Nearly 20 years ago, when in my mid-twenties, I underwent a series of two transplant sessions and a scalp reduction process. Needless to say, the transplant method of that time was the plug variety, and the donor area has suffered, and the over yield is apparently reduced.

Last year, after 20 or so years of additional hair loss, I needed to go at it again, knowing full well that I was not a very good candidate because of being "plugged" years earlier.

My doctor was able to harvest 700 and 500 grafts in two different sessions. Now the concern is the elasticity of my donor area, the scarring in the area, and of course... the fact that plugs of donor hair have been removed.

I feel like I need another 1000-1200 grafts to get to a place that I could really live with for the rest of my days.

My question is twofold:

Is the such a thing as "spot-harvesting". In other words, taking very small sections of donor hair. Secondly, is there any means of increasing elasticity of the scalp?

Any suggestions much appreciated. The methods for transplant have some light years in two decades. I wish I would have waited for my first session until more recently, but I still want to take an aggressive approach to making my hair as natural and full as possible.

Thanks,
MB

I am in the same situation as you, as I had some plug grafts many years ago. I have recently had a total of 2200 grafts, 1600 last year and 600 just 10 days ago. The difference from the first 1600 was dramatic, but of course the results from the last one won't be seen for a while yet. In general I think it's better to remove the old scars (bare areas) with the strip, because this reduces the overall scarred area. I think removing just the good donor area between the old plug scars, if that's what you are suggesting, would be undesirable because it could leave a visible bare area. I have heard of people increasing their scalp elasticity using massage, but I haven't tried it myself.

Dear MB,
It is possible to harvest future donor hair and not cause further wide scars - because you are right in saying that the elasticity of the remaining donor area does decrease with increasing number of donor harvests, especially if they are done all over the place. There is one marvelous, magical quality of the scalp that can allow this to happen - and that is the ability of the scalp to regain the great majority of the previously existing elasticity and laxity - but you have to be very patient and not try and pressure your doctor into taking too wide of an area and doing it all at once. In most men who are in your situation, you can take a 6-8mm wide strip (give or take a mm or two) - and obviously depending on the characteristics of your individual scalp after exam by the doctor - you CAN get a very thin scar, and then the doctor can go back 8-10 months later and remove the same width again. Sometimes, as you correctly suggested, the best way to do this is to take these strips as short segments from two or three areas and avoid other areas (such as the rear corners, which notoriously are where wide scars most commonly occur). Again, rather than try to get the 1500, 2000, or whatever number of grafts you think you need to have transplanted for you to be "set for life" (there is no such reality in male pattern baldness, by the way), think of accomplishing it in small, safe steps rather than with one grand flourish, which is almost a guarantee for a wide scar and a worse situation than you have now. Also, the suggestion made by Gary is a very valuable one, namely that the good hair not be sought out to the exclusion of removing scar tissue, as this only accentuates the percentage of your donor scalp that is covered with scar tissue.Balancing the harvest to remove old scar tissue along with hairs to transplant is the best way to end up with an improved donor area. Good luck.
Mike Beehner, M.D.

Great input and thanks. It falls right into line of what I was anticipating. And absolutely agree with the notion of removing old plug-harvested areas. While the yield is going to be relatively low, it raises the ratio of scalp coverage to scarred area.

My most recent session saw harvesting from two donor areas of approx 3 inches each, and extending to the area just above the ear... not my favorite experience.

I wouldn't think of going for a robust session to get as much done sooner, to the contrary... after my experience of years ago, I want to be cautious... perhaps even going in a few times over the next couple of years for very small (200-300 grafts) and strategically build up density where needed.

The elasticity is the primary concern my Dr raised, and was concerned enough that he even mentioned that we may not want to do futher sessions... so I'm a little dismayed at that prognosis, but perhaps I can hire a scalp-masseuse and write it off as a medical expense!

Sincere thanks for input, hoping for more perspectives in the coming days, and will keep all posted as I go for a follow-up exam within 60 days or so.

Best,
MB