Hair Plug Horror - Revisiting Standard Punch Graft

Standard punch grafting is the procedure responsible for giving the hair restoration industry a bad name. Unrefined in technique and esthetically displeasing in appearance, standard punch grafting is the old “hair plug” method that was popularized in the 1980s.

This hair transplant procedure involved removing skin from the front of the scalp to make room for the large plugs (about 4mm) that were to be implanted. The plugs contained many hair follicles and gave an unnatural, obvious look to the hairline and scalp. Hair plugs were the standard form of hair restoration for many years.

The Problems with Standard Punch Grafts
There are many negative aspects associated with the hair plug procedure:

- Hair plugs contain about 15-35 hairs each and are the size of pencil erasers, giving the scalp an unattractive, “corn row” look.
- Only a small number of hair follicles take root after the plug is transplanted because many of the follicles are severed during removal from the donor area. This is damaging to the patient because it destroys precious hair follicles.
- Punch grafts leave large wounds on the scalp which increases the length of the recovery period. This limits surgeons to perform only 20 to 50 grafts each sitting, thereby prolonging the hair restoration process to many sessions.

Due to the significant negative consequences of punch grafts, many hair restoration surgeons today are being asked to repair hair plug disasters. About 10% - 20% of a surgeon’s clientele requests repair work. Usually, it involves re-transplanting individual hairs from the dense plug into the sparse areas between the plugs.

Today, standard punch grafting has been replaced by a more efficient technique called follicular unit extraction.