the revision will help cover bald spots. When choosing a doctor, speak with them about preventing another revision in the future. With the proper research of the patient, and dealing with an expert in the field, another revision shouldn’t be needed. 


Written by Cosmetic Town Editorial Team - MA

Based on an exclusive interview with Dr. James Vogel in Owings Mills, MD