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Dr Bertram – Documented Outcomes in Complex Repair & Restore.
Last Updated: 6 Nov 2025
A hair transplant is a meticulous surgical procedure that depends on careful planning, surgical skill, and proper aftercare. When one or more of these elements are lacking, the outcome may be unsatisfactory or even harmful.
Over the years we have performed many repair cases. Repairing other doctors’ work is a difficult but challenging job which demands a lot of skill and experience. Unfortunately some cases were beyond repair, and we feel sorry that we cannot help everyone.
Below are key indicators and causes of a failed hair transplant:
Definition: Less than 70% of the transplanted grafts grow permanently.
Causes:
Graft dehydration during surgery
Excessive trauma or transection of follicles
Poor storage (temperature, solutions)
Improper handling during implantation
Smoking or vascular compromise in the scalp
Inadequate post-op care or infection
Definition: Hairline appears too straight, low, or doll-like.
Causes:
Designed by non-medical staff without understanding facial harmony
Ignoring age-appropriate placement
Overuse of multi-hair grafts in frontal zone
Failure to follow natural hair flow
Definition: Obvious linear or punctate scarring in donor or recipient areas.
Causes:
Poor surgical closure in FUT
Overharvesting in FUE
Use of large punches or tools
Infection or delayed wound healing
Definition: Existing native hairs fall out post-surgery and do not regrow.
Causes:
Preexisting miniaturization not addressed
Aggressive graft placement damaging surrounding follicles
No pre-op medical stabilization with minoxidil or finasteride
Definition: Sparse or uneven coverage, with visible scalp despite transplant.
Causes:
Inadequate number of grafts used
Uneven distribution or poor angulation
Underestimation of hair loss progression
Overly conservative design
Definition: Overharvested donor zone with visible thinning or patchiness.
Causes:
Extracting too many grafts in one session
Ignoring donor density limitations
No long-term planning
Definition: Skin damage, pus, or blackened graft sites indicating tissue death.
Causes:
Unsterile environment
Inadequate post-op care or hygiene
Use of unqualified technicians
Overly tight packing of grafts
Definition: Patients undergo transplant despite not being suitable.
Causes:
Diffuse unpatterned alopecia mistaken for male pattern baldness
Active autoimmune alopecia (e.g., LPP, alopecia areata) not identified
Hair loss not yet stabilized
Here’s a classification of the eight major causes of failed hair transplants into three categories — suitable, conditionally suitable, and unsuitable — for repair via hair transplant surgery :
These conditions can typically be corrected with careful planning and skilled surgery:
Can be redesigned using finer grafts and better angulation.
Old grafts may be removed or redistributed (e.g. graft excision or laser hair removal if needed).
A second session can add more grafts to fill gaps.
Requires good remaining donor supply.
Scars from FUT or FUE can be camouflaged using grafts (especially scalp micropigmentation or FUE into scar).
Success depends on local blood supply and scar type (atrophic > hypertrophic > keloid).
These cases need careful assessment and selective patient acceptance:
A second transplant may help if the donor area is still intact and causes have been corrected (e.g., poor technique, storage, or handling in the first surgery).
If the surrounding native hair was already miniaturized and didn’t return, a transplant may replace what’s lost.
Patients must be stabilized medically first (finasteride, minoxidil, PRP, etc.).
Repair is limited.
May require scalp micropigmentation, body-to-scalp hair transplant, or a reduced aesthetic target (e.g., limited coverage).
These cases are generally poor candidates unless underlying issues are corrected or ruled out:
If tissue damage is extensive, transplant may not be possible.
Requires scar remodeling and vascular assessment before any repair.
Example 1 :
Position of the hairline was reasonable, but the density was too low. Also the hairline was too rigid and orderly to be natural.
How We Fix It：
Randomly add on density in front of and amongst the existing hairs
Example 2 :
The new apex was too rounded. The transplanted hairs did not match the existing ones in angles and directions.
How We Fix It：
Punch out the unwanted transplanted hairs and recycled, will leave scars
Example 3 :
Not enough grafts to fill in the center behind the hairline, creating the look of a Kappa
How We Fix It：
Simply add on the density
Example 4 :
There was inadequate density of grafts behind the narrow hairline.
How We Fix It：
Add more grafts in the empty area.
Example 5 :
Asymmetry in the hairline – the right side is higher than the left by 2cm.
How We Fix It：
Lower the right side by 1cm may improve.
Example 6 :
Difficult to style the hair as the grafts were inserted perpendicularly. Correct angle should be 35-45°.
How We Fix It：
No!
Example 7 :
The typical ‘Corn Rows” appearance, when minigrafts instead of follicular units were used. The insertion was too orderly.
How We Fix It：
Put some 1-hair FU in front, and add more grafts in between.
Example 8 :
Another typical example of the “Corn Rows” appearance. The pattern is more obvious on cutting short the hair.
How We Fix It：
Add grafts in between inorderly to be more natural looking.
Tell us the shape and pattern you desire, or our beauty consultant Sara is delighted to help. Sara is a certified beautician with years of experience. She will design eyebrows to best match your facial features. Or you can consult your own beautician.
You can then ask your friends and family for comment till you are fully satisfied with the new look.
Size and location of the area needing correction
Type of deformity (hairline, scar, plug)
Most importantly, availability of usable donor hair
conditions of use
Information provided on this website is for educational purposes only and is not intended as medical advice. It should not be interpreted as promotional material or as claims of superiority over other techniques or providers.
Individual results may vary, and no outcome can be guaranteed. Always consult with a qualified healthcare professional before making any decisions about medical treatment.
Pre-Consultation Review
If you want to get a personalized answer from our medical team, you can reach us using this form here. We will cantact you as soon as possible.
Our practice adheres to guidelines established by leading international organizations in Hair Restoration.
International Society of Hair Restoration Surgery is the leading global medical association that establishes international practice standards and patient safety protocols.
The American Board of Hair restoration Surgery represents the highest standard. To maintain rigorous certification requirements the physician must demonstrate surgical expertise.
Worls FUE InstituteI serves as the premier educational body focused exclusively on Follicular Unit Extraction methodology. The institute ensures consistent application of safe FUE.
