Despite being only a Norwood class 3 at the time of his surgery, this patient decided that he wanted to put his hairline back where it used to be when he was younger, before it got any worse. After 4 procedures totaling 3790 grafts in all, he is very pleased with his results.

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The information below was provided by Dr. Rassman upon request due to information typed incorrectly on the initial post.

The patient actually received 3790 grafts (sorry for the typo), 1350 in the first procedure and 1025 in the second. The patient lost some hair behind the original transplant. After the second procedure, the patient had a stretched scar measuring 1cm in width in its widest portion. The third and forth procedures were combination of two hair transplant procedures with scar revisions. The grafts were placed to thicken the work previously done. The entire scar was removed and closure tensions were low at both procedures and although some scar returned, the scar was improved.

All strip procedures produce scars. In some patients, the scars widen. I believe that the scars that stretch are more tied to the patient's healing characteristics than the surgical technique or the size of the strip. In this patient, there was no wound tension at the wound closure on any of his procedures, but scar revisions are less than a perfect process. I have not seen any patients where the scar revisions made the scars worse (although I heard of one patient who had a genetic collagen defect and had his scar widen when an attempt at repair was done). Most patients get some improvement from a scar repair, possibly because the strip is limited in width. Amongst physicians who perform strip surgery, there is no general agreement as to the proper scar repair technique. Many surgeons close the wounds with a single running skin suture, while others close the wound with a two layer closure to guarantee a lower wound tension. In the two layer closure, the deep layer can be closed with interrupted absorbable sutures, or they can be running sutures. I have been using a running quill suture for my scar repairs and the sutures are anchored in the occipitalis fascis (deep layer) which is imbricated to take up the tension at the closure. With these closures, the skin tension is often very low, yet the scar may still return despite the logical value of the deep layer.

Comments were made by some of the posters of my classification of this patient's balding pattern as a Norwood Class 3. I would rather consider it a 3A evolving into a 4A pattern. The nubbin of hair in the center on the original pictures was highly miniaturized. There was critical comment about the shape of this patient's hairline. I recommend on most of my Caucasian patients is what I discuss as the normal mature hairline as shown in: http://www.baldingblog.com/200...-mature-with-photos/ . The midline is measured one fingerbreadth above the highest crease of the wrinkled brow and the shape is convex. In many Asians, some people from the middle east and many Africans, the hairline is flat. The child's hairline is lower, located at the highest crease of the wrinkled brow and is concave in shape (look at your children if you do not believe me) as are women's hairlines.

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Don't get me wrong, the work itself is very good, but 7400 grafts!! It seems like overkill for such a small area and poor planning for the future. I can't help but feel a good result could have been achieved with 3000-3500 grafts.

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On Propecia since July 2008 and maintaining.

very poor result and looks kinda strange.

there's that headband thingie again.

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My Hair Loss Website - Hair Transplant with Dr. Arocha

I would have said it looks good, but was the outlined area(so frontal third) the only area where these 7390 grafts were addressed to?
Now lets guess he had an area of about 60cm2 to be filled in which would be lik 123 grafts per cm2 ? even when It would be 80cm2(highly doubtful) that would mean 92 grafts/cm2 and still somewhat a see through hairline with what looks likes some folliculitis? I really thought this amount of grafts should have made it extremely dense looking like some of the hairlines we see on here in same situations as this patient with fewer grafts. The only thing which matters if the patient is happy about the result and will be happy with it many years from now on.
the result itself; looks good.

this poor guy likely made a big mistake.. he had better pray hes the first person to ever STOP the balding process, cause it looks to me like an outrageous amount of grafts used to foolishly lower a hairline and its STILL not very thick... if that is what Rassman does with 7000+ grafts its easy for me to see why that poor young guy who THOUGHT he was winning a life changing free transplant on that tv show got such a terribly thin outcome also....

terrible future planning, i dont care if its what the patient wanted.OBV patients dont always know whats in their best interest. the doc should have declined... instead he just kept taking his money 4, count em, 4 different times..your a saint doc, bravo.........

to top it off we get that deceptive band that pulls the hair straight back again.... MY HT hair looks like that when i pull it back and my HT sucks....

how was this guy ever highly regarded in this industry?? anyone??

no way 7390 grafts, also looks like an HT.

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My Hair Loss Website

I agree with LMS!

i think it's time for rassman to stop performing hts. 7k grafts to achieve that? ridiculous....

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HT #1: Karamikian Unknown # of grafts Sept.2006

HT#2 Nov.23rd, 2007
Dr.Feller
Almost 3200 grafts via strip

HT#3 April 2010
Fue 200/side into temple points

HT#4 February 2011

My Hair Loss Website - Hair Transplant with Dr. Feller

Maybe he meant 7390 hairs?

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2008 Dr. G – presumably 1,000 grafts / 2,142 hairs
2009 Dr. Paul Shapiro – 2,348 grafts / 4,258 hairs
2011 Dr. Paul Shapiro – 1,999 grafts / 3,624 hairs

My Hair Transplant Journey with Shapiro Medical Group