Hair plugs: The ultimate bad hair transplant

Published on November 20, 2020
Updated on November 20, 2020
man being prepared for a hair transplantation procedure
Hair transplants have come a long way since they were first developed in 1939

Back in the 60s, 70s, and 80s, people suffering from hair loss had limited treatment options. One of the main treatments was a form of hair transplantation known as hair plugs.

Hair plugs were technically a successful hair transplantation technique. But as they grew out, most people weren’t that happy with them because they gave people’s scalps an unnatural, doll-like appearance. Much better forms of hair transplantation are used today.

What are hair plugs?

Hair transplantation has existed since the 19th century, but it wasn’t until the mid 20th century that this procedure became popular. According to a study in the Plastic Surgical Nursing journal, it was around this time that hair plugs were developed and became popular.

The hair plugs technique utilized a punch system that’s a bit similar to a paper hole puncher. The clinician would essentially extract small areas of the scalp where people were experiencing hair loss. They would then transplant skin and hair from the back and sides of the head to fill these regions. Each area was a small circle just a few millimeters in size. 

The hair plugs transplantation procedure was successful – and it was actually popular for many years. But – it came with a pretty unusual side effect: It gave people a strange, doll-like appearance that became even noticeable as it grew out.

Hair plugs and your scalp   

Every kid has encountered a doll at some point in their life. Whether it’s a retro action figure, a Barbie, or your little sister’s baby doll, these toys generally have some amount of hair on their head. Most dolls have synthetic hair, but it looks pretty natural – until you cut it off.

If you try to give a doll a buzz cut, you end up with something pretty unusual. Remember Babyface, the mutant spider baby in Toy Story that eventually became one of the movie’s heroes? Most doll scalps look just like Babyface’s head when shorn.

Unfortunately, this is also the appearance that hair plugs often produced. These grafts could result in patchy tufts of hair growth – and particularly looked like a doll’s scalp if the transplants had been spaced widely apart or were very large. To make matters worse, each hair plug graft was placed in a row. This resulted in hair that grew in badly and didn’t flow with the original hairline.

Over time, hair plugs infamous for giving people’s scalps a strange, doll-like appearance that was particularly evident when grown out. This wasn’t the end of hair transplantation, though. Surgeons started trying to transplant smaller and smaller regions of skin and hair.

According to a study in the Journal of Cutaneous and Aesthetic Surgery, progress in hair transplantation eventually led to the technique being scaled down. Instead of long rows of hair plugs being transplanted, individual follicular units were able to be transplanted, instead.

Modern hair transplantation techniques

If you decide you want a hair transplant, it’s unlikely that any doctor or surgeon will talk to you about hair plugs. In fact, even a study from the Journal of Pakistan Association of Dermatologists said that hair plugs are practically obsolete. 

Instead, you’re more likely to hear about two newer techniques: follicular unit excision (FUE) and follicular unit transplantation (FUT). People with older hair plugs sometimes even have their hair transplants removed and redone through one of these procedures.

According to the International Society of Hair Restoration Surgery’s journal, Hair Transplantation Forum International, FUT is a surgical procedure where a strip of scalp is removed. Follicular units (usually between one and four hair follicles) are removed from the strip and transplanted back onto the person’s head in the area that’s been affected by hair loss. 

FUT is considered to be very effective. However, the nature of this technique results in a large hair transplant scar that deters people from the procedure.  

FUE, on the other hand, is a newer technique that doesn’t leave a major scar. It involves the harvesting of individual follicular units from various areas around the scalp. This type of hair transplantation is generally considered to be challenging, though, and can be much more difficult for medical practitioners. 

Until recently, FUT was considered to be a better form of hair transplantation as it was simply easier for doctors to obtain good results. However, in recent years, both FUT and FUE have been shown to be equivalently effective when compared to one another. 

A different study from the Hair Transplant Forum International even reported that applying both techniques might be the best way to treat hair loss. This study showed that the combination of first having FUT, then having FUE was the most effective type of hair transplant.

Other treatments for hair loss

While FUE and FUT are both effective hair transplantation strategies, many people aren’t convinced by the good results they produce. This is because hair transplantation is only effective in the area where the hair has been transplanted. If your hair loss is due to a progressive or recurrent condition, you’ll still continue to have hair loss despite having these surgeries. In fact, you’ll probably need further procedures in the future.

People who decide against FUE or FUT might not want to undergo repeated surgical procedures. They might also find the thought of having scars to be distasteful or simply find the cost of these treatments to be out of their budget. However, one of the biggest concerns is that, as with any surgical procedure, there’s also a significant risk of complications. 

According to a study from the Aesthetic Surgery Journal, around 5 percent of people who undergo FUT are likely to experience some sort of negative side effect. The complications of FUT include problems like:

  • An enlarged scar
  • Inflammation of the hair follicles
  • Death of skin and tissue 

These issues typically occur around the area where the surgery was performed.

FUE-related complications tend to be less serious than those of FUT, but they still occur. According to a report in the Journal of Cutaneous and Aesthetic Surgery, people may find that the areas where their hair follicles were removed from have issues like:

  • Numbness
  • Scarring
  • Infection
  • Cyst formation
  • Tissue death

Perhaps the most notable risk of FUT and FUE is that hair might not grow back in the areas it’s been extracted from — which is fairly ironic since both procedures are meant to counteract hair loss. As you might imagine, this is a major turn off for people considering hair transplantation.

Fortunately, several alternatives exist. The Food and Drug Administration has approved minoxidil, finasteride, and low-level laser therapy treatments for hair loss. These treatments are long-term, but have high success rates and are completely noninvasive. The exact treatment that will work best for you will depend on the reason for your hair loss and the stage of hair loss you’re experiencing. 


Hair plugs are a hair loss treatment of the past, but hair transplants still aren’t for everyone. Scarring and cost are both major deterrents from undergoing this surgical procedure. 

Talk to your doctor about your hair loss treatment options. You can always try a topical treatment with fewer side effects, like minoxidil, if you’re wary of committing to hair transplantation surgery.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.


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