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Hair Loss: Procedures to Avoid

Linear or Line Grafts

A three- to four-mm linear strip of donor hair is removed from the side or back of the head and instead of dividing the strip into follicular unit grafts, the entire strip or large parts of it are transplanted.

Since this large graft can't be placed in tiny recipient sites, a trench must be surgically cut into the bald area and the large graft is placed into the trench. As hair grows, it looks like a manmade line of hair that is not cosmetically acceptable.

Round or Square Grafts

These are the original, standard, out-of-date pluggy-looking grafts. Each three- to five-mm graft is made with a hole punch device, resulting in a plug of hair about the size of a pencil eraser. Whether round or square, these large grafts are too large and do not resemble the way hair grows naturally from the head.

When transplanted, because the grafts are so large and therefore compromise the blood supply, hair in the middle of the graft often does not grow, leaving the patient with a doughnut effect. These large grafts are responsible for what looks like doll hair -- a pluggy look of islands of hair in an ocean, as they are now described. Cobble-stoning, a common scalp deformity in hair restoration patients, is caused by this procedure.

Even the more recently developed smaller version of the grafts -- the mini grafts and micro grafts -- can give a less-than-natural appearance, which is why transplants should be made up of naturally occurring grafts called follicular units comprised of one to four hairs.

Scalp Reduction

Also known as alopecia reduction (AR), galeoplasty (GP), or male pattern reduction (MPR), scalp reductions can result in an unattractive appearance. Performed in the doctor's office under local anesthesia, the bald part of the scalp at the top or crown of the head is cut away, and the edges of the nearby hair bearing skin are sewn together, bringing the hair-bearing scalp from either side to meet in the middle. In some cases a scar results, commonly know as a "dog ear" scar.

Scalp reduction problems also include:


  • Accelerated hair loss, more than the natural course your hair would take. This hair loss can occur within just weeks or months and often doesn't return.
  • An unnatural appearance because the direction of hair growth is altered.
  • Infection
  • Hemorrhaging and hematoma (blood pooling)
  • Stretch back, a problem in almost 100% of scalp reduction cases. The stretched part of the hair-bearing scalp that has been stitched together loses its tightness and stretches out partially or totally, leaving a visible bald area created by the stretching. The dog ear scar is not only unattractive; it is extremely difficult to repair.
  • Suture reaction, in which the stitches in the deep layers below the skin can cause pain and swelling. The body can reject the sutures, causing holes in the scalp at the suture sites.
  • Loss of hair for future transplants. Scalp reductions do not preserve hair for later use, as some physicians may try to claim. The same wreath of permanent hair is stretched to cover the wider area in the crown, thereby thinning the permanent hair that would normally be used as donor hair for transplantation.

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