This 38 year old male did not want to cut his hair short prior to surgery. If I cut his hair it would have done a 3,500 + case, but without cutting his hair it was a 2,600 case.
He came in at 7 months, very happy, and most likely he still will have more growth.
The results are not as dense as a 3,500 case, but still cosmetically there is a big change.
So like most things in life there is a trade off.
With out cutting his hair, he did not have to deal with a "funny" hair cut for 3 to 6 months, and none of his colleges knew he had a hair transplant. The transplanted hair grew in so gradual that no one has know he has had a transplant.
If he had allowed me to cut his hair, he would have ended up with more density, but would not have been able to hide the fact he had a transplant. Hiding the fact he had a transplant was important to him.
I have included photos 4 days post op and it is almost impossible to tell he had a transplant.
Sorry the 4 day post op photos are a little blurry. I tried to take them without a flash indoors and the contrast did not come out too good.
His graft count is as follows:
1 Hair FU 493 Hairs 493
2 Hair FU 1295 Hairs 2590
3 Hair FU 680 Hairs 2040
4 Hair FU 151 Hairs 604
Total FU 2619 Hairs 5727

Nice job once again
That top shot shows how good the outcome really is.

Dr. Paul, nice result, as PGP said the top down shows it the best I think.

Quick questions, was the limitation on the 2,600 because of the extra time it took to work around the existing hairs? Is that in your opinion the max amount (or around that) that can be done without shaving? I'm curious because I prefer to not shave, but would like to have (based on feedback and the results i'm looking for) between 3 and 4K grafts. If you can elaborate on the limitations on this gentleman (and in patients in general) that do not shave it would be appreciated. Thanks.

HTHELP

The reason the number of grafts I can do in one session is lower when the patient does not cut is hair is mainly technical.
When the patient cuts his hair short it allows me to dense pack while avoiding transecting existing hairs. When I am making incisions and a patient cuts his hair I can see clearly between all hair follicles and I can make my incisions closer together while still being sure not to transect existing hair. When the hair is longer, even with careful combing there is overlapping hair which partially obstructs my field of view and I need to make the incisions further away from the existing hair to avoid transcetion. It is also much easier to keep the field clean when the hair is cut short. There is always bleeding after an incision is made. When the blood sticks to the existing hair, it is more difficult to keep the field clean and see the filed for making incisions and planting the grafts. When the technicians or I am planting the grafts and a patient cuts his hair short, it is very easy to get the angle of the incision, and plant the graft. When the patient does not cut his hair, the longer hair can get in the way so I need to make the incisions further away from the existing hair. It is important that the planting of the grafts go quickly and smoothly for good graft survival.
In the first few post operative days, most patients ooze some fluid from the incision site.
When the hair is long there is a chance that the existing hair will stick to the new transplants and then if the patient brushes his hair, he may pull out some grafts. This risk is only in the first couple of post op days. It is a small risk and if a patient follows the post operative instructions it should not happen. But it is still a risk.

Because of the above technical aspects of surgery I believe that graft survival can be compromised if one tries to do too large a case between long hair, and there is an increase chance of damaging existing hair with transcetion.

Sometimes it takes longer to do a case in a patient with existing hair and sometimes it doesn't. Factors such as how long the patient wants to keep his hair, the color and texture of his hair, whether his hair is curly or not, the quality of the patients skin, how much bleeding there is, can all effect the time it takes to do a transplant.

I do think the time element is an important factor in all surgeries and I like to keep the total time for any surgery to under 8 hours. Once the strip is taken out graft survival starts to decrease after 4 to 6 hours. Also, I think some of the risk of surgery starts to increase after 6 to 8 hours. But that is a whole other topic I would like to address sometime.

I hope this is helpful

Dr. Paul

Dr. Shapiro.

Very nice work and a concise explanation to the earlier posters question.

Thank you.

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My Hair Loss Website - Hair Transplant with Dr. Ron Shapiro

Dr.Paul, thanks so much for that detailed response. it makes perfect sense to me. In your opinion at what point (number of graphs) does the survival become compromised? Is the 2,600 graft basically the breaking point in those cases? Again, job well done as always.

HTHELP
The amount of hair I fell I can transplant safely varies from case to case. It depends on the area I am going to transplant, what I estimate the patient's native density is, and the quality of the patient's hair. So the 'breaking point' depends on what the case..
In this patient the area to transplant is about 100 sq.cm., and I would say the density of his hair native hair ranges anywhere from 20 to 50 fu/sq.cm. In a case like this I would plan on transplanting 2,500 FU.
If the area to transplant was smaller, I would have chosen a smaller number of FU to transplant, or if the density of his native hair was greater I may have chosen to transplant less hair.
Dr. Paul