I am 43 years old and had a procedure done 15 years ago involving mini grafts and micro grafts. Over the years it was fine and as I had a full head of hair and never really noticed the minis and micro grafts much.

Since last year I have lost some hair and the minis are now the transplants are more obvious to me. I have been very stressed, my wife left me and the hair started to fall out shortly after she left. I am not on propecia or rogaine or any other such drugs.

What can I do? With my hairline now looking pluggy and less and less hair to cover it, will a transplant help me? I am reluctant to have a transplant again as I am frightened that my pluggy look will be worse. Can I just remove these plugs and take on the bald look that I would have had normally?

Here’s my questions…

1. Most of my grafts are middle size (about 1-2 mm in size). If I go with the FUE approach to thinning these grafts, how small are the holes created by FUE ?
2. Are different sized instruments used ?
3. What is the exact process ?
4. How are these holes closed (sutures? ) and how long is the healing ?
5. Do these holes upon closing leave a white spot like the pictures I have seen ?
6. Some of my grafts are small 1-2 hairs but stand out (i think its the skin around is a little pushed in) ,doing this procedure will take care of the skin depression/irregularity ?
7. What is the success of such procedures & What can I expect in terms of the look after this process ?
8. I would like these grafts to be replanted on the top or in the scar area.
9. Can you please tell me about this process and advise if what I am looking for is achievable ?

It is not unusual for people to see the older plugs when they lose hair. This is because many doctors would put plugs (in the old days) into places where hair existed as a prevention for hair loss or to cover a person’s eventual hair loss migration. This was and is today a terrible and immoral practice. I feel you have a series of options:

• You can put back the hair that has hidden the plugs and go back in time, so to speak.
• You can remove the plugs altogether. This will not bring you to look like the balding man you would have become, because the plugs tend to leave scarring and even removing them does not change the scarring.
• You can remove the frontal plugs, thin out the plugs behind and redistribute the hair, and then transplant the entire frontal area.
• You can lower the hairline very slightly and in doing this, you can add a deep transition zone which will bury the larger grafts that you have.

Now to answer your numbered questions…

1. The diameter of the punch is 0.9mm.
2. None smaller at this time
3. Usually it is best to use a two step procedure — score the skin first, and then use a dull punch second to core out the targeted FUs.
4. These are not sutures; too small. They are left open and close on their own.
5. This is a risk. The small white patches are far less obvious than the plugs. The lesser of two evils.
6. Yes, in most of them, provided that they are not the larger grafts that had hair killed off during the transplant. There is a condition called donuting where much of the central hair dies in the older type of grafts. The skin changes with this older technique frequently are larger than just where the hair are.
7. For each group of hairs that are successfully removed, the success is good. Please note that I used the term successfully removed. Sometimes the scars that surround the plugs make it impossible to get them either out at all, or completely out. Every person is different, as is each scar.
8. Always do this.
9. It can be achieved, but without examining you and testing you with a FOX biopsy or trying it, one can not be 100% sure.

For an example of the procedure, please see Dean’s Story.