This 26 year-old man had hair loss in front but still had a strong midfrontal forelock (or 'island' or 'central tuft'.) He also has a strong cowlick which is like an S-whorl in his frontal hairline. He hoped to be able to brush his hair backward without the recessions showing but agreed that a mature hairline would be sensible in view of his potential to lose more hair as he ages.

He uses Minoxidil regularly but stopped Finasteride due to side effects after 2 separate trials.

He has fine hair but has more hairs per graft than average. We don't keep separate graft counts but did note that he had more 3s than 2s or 4s and had more 5s than 1s.

We transplanted 3088 follicular unit grafts in front, excluding his midfrontal forelock, at densities of 56 -> 49 -> 42 grafts per square cm. He had 373 1-haired follicular units in his hairline. We had to follow his natural direction in his cowlick.

At that time, I was routinely undermining only the lower edge, whereas I now routinely undermine both edges. He is happy with his trichophytic scar. I think it is OK but undermining both edges works better for me.

Patients with acne seem to have a higher risk of getting post-op scalp pimples but using Tetracycline immediately post-op worked well at prevention.

Some men keep their midfrontal forelock for life but others eventually lose hair there too. He knows that he will need more hair transplantation if and when he loses the hair in the midfrontal forelock and may want more hair transplantation if and when he loses more hair in his midscalp and crown.

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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

Nice work doc, the patient has beautiful hair.

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My Hair Loss Website - Hair Transplant with Dr. Feller

Great documentation and nice work. Why only undermine one side though?

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My Hair Loss Website - Hair Transplant with Dr. Arocha

This is amazing work. Nice job!

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My Hair Loss Website

Dr. Simmons,

What a beautifully crafted and natural looking hairline reconstruction.

In my opinion, your work is very impressive.

Best wishes,

Bill

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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.

Thanks hair_care and rpachigo

I am asking that myself!

Actually, in Dr. Frechet's original article on trichophytic closures, he said that you could either undermine both edges about 1/2 the width of the donor strip or 1 edge the full width of the strip. Dr. Frechet limits the strip width to 10 mm but I will take a wider strip if the VSL (vertical scalp laxity) allows.

If the results were equal, it would be easier and faster to undermine one edge the width of the donor strip than to undermine both edges half the width.

I felt the results weren't quite as good so I switched back to undermining both edges.

Even when the strip is 10 mm wide, in my hands, the scar is narrower if I undermine both edges.

It may be different for other doctors.

This patient is content as he is. If he has more hair transplantation in the future, I will remove the donor scar with his strip and undermine both edges.

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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

Thanks very much Bill

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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

Amazing transformation. Great natural hairline. Patient must be thrilled. Obviously, as you have explained, if the frontal forelack does recede thin, then a further session would be necessary as this would look extremely unnatural.

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1.25mg Finasteride
3000mg MSM
Vitamin C
Omega 3
Nizarol

My Hair Loss Website - Hair Transplant with Dr. Rahal

That's very interesting regarding the minutiae of undermining. Articles have been written describing undermining one side the whole length of wound vs. undermining half the length on both sides - very academic but useful I suppose.

That's brings up a few other questions in my mind. If you are underming, are you doing so subgaleal or above the galea above the occipital protuberance? Also I guess you are undermining above the galea b/c when you go laterally, the galea blends with the temporal fascia. So is there any time you would go subgaleal and score the galea and maybe be less tension on closure with the deep stitches placed into the galea - also possibly less chance of deep sutures catching the follicles? Does this make any sense? Also with suture closure of the skin, I have seen some using locking sutures - I don't remember who that was. Would it make more sense to use a horizontal mattress everting suture which may possibly be less asphyxiating to the follicles or does this not matter? Ideally if deep sutures approximated the wound like they should, you could put steri-strips for the skin - that's extreme of course.

My only experience with this is doing bicoronal flaps for frontal sinus obliteration for chronic frontal sinusitis and also flap closure of large scalp defects after skin cancer removal which I haven't done in a long time. I remember scoring the galea to release some tension - not sure if it helped a little or a lot.

Any observations appreciated Dr. Simmons.

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My Hair Loss Website - Hair Transplant with Dr. Arocha

Thanks Raphael84

Hair transplantation is a team sport and I am very lucky to have a great team.

If this man's midfrontal forelock does get thin, he and I will notice it before the general public does. We won't wait until he goes bald there but will transplant it as soon as there is enough room to put enough hair to finish it.

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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