Island of Plugs

I had hair transplants 20 years ago. When I had them, my hair loss was just starting. Now I have an airport runway on my head and there are these plugs in the middle of my runway (rear of my bald area) like an island in the sea or an oasis in the desert. Can I take these out or do I have to get more transplants?

Your problem is a common problem which we see wherever crowds gather such as airports and sporting events. This surgery was done in the early days of hair transplantation and as the balding progresses, the plugs are ‘abandoned’ by the surrounding hair. My suggestions would be:

• You can have them removed if there are not too many, as it should look better than to leave them, but there may be scars remaining after the removal
• You can have a modern hair transplant procedure performed and bury them in a full-appearing head of hair, assuming the hair supply is adequate. In this way you can finish what you started years ago. The good news here is that the modern hair transplant will not produce these types of results and if it has been 20 years since the last time you did it, I suspect that the hair loss is largely finished and you will therefore not become another moving target, chasing more change over time.

Your question addresses two important problems:

1. The balding process is progressive in young men unless drugs like Propecia are used to slow or stop the progression. Anything you do that alters the course of your appearance will be modified by the progressive nature of the hair loss. When you had it done 20 years ago, there was probably only some crown thinning so that the transplants made you look fuller. As you continued to bald however, the older plug technique showed itself in all of its awfulness.
2. These problems can and should be fixed. The good news is that repairs work in most situations to return a person to a normal appearance.

Here is a photo illustrating an “island of plugs” in the crown of a patient before we did his repair: