Reparative Hair Procedure in Miami

Expertise in Hair Reparative Procedures

Poor outcomes from hair transplants, despite developments in techniques, are still seen today.  Fortunately, these results can be significantly improved using a variety of approaches.  Sometimes this can mean further grafting, but in other cases grafts may need to be removed and replanted or partly reduced in size, or the hairline needs to be excised in its entirety, or hairs from the beard need to be used, or scars need to be repaired.  With over 20% of his 15,000 prior hair procedures reparative, and having written and lectured on his techniques extensively, Dr. Epstein is experienced in the full scope of reparative techniques, and thus is able to help his patients achieve much more natural appearances. 

Most common reasons to undergo a reparative hair procedure

• Unnaturally placed grafts, particularly along the hairline, consisting of two, sometimes three or more hairs
• Insufficient density
• Improper direction of hair growth, too perpendicular rather than angled forward
• Scarring of the donor site from a prior strip/FUT procedure, or from FUE where the area was overharvested using large punches
• Scarring of the skin (such as cobblestoning) or pitting due to poor graft placement
• Unaesthetic hairline design, most commonly too flat or too low
• And others…

All of these conditions can be addressed by Dr. Epstein.  He has experience with a variety of techniques that include:

• Additional hair grafting, with the use if available of scalp hairs, and if needed of beard hairs (click HERE to read about BHT- body hair transplantation)
• FUE punch removal, removing entire grafts then retransplanting the hairs from the grafts after they have been dissected down, into a better position and or more aesthetic orientation
• FUE plug punch reduction, reducing in size large grafts, with the removed portions replanted
• Frontal hairline excision, involving the excision of the entire hairline or a portion of the hairline.  As much as one inch wide of scarred skin and poorly placed grafts can be removed in this procedure,  leaving a fine-line scar that can be transplanted into if a softer look is indicated.  Balloon tissue expansion, whereby portions of hair-bearing scalp are gradually inflated (much like a pregnant belly) over several weeks, permitting the removal of large areas of scarred or unaesthetically transplanted scalp, , is sometimes indicated if the scalp is tight or the area to be excised is large.  This is a particular technique Dr. Epstein utilizes for large scars from burns and other trauma.
• Endoscopic ridge reduction, removing scar tissue to reduce the ridging or fullness caused by prior grafts.  Access to the scar tissue is provided through one or two small incisions to minimize scarring.
• Sometimes patients prefer to “just be bald”, having all prior placed grafts removed and the scalp allowed to heal and become as smooth as possible.  The hairs from the removed grafts can be either discarded or replanted into old donor site scars.

Hairline excision for repair of prior transplanted hairline
This patient had several prior FUE hair transplants performed elsewhere with scarring and unnatural appearances.
He desires to have the removal of this entire prior transplanted hairline with removal of the scarred skin. This will be achieved by lowering his original existing hairline, permitting the removal of the prior hair grafts which will then be transplanted into his FUE donor site scars in the back and sides of his head.

Options For Your Evaluation

CONSULT IN PERSON  –  You can meet with Dr. Epstein in the Miami office if you live in or will be visiting south Florida.  Here you can not only have a chance to discuss your goals and undergo a full evaluation, but also see the modern facility that is designed with patient comfort and safety in mind.  Our office is located in South Miami close to Coconut Grove, Coral Gables, downtown Miami and Miami Beach, and is just 20 minutes from Miami International Airport.  The office is on the campus of South Miami Hospital (affiliated with Baptist Health), and provides covered underground parking and sufficient privacy.  Please be sure to bring your parking ticket for validation.  You can schedule a consultation or learn more by clicking HERE.  The $200 consultation fee gets applied to your procedure or any other purchase.

CONSULT BY WEBCAM – Dr. Epstein is no stranger to webcams, having provided many hundreds of patients consultations over the past five years.  Today, this has become the most popular method for patients to “meet” Dr. Epstein, especially considering that most patients are traveling from out of town.  Your consult can be performed just like a regular in-office consultation, with the doctor discussing with you your goals and explaining his recommendations in a formal manner from the comfort of your home, your office, or even your car.  The most common formats for the webcam are FaceTime or Zoom, but other modalities are available.  You can schedule a consultation or learn more by clicking HERE.  The $200 consultation fee gets applied to your procedure or any other purchase.

EVALUATION BY PHOTO REVIEW – This is an easy way to have your case evaluated, without any charge.  By sending your photos, along with information on your age, hair loss history, any prior therapies or procedures, family history of hair loss, and your goals, Dr. Epstein can provide his recommendations and advice.  If desired, once you receive his recommendations, you can have a webcam or in-office consultation to learn more, however by photo review you will have the opportunity to ask questions and speak with his assistant Roxy or Dannette who will be able to guide you through this process and schedule your procedure.

FUE graft removal and FUE plug reduction

Reducing or removing altogether undesirable grafts

These procedures use FUE hair transplant techniques (similar to what is used to harvest grafts in hair transplants) to reduce in size or more commonly to remove completely prior placed unaesthetic grafts.  Sometimes these grafts were placed improperly such as too low or too flat or too perpendicular, other times they contain too many hairs to look natural especially along the hairline.

Each graft is removed one at a time, then usually replanted into another area of the scalp, sometimes in areas higher up to achieve better density, other times into old donor site scars.  Once the grafts are removed, when properly performed there is minimal to no scarring in the area, leaving a much more natural appearance.  Healing is usually completed in three days, leaving no signs that anything was done.  In some cases, as soon as three months later the hairline can be retransplanted using more aesthetic hairline design principles. 

Further grafting

Further grafting is a very common approach for improving the unnatural appearances of prior transplant work. Most commonly these grafts are harvested from the scalp using FUE techniques, but in certain cases they can come from the beard which tend to grow similar to scalp hairs.

Repair of Donor Site Scars

One challenging area if the widened or visible donor site scar.  Traditionally these are the result of a prior FUT/strip procedure, leaving a linear widened scar, however these are seen more and more often the result of poorly performed or over-aggressive FUE harvesting.  A variety of reparative techniques may be needed, one being the excision then closure of the scar using plastic surgery techniques, another being the planting of FUE grafts into the scar where they can then grow and allow for better concealment of the scar.  Regrowth rates are typically lower in scar tissue, so special steps must be needed such as the use of primarily two and three hair grafts, and the injection of Growth Factors into the scar to enhance regrowth.  Sometimes these grafts come from the beard if there is a lack of sufficient scalp donor hairs.

SMP or scalp micropigmentation can also be an effective technique to use for scar repairs, whether due to prior strip/FUT or dot scarring from prior FUE click here.  In one or two hour-long procedures, it is possible to reduce the visibility of a scar by as much as 70%.  In some cases, the SMP can complement the improvement achieved with hair grafting into the scar.  

Surgical Hairline Excision

SEE THE EXAMPLE ABOVE

This procedure is usually performed under twilight sedation and local anesthesia.  Recovery is usually a week, after which sutures are removed from the hairline the patient can return to most activities.

Endoscopic Ridge Reduction

The endoscopic ridge reduction is a procedure developed by Dr. Epstein, designed to remove the ridging (thick tissue) usually along the hairline in areas of prior placed plug grafts. Recognizing that the ridging is due to the buildup of thickened scar tissue at the level of the galea and deep subcutaneous tissue (deeper levels of the scalp), Dr. Epstein applies endoscopic plastic surgery techniques to excise most of the scarring through several small incisions.  Like the surgical hairline excision, the endoscopic ridge reduction takes less than two hours to perform usually under oral sedation and local anesthesia, and patients are usually presentable in two days.

Special Focus: Fat transfer in the treatment of scarred scalps

In some patients in whom old plug or similar large-sized grafts were performed, resultant scarring of the scalp can result in loss of the transplants and prevents future hair growth of transplants. Dr. Kuka Epstein, together with Dr. Epstein, have developed a two-stage approach to these cases, where the first stage involves the injection of the patient’s own fat into the scarred scalp along with Growth Factors –  a procedure called autologous fat transfer. Three months later, after the fat has induced new blood vessel growth and made the scalp softer, the second stage is a hair transplant that results in a higher percentage of hair regrowth.  This technique has been written up in several scientific articles.

Seek an Expert

Note that most surgeons do not perform some of these procedures, including surgical hairline excision, endoscopic ridge reduction, beard donor hairs for use in the scalp, and even FUE removal procedures, instead recommending further grafting.  While this may be appropriate in some patients, many others are best treated with a combination of techniques, and should be educated on all their options.  When performed properly, as shown in the photos above and this photo gallery, the results of these procedures can be quite effective.