Here is an example of a point that will hopefully be instructive and of interest. This man in his 30s is Stage 6 and has fine hair and received 2070 follicular unit grafts in July 2004. He had a thin, tight scalp that precluded taking a donor wider than 1 cm. I had estimated that we could get 2200 fugs. The surgical pattern is a variant of the 3 vertex pattern of balding. (See below for further comments regarding this pattern.) I feel strongly that this is the advisable pattern for men who may progess to advanced degrees of balding. He has had a second procedure within the last year and I will post these photos when I see him in followup.
Every set of hair characteristics has strengths and weaknesses. With fine hair the strengths are that it can look natural in surgical plans that have a low density as the end point such as with this case. Fine hair?*s weakness is less hair mass per hair grafted.
Hair mass in an area of the scalp is the result of 1)how many hairs are growing in it, 2) what the diameter of the hair fiber?*s shaft is, 3) what the length of the hair growing in the area as well as 4) how much hair length is coming into the area from adjacent scalp due to hair style. Waviness will create the illusion of more hair mass as well. (It?*s really simpler than all this verbiage makes it seem.)
The area of a circle or the cross section of the hair fiber will determine how much hair mass results from the thickness of the hair fiber. Normal hair fiber diameter is between 40 and 80 microns. (There are 1000 microns in a millimeter.) The formula for the surface area of a circle is pi times the radius SQUARED. The square of the radius explains the magic of the hair fiber diameter: if you work this formula on the difference of hair mass between a very fine hair of 40 microns and a slightly less fine hair of 50 microns you will find a difference in hair mass of 35%!!! You can imagine (or calculate for yourself) the difference between fine and coarse hair (40 and 80 microns),
I feel that this case is useful to see where the zones of grafting are and then compare them to hairs in the ungrafted, forward margin of the central tuft. Doing so shows the advantages as well as the disadvantages of fine hair, i.e., low hair mass but a natural look in a low hair mass environment. This result allowed styling options not available prior to transplantation that the patient perceives as very desirable.

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William Reed, M.D.
Member of the Coalition of Independent Hair Restoration Physicians

Ummm, ahhh never mind.
Hope hes happy

Ya, I dunno, if he's happy that what matters....this looks really thin, though....but, it's such a low # of grafts for a NW6, don't know what kind of "illusion" could even be realistically expected.

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*A Follicles Dying Wish To Clinics*

1 top-down, 1 portrait, 1 side-shot, 1 hairline....4 photos. No flash.

Follicles have asked for centuries, in ten languages, as many times so as to confuse a mathematician.

Enough is enough! Give me documentation or give me death!

I think it looks very natural and if that was all that could be taken in the first surgery due to poor laxity then what can you do? The guy had a second surgery so the results can't be fully assessed yet. Clearly he wasn't totally happy or he wouldn't have gone for #2 but if he is happy with the combined result then that is the main thing.

I think you guys are being too harsh. Yes, the result is thin, but it looks very natural and only 2000 grafts were used. If you saw that guy walking down the street you would think that he was thinning, but nobody would suspect that he had a transplant. Bottom line is that this is a good result when you take into consideration the number of grafts and the other limitations that Dr. Reed outlined in his post.

Umm yes and I would think he needs a transplant or shave because he is about 6 months from being bald

I agree with TC17. This is a very realistic and appropriate result for just over 2000 grafts.

It's obvious Dr. Reed had to work with the patient's limitations of a tight donor scalp and thin skin. To those who are not aware, it's important not to take two wide of a strip on thin skin since there may be extra risks of scar stretching.

I think that in addition to appreciating the "wow" results, members should also learn to appreciate the limitations doctors run into and developing realistic expectations. The patient may not haev a full head of hair now, but it's a nice improvement and very natural looking.

Nice work Dr. Reed. Thanks for posting.

Bill

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To learn about how I restored my hair, view my my hair loss website.

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I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

Yeah if your a NW 6-7 with a tight scalp then SHAVE.
Bill is right

Thanks for your comments. I expected remarks about "thin" and too few grafts, and I appreciate the remarks acknowledging that some people don't have the option of getting a more dramatic result whether it be because of a tight, low density donor, fine hair or both. What does one do in that circumstance? That is why I thought this case might be useful. You can check out other cases in my file to see the results of higher density donor composed of thicker diameter hair. It's all about hair mass, both short and long term. Getting the hair mass desired short term had better be in a pattern and density that will work out long term as balding progresses. Unfortunately, this patient is never going to have a high hair mass solution for his balding. He feels the growth he got from his transplant is the option that is better than doing nothing. I respect others of you choosing to do nothing. The physician's setting up expectations to allow you to make this choice is as important as technical proficiency.

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William Reed, M.D.
Member of the Coalition of Independent Hair Restoration Physicians

I agree with everyone here! Yes this a good result for only 2000 grafts "very natural looking", also yes for such a balding area and poor donar quality he should have shaved it all off instead of a HT! Overall though judging on results alone for the #'s given you propably cant ask for much more than this!