Hair Plugs: A Beginner’s Guide

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At some point in his life, almost every man will experience some degree of hair loss and the embarrassment, anxiety, and depression that goes along with it. American men spend over $1 billion to combat hair loss through medications, natural remedies, lasers, and surgery. But with so many different options (most with less than stellar results), it can be hard to know where to begin.

Often times, when we start down the road to hair restoration, we can get confused or misinformed about what we are actually talking about. Terms and definitions are switched around and something that means one thing ends up meaning something completely different. This is especially true when researching hair restoration surgery. Common vernacular has not caught up with the technological advances, and catch-all words are often used incorrectly.

Let’s set the record straight so we can begin to understand what treatments are old and outdated and which are now the cutting edge of hair loss treatments.

What Are Hair Plugs?

The term hair plugs are often used to refer to hair transplants generally. When you google the term “hair plug”, most of the results include “hair transplant” or “hair transplantation” as keywords. While the terms are often used interchangeably, they are, in fact, two different things. “Hair transplants” is a more overarching or umbrella term for a variety of different methods used to restore hair to the balding areas of the scalp. “Hair plugs” is one of those methods, though it is not routinely used today.

Hair Plugs a Type of Hair Transplant That is Not Often Used Today

Modern hair transplantation began in Japan in the 1930s and rose in popularity in the United States during the 1950s. Hair plugs were one of the first methods used to treat male pattern baldness at that time through a method known as a punch graft. As with everything else in life, technology has improved hair transplantation over the last half-century. Hair plug transplantations fell out of favor in the 1980s and 90s, giving rise to new treatment options such as follicular unit extraction (FUE) and follicular unit transplant (FUT).

How Do Hair Plugs Work?

Now that you know what hair plugs are, how do they actually work?

Punch Graft Technique Used to be Popular

As the name implies, the punch graft technique required a 4mm punch to remove a small cylinder of donor skin from the back of the head. Each donated cylinder contained 15 to 30 hairs and would be placed in the balding area after extraction.

Punch grafts have several problems. First, the harvested area is rather large compared to newer methods (4mm vs. 1mm). The larger extraction area combined with a more invasive procedure creates a polka-dotted look which takes longer to heal. Second, due to the shape and implantation process, punch grafting creates a noticeable patchy look (think about a carrot patch) which does not flow well with the natural hairline.

Mini/micro Was Another Hair Plug Technique

Mini/micro hair grafting can be considered the transitional step between the punch graft technique and the newer methods used today. Both types required removing a strip of hair-bearing skin and then reattaching the donor skin to the balding area. The only real difference between the two procedures is the number of hairs on each strip. Mini grafting contains three to eight hairs where a micrograft may only contain one to two hairs.

Mini/micro grafting has the potential for several different side effects. If the procedure is not performed correctly, excess trauma to the skin can lead to infection and even tissue necrosis. If the tissue from the graft isn’t absorbed into the scalp properly, the skin can look uneven or lumpy. Scarring is still a major consideration with mini-micro grafting which could also result in an unnatural look.

Comparing Hair Plugs vs. Hair Transplants That Are Performed Today

As mentioned earlier, the major change between hair plugs versus other hair transplant options has to do with advancements in technology. New surgical tools, better magnification, and an expanded knowledge of hair loss created new opportunities for hair restoration. The basic concept is still the same; it is just done on a smaller scale.

Hair Plugs Before and After Images Show Unnatural Look

The before and pictures of hair plugs slowly the limits of the technology at the time. While there is no doubt hair plugs cover the balding areas of the scalp, the look, and flow of the hair is unnatural. The major problem with hair plugs was having a large quantity of hair in each punch without the ability to extract and separate the individual hair follicles. Placing the large 4mm punches side by side, even with minimal spacing, creates a look similar to closely planted flowers or crops.

Strip Harvesting is a More Modern Technique

Strip harvesting has led to a more natural look for hair transplantation. Techniques such as follicular unit transplant and follicular unit extraction allow surgeons to remove individual hair follicles and place them where they are most needed. Using smaller incisions and smaller hair groups (one to five hairs) often takes longer but creates a better look with less scarring.

One of the major technological advances to advance hair restoration was the use of stereoscopic dissecting microscopes. These microscopes allowed surgeons to better identify and harvest individual hair follicles and replace them in a more natural looking way. Before, surgeons used a jeweler’s loupe and were limited by the magnification.

Follicular Unit Transplant (FUT)

Much like mini and micro hair grafting, follicular unit transplant (FUT) involves removing a small strip of tissue from the back of the head. The hair follicles are extracted and transplanted back to the balding areas of the scalp.

Compared to punch grafting, FUT is less invasive, less painful, and results in smaller incisions and scars. FUT also has a more natural look because much of the excess tissue has been removed and allows for hairs to be placed more evenly and closer together.
While FUT is a much better process than early therapies, it is not without disadvantages. Strip harvesting limits the use of some short hairstyles because even some of the smallest scarring can still be visible. In some cases, the patient can have nerve damage which results in numbness in the donor area for several months.

Follicular Unit Extraction (FUE)

Follicular unit extraction is very similar to FUT. The major difference is FUE does not remove a strip of tissue from the scalp, but rather extracts the hair follicles directly from the donor site. FUE could be compared more to punch grafting only which a much smaller diameter punch.

The increase in popularity in FUE is primarily due to the reduction in scarring compared to FUT. It is important to remember FUE is a minimal scarring procedure, not a scar-free one. While this could allow for shorter hairstyles compared with FUT, it is still trial and error to determine how short the hair can be cut.

Another difference between FUE and FUT is the number of grafts a patient can receive. With FUT, a patient has a diminished return after each session due to a lack of available strips for harvest. In FUE, the patient is only limited by their hair density at the time of the first appointment. The denser the hair, the more follicles can be harvested from various locations.

The only real limit is the threshold where the donor area begins to look thinned and visually unappealing.

FUE is the least invasive of the options mentioned but is often more time consuming and costly. Because the hairs are individually extracted the overall hair yield from FUE has been shown to be less than FUT due to the time it takes to harvest the hair. Regardless, FUE is growing in popularity and demand and is on pace to replace FUT as the preferred hair loss treatment.

How to Find a Safe and Effective Alternative to Hair Plugs

Now that we’ve basically ruled out hair plugs as a realistic hair loss treatment option, we are left with FUE or FUT as a surgical option or looking for other less invasive options. Here are some tips for whichever path you choose:

Do Research to Find an Experienced Hair Restoration Surgeon for FUE or FUT

Research is the key to any good decision-making process and finding the right surgeon is critical to getting great results for FUE or FUT. Before you get started combing the internet looking for hair restoration clinics here are a few things to consider.

  • Is the surgeon a member of the International Alliance of Hair Restoration Surgeons? The IAHRS is a select group of surgeons reviewed and selected based on both their surgical competence and their ethics in advertising and marketing. This is a great resource to narrow down a list of names.
  • Hair transplantation is a team sport. Not only should you have an excellent surgeon but also a competent team of technicians and assistants. Ask the team how long they have been working together. A high turnover rate can be a sign the team hasn’t practiced together for long.
  • Ask for photos and references. Before and after photos can show results but sometimes don’t tell the whole story. If you can speak with previous clients, you can get a better understanding of the entire experience.
  • Check with the state medical board and the Better Business Bureau. Does the clinic, surgeon, or the technicians have any complaints or other legal action associated with their practice? This can be a red flag signaling a bad experience is ahead.

Try Minoxidil and Other Products to Halt Hair Loss

If your hair loss isn’t extensive enough to warrant a hair transplant, there are other methods to explore. Several prescription and over-the-counter treatments exist to treat hair loss.

Here are a few options:

Minoxidil

More commonly known as Rogaine, minoxidil is a topical treatment for hair loss. The cream is applied twice each day and shows results in 3 to 6 months. Treatments must continue indefinitely to keep any regrown hair or prevent future loss.

Dutasteride and Finasteride

These prescription medications are often given to treat prostate problems but have the beneficial side effect of growing hair. Finasteride is FDA approved to treat hair loss under the brand name Propecia. Dutasteride is not FDA-approved but can be used off-label by prescribers.

Spironolactone

Another prescription-only drug, spironolactone is commonly used for hypertension and other heart-related issues. The medication works against the concentrated form of testosterone known as dihydrotestosterone. DHT is known to inhibit hair growth on the scalp.

Vitamins, Herbs and Other Supplements

Several natural substances have shown benefit in hair restoration. Ginseng and gingko biloba increases blood flow to hair follicles. Saw palmetto works similarly to finasteride and dutasteride. Vitamins B7 and D3 promote healthy skin, hair, and nails.

Make Lifestyle Changes to Halt Hair Loss

No matter the stage of hair loss, developing good hair habits and creating a healthy body can slow down the progression of hair loss or even promote new hair growth. Changing up your diet and adding foods rich with growth-promoting vitamins and minerals can give your scalp the nutrients it needs.

Healthy hair habits:

  • Avoid harsh chemicals or dyes
  • Wash hair only 2 to 3 times per week
  • Use products designed for dry, damaged, or thinning hair
  • Towel dry hair instead of blow drying.

Healthy hair foods:

  • Eggs
  • Milk
  • Salmon
  • Spinach
  • Broccoli

Final Thoughts on Hair Plugs

While it still may take a while for the world to catch up with the new terms, we can see that “hair plugs” are no longer a realistic option for hair restoration surgery. The methods have improved thanks to enhanced techniques, microscopy, and knowledge.

Even still, FUT or FUE may not be right for you at this time. Consider the whole picture including lifestyle changes and prescription or over-the-counter therapies. If you’re ready for hair transplant options, remember to do your homework and find an experienced and qualified surgical team to give you the results you want.

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