Hair restoration surgery has emerged as a leading technique for rejuvenation of the upper third of the face. Using contemporary techniques, the results are generally indistinguishable from the appearance of native scalp hair. Unfortunately, older techniques of hair transplantation did not produce this quality result. As a result, there are a considerable number of patients who bear the visual and psychological burden of older hair transplant techniques. In addition, there are regrettably additional patients who have similar unnatural hair transplant results from poorly performed procedures completed in recent time. Understanding the anatomic problems associated with the unnatural-appearing hair transplant is fundamental to the successful correction of the deformity. The most common problems associated with the unsatisfactory hair transplant seen in clinical practice are reviewed, and possible approaches to treatment are presented. The challenge for the hair restoration surgeon is to provide a level of expertise and honesty to these unfortunate patients to restore their appearance and self-confidence. Fortunately, a tremendous benefit for the patient can be achieved when a correction of the unsightly transplant is performed.