This man is in his late 30s and his only concern was his crown. He has slight recession of his hairline but no visible loss in front or on top (yet). He has dark, wavy, coarser than average donor hair and has excellent donor density.

We discussed, at length, how hair loss progresses and the long-term implications of transplanting his crown and I prescribed Finasteride and Minoxidil at his initial consultation.

As always, I designed his hair transplant as if he would not use medical treatment for the rest of his life. Despite his initial intention and my repeated encouragement, he has never filled the prescription for Finasteride. He has decided to use only Minoxidil until it is clear that he is losing more hair.

We decided to transplant 1500 grafts at 38 grafts per square cm to his crown and were deliberately not aiming for a dense result. He knew that he would need at least 2 more big sessions to cover his front and top later, if and when he lost more hair. His donor reserve should allow him to do this with hair left over in case his sides receded downwards.

His donor strip was 13 cm long and 12 mm wide but his donor hair was even denser than I had calculated and he ended up with 1886 (natural) follicular unit grafts, giving him a bonus of 386 grafts. Rather than increase the density in his crown, we decided to work further forward into his existing hair so he would have a bit smaller area to cover later.

It would have been very easy to have transplanted 2000 grafts at a density of 50 grafts per square cm into the original area and he would have probably been pleased with the greater density at first. However, it would have been very hard to keep up with this greater density when he lost more hair later.

He has a natural but slightly thin result. His double whorl will always make it impossible to style his hair perfectly to match his hair direction. (The left whorl dominates the right for overall hair direction.) These photos won't knock anybody's socks off. I have presented this patient because I think we may generate some interesting and worthwhile discussion.

__________________
Cam Simmons MD ABHRS
Canadian Hair Transplant Centre,
Toronto, Ontario, Canada

Dr. Cam Simmons is a member of the Coalition of Independent Hair Restoration Physicians

Dr. Simmons,

Thanks for providing an excellent photo presentation with plenty of detail.

This result is highly impressive.

Best wishes,

Bill

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Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog and the Hair Loss Forum and Social Community

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

Remember, true beauty radiates from within, not from the skin.

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

I wouldnt say highly impressive. It looks to me that the hair is combed back to give the appearance of more density. For almost 2000 grafts I would expect more density in such a small area to cover but maybe my expectations are to high.

dakota,

To get any level of full looking density in the crown is impressive in my opinion. Mind you, I'm sure there's most certainly some layering of the natural hair as one would expect. Even after 2500 grafts in my balding crown, I can't get it to appear completely full without some dermmatch or toppik. But maybe after this one...we'll see :-).

Bill

__________________
Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog and the Hair Loss Forum and Social Community

Follow us on Facebook | Twitter | YouTube

Subscribe to our Newsletters | How We Recommend Physicians

-----

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

Remember, true beauty radiates from within, not from the skin.

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

Hi dakota3

Thanks for your post.

Please take a closer look at the hair direction in the back and top views at 12 months. You can detach them and blow them up. His hair is not combed back at all. It is brushed forward but falls clockwise in the direction of his left whorl.

In fact we did not transplant a small area. The original marked area was about 40 square cm and we actually increased the area when we got more than 1500 grafts (instead of increasing the density in the area.)When I look back at the plan and post-op photos I can see that the area does look smaller because the boundaries are hard to see. I should have parted the hair to show the whole area better. Sorry about that.

38 grafts per square cm will never look dense and particularly won't look dense in the 2 whorls where the hairs are all directed away from the centres. We wanted to make sure that he would have enough scalp donor hair left to cover the front, top, and sides later, if needed. We therefore wanted to improve his crown without making it really dense.

I hope that this makes things clearer.

__________________
Cam Simmons MD ABHRS
Canadian Hair Transplant Centre,
Toronto, Ontario, Canada

Dr. Cam Simmons is a member of the Coalition of Independent Hair Restoration Physicians

And this patient looks like a prime example of whom the meds where made for and he didn't want to take them. Hopefully, this move won't end up biting him back.
Good job though.

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My Hair Loss Website - Dr. Hasson