Many women lose hair or see thinning in their frontal corner hairline. This female patient had such a problem on one side, which was transplanted with 600 grafts. She had a wonderful result by her assessment and mine.
Before photo on the left / After photo on the right. Click to enlarge.
This is a 60 year old woman who had 2700 grafts to fill in the area where she was very thin. She uses a combination of Toppik in the first inch of the hairline only, a good solid perm for the rest of her head and a reddish hair coloring that works to minimize her hair color contrast. Red coloring at times gives wonderful results and this lady was very careful to style her hair to maximize coverage. The curly nature of her hair changes the characteristics of her hair, which is normally straight.
She could have done it all with transplants alone, but it might have taken twice the amount of hair transplants than she got with the three step approach she used. Click the photos to enlarge.
After
Before
There have been concerns expressed that people that have had a hair transplant look like a bloody mess right after the surgery. When I recently posted a photo of a typical post-op case to another website, some forum members there expressed surprise and disbelief that a patient could not have blood on their scalp as they left our office immediately after the surgery.
To handle any concerns over whether it is actually possible to leave an operating room without having your scalp dotted with blood, I am presenting a case done just last week where the patient received 5,019 grafts in a single session. These photos are not retouched and are typical of 90+% of our patients at the time they leave our office after surgery. The technique that produces this result reflects the instrument we use for site creation. The recipient sites that are made will tighten around the graft to create a mechanical seal around the site and minimizes any post operative bleeding. With good daily washing, the wounds usually do not form any crusts (scabs). If there is any hair present, the patient can often walk around without a hat and be virtually undetectable with regard to the hair transplant visibility.
Immediately after one session of 5019 grafts. Click to enlarge:
This patient has been taking Propecia for 2 years and not only did the hair growth fill in the crown, but even the miniaturization study showed significant microscopic benefit. This is what I keep talking about in this blog, there is the measurements of science behind what the eye sees.
Miniaturization mapping (captured with video microscope):
Before photo on the left / After photo on the right (2 years on Propecia — no surgery). Click to enlarge:
I’m very curious on the progress of the TV show contestant, Russ Jowell, that you transplanted in April of 2007. How is his progress? how was it compared to the photoshop projection that was shown the day of the show prior to the transplant?
For those that missed it, ABC ran a special called The Great American Dream Vote where this young man with a Norwood Class 6/7 hair loss pattern (pretty extreme for a 22 year old) won his dream of getting a head of hair. Unfortunately, the show was canceled before his results could be shown… so here we are.
Russ’s results came out well, but he’s not at that Photoshop projection the producers of the show asked us to make. He has very fine hair, and the projection was made by taking the results of another patient’s hair transplant (who had a medium weight hair), so that will account for the difference in fullness from the frontal view. A coarser hair will have three or four times the volume (visual effect) than a fine hair with less bulk to it. Russ had another surgery after that 1st one for a total of 5816 grafts (photos below) and he just recently had yet another procedure (2856 grafts), this time to the top and crown to give him more coverage. We heavily weighted the transplants in the front on the 1st and 2nd time around, and it’ll take some time before we get photos of his 3rd procedure results, since that surgery was recent. Russ is very happy with the results thus far and can’t wait for the top and crown to grow in. Click the photos to enlarge.
After two procedures totaling 5816 grafts
Before
Hello,
I’m 22. I have had long hair for about 2 years now, and I hadn’t paid much attention to my hairline at all. Recently, in about the last 3-4 months, I began to start looking at it and noticed that I do indeed have a receding hairline. However, due to my long hair, I cannot quite tell if I have any vertex hair loss as well. I took a picture and have a spot, but it’s possible that it’s just the way my hair part. It has been like that ever since I’ve had my longer hair (I never paid attention to the back of my head). I have also noticed similar parts in other guys with long hair. None of my friends or family have mentioned it to me, especially my friends, since we talk about this type of stuff all the time.
What do you think?
First, thank you for allowing me to post your photo.
It is difficult to tell based on the lighting in the photo. Sometimes under harsh lights, the scalp can be seen even without any balding present. This indeed may be early crown balding, but the way to determine this is to map your scalp and look for miniaturization in both the frontal hairline and the crown. Then, if you have miniaturization, you are genetically balding and should consider treatment.
This patient has 1235 grafts placed into the corners of her hairline. The After photo was taken when she was 2 weeks post surgery. She showed many people and most people did not believe she had a transplant. None of the hairs have fallen out yet, although I would expect that the shedding of the transplanted hair would occur at between 2-3 weeks.
One of the most frequent requests we get are about how you can expect to look after a hair transplant, and many people imagine a deformed, scabby area. But our post surgical patients usually have no scabbing if they wash their hair diligently as we’ve defined it.
I’m sorry about the slightly different angles on the before and after photos. I messed up when taking the after photo so this is the best I’ve got until I see this patient again… but this still gives a good idea of what one can expect just a couple weeks after surgery. Click the photos below to enlarge.
Before on the left; After 1235 grafts on the right:
I am often asked why hair transplant patients seem to always comb their hair back (particularly in the After photos on the web). The answer is that they do it because they love their hair and want to show their normal hairline. I think that secretly, they get a thrill from taking a chance that someone might identify that they have had a transplant and they challenge that risk. You can comb your hair any way you want after a hair transplant, but by combing it straight back they can show off the hairline that they didn’t have for many years.
Here is a great example of a patient who had 4196 grafts (before and after) over a two year period. Click the photos below to enlarge.
After:
Before:
I saw this patient last week for a follow-up and he had a wonderful result from a single session of 1807 grafts in the frontal area. When I looked for the scar to see how well it had healed, I could not find it. The scar was closed with an upper and lower trichophytic closure and the results of doing this make strip surgery more than competitive to follicular unit extraction (FUE). This type of closure allows hair around the wound to grow through the scar, making it extremely difficult to see once it heals. To learn more about this, see Techniques to Minimize Donor Area Scarring. I have been routinely getting this type of healing from trichophytic closures.
The after photos were taken about 22 months post-op. Click the photos below to enlarge.
Before on the left; After 1807 grafts on the right:
Donor area – After. Can you find the scar?
This patient came to our office a year ago showing a Norwood Class 3 pattern of hair loss. Dr Pak prescribed Propecia to this young man and after a year of taking it every day, the patient returned to our office to show off his results. He had no hair transplant surgery. The results shown (in the photo on the right) are strictly from a daily Propecia pill.
Before on the left, after on the right. Click the photos below to enlarge.
The following comes from Dr Paul Cotterill in Toronto, Ontario, Canada:
Here is an example of why proper training and regional workshops are a pretty good idea:
I saw this patient in my office yesterday that was referred to me for assessment. This 38 year old fellow ( Class IV-V ), had a transplant 4 weeks ago in Ludhiana, India. He felt that the procedure didn’t go very well.
On examination the crown had been transplanted with 60 – 65 punch grafts that were 2-3 mm in diameter and the distance between grafts was 1 – 1.75 cm, very irregularly, across the crown. Peri-folliculitis was evident and residual crusting on some of the grafts. There was up to 7 hairs in some of the grafts. The grafts were removed via FUE from the occipital area. The procedure took 1 hour and he was told to return next month for a second session of the same. The cost – $500.00 for both sessions.
I have swabbed for C&S what I could, cleansed the scalp, started an antibiotic and suggested Propecia, with follow up in 1 week. He would like further sessions to the crown. He needed a proper consultation as to planning and the consequences of starting the crown in a 38 year old with certainly further thinning in the future. Further sessions at this point are unwise. I will be following up with him closely.
Dr. Cotterill has given me permission to repost these photos. It is unfortunate that people treat a hair transplant procedure as if they’re just getting a haircut. This is surgery! You want to do your research and know what you’re getting into. How could anyone recently get the old, ugly plugs of decades past? It’s disturbing on many levels. So he only spent $500 on 2 sessions to get this look. Now how much time and money will he have to spend to try to undo this foolish mistake? A bargain indeed.
Click the photos below to enlarge.
This is a person with very fine hair that had a small transplant with minimal coverage only in a wide area from hairline to about 4 inches back. The hair was very see-through, but considering where he started, he was very pleased and came in for another transplant to increase the density in the front and top areas. We put concealers (here DermMatch and Toppik in combination) and his resulting photographs now show the appearance of far more fullness than he had from transplants alone. The photos below show the value of these products.
Click the photos below to enlarge.
Before apply concealers:
After Toppik and DermMatch:
From time to time, I get emails from men that are incredibly embarrassed about the results they got from an old, pluggy hair transplant. They’re so embarrassed that they request I don’t even publish their emails (even if there’s nothing identifiable in there)… and that’s fair enough. So I just wanted to write a post to quickly explain the best way to fix a pluggy hairline: you need to cut out the plugs and then put transplants in the place the plugs originally were. This is generally done in two sessions (8-10 weeks apart) and we have been doing this for years. It turned out that this man’s scar (from excising the grafts) healed very well, so well that it could not be detected. I put hair wide enough in front of where the scar was so that his hairline was lowered quite a bit. We built a wide transition zone in the leading frontal edge. Here is such a case on a man with black hair.
Before on the left, after on the right. Click the photos below to enlarge.
There’s another plug repair case at the NHI site — Dean’s Story. Be warned, some of the photos there contain surgical content, so if you have a weak stomach, you may want to avoid that link.
This patient came in last week, a few years after having 709 grafts taken from a very depleted donor area. Half of the grafts contained just one hair. Getting those 709 grafts was a challenge, as his scalp was tight and the donor area heavily scarred. Because of the anticipated poor yield, I elected to spread the grafts over an inch from the plugs (forward) creating a loosely built thin hairline. When he allows his hair to stand up rather than pull it back as shown here, the results are even more spectacular. This patient gave up his wig and is thrilled with his result. We will try to do another procedure with up to 700 grafts in the recipient area to thicken it, but that will be even more of a challenge because the scarring is very bad and the density of the donor area is very low and he knows it.
Many of what I will call the “normal transplant patients” we perform surgery on today who have not had the old type of plugs, may look at pictures like those shown here and get very frightened. I understand the fear that gets invoked by these patients, but some of my most satisfied patients are those who walked around for years and found that people never looked into their eyes, only to their hairline. This man is an example of a patient where just a small change had a major impact on his life, allowing him freedom from a wig he despised to cover a pluggy look he hated.
Click the photos below to enlarge.
Before:
After:
My mother told me that she does not know what I have been doing but I looked younger and more vibrant than in years. Considering that I am about to turn 50, that comment made me take a real close look at myself when she said that and I realized today when you showed me my before pictures, how much I have changed. I remember always looking in the mirror to see what I could do to improve my look. but no more. Not only has my career done well, but I never think twice about my hair, that is until I see you.
The above is an email I received from a patient after he came in for a follow-up last week. He’s given me permission to share his results, which are after a total of 4184 grafts over two sessions. His before photos present a Norwood Class 5 pattern, and his medium fine, wavy hair helps with the after results.
Click the photos below to enlarge.
Before:
After 4184 grafts:
