Jump to content

Dr. Thomas Nakatsui

Elite Coalition Physician
  • Posts

    246
  • Joined

  • Last visited

Posts posted by Dr. Thomas Nakatsui

  1. This patient came in to the office concerned about thinning of the frontal hairline. We performed one FUE procedure approximately 1.5 years ago and used 173 single grafts, 720 double grafts, and 752 three-hair grafts, for a total of 1645 grafts.

    Here are his results approximately 1.5 years postop. He is very happy with his new hairline.

    Dr. N

    spacer.png

    spacer.png

    spacer.png

     

     

     

     

     

    spacer.png

    spacer.png

     

     

     

     

     

     

    spacer.png

    spacer.png

    spacer.png

     

     

    • Like 5
    • Wow 2
    • Well Done 1
  2. 23 hours ago, GoliGoliGoli said:

    Do you have pictures of before and after his first op? How many grafts was the first? It looks like a lot did not age well

    Hi GoliGoligoli,

    Thanks for the question. He only had one session eight years ago. I'm sorry if it wasn't clear but he only had the one session. The preoperative photos show his hair at its natural, longest look. Some might think his hair was cut to look like this, but the hair on the top of his head was not shaved down. This was as good as it got because the hair on top of his head grew in extremely fine and just didn't grow very long. He combed his hair from the side to cover the thinning area because that was the best he could do.

    Not everyone thins following the same pattern (like the Norwood scale suggests). Some people experience diffuse miniaturization of hairs over a large area (ie.g. all the way from the crown to the frontal hairline) before they start losing substantial number of hairs, as in this patient. It is a much more difficult pattern of hair loss to treat than thinning of the frontal hairline and temples for example (in those, you can transplant densely and get dense results). However, some patients even have a worse situation than this patient, diffuse unpatterned alopecia (DUPA), which is not amenable to hair transplantation at all.

    I do not have any other photos as this is the first time he came back for follow-up. He has undoubtedly lost much of the pre-existing, miniaturizing hair over the last eight years, leaving only transplanted hair. If you fast forward his hair loss from the pre-operative photos, I suspect he would likely be almost completely bald right now if he hadn't had a transplant 8 years ago and he is very happy he had it done.

    This brings up an important point as this was indeed a more challenging case. One of the challenges of transplanting into preexisting hair is that I typically won't damage a preexisting hair to place a new one. As a result, if you have pre-existing hair, I won't place new hairs at full density because I would risk transecting your natural hair.  For example, say you ideally would place 55 follicular units in one square cm, but there is pre-existing hair in 30 of those spaces. Then, I would only add 25 follicular units into those spaces (not 55 as I would ideally have done). Realistically, I might add a bit more than 25 and get in between those pre-existing hairs to try to compensate (e.g. 30-35) but I still wouldn't max out the density for fear of damaging a pre-existing hair. This is one of the limitations of transplanting into pre-existing hair. In some patients, an additional transplant a few years later is necessary to fill in the spaces left by those pre-existing hairs as they are eventually lost. In this case, he likely has lost a lot of the pre-existing hair.

    So, if you look at the preoperative photos in this case, you can see that he had a lot of pre-existing miniaturized hair present over a large area. The problem with his hair was not that the numbers of hairs was so low, it was more that so much of his hair had miniaturized and was extremely fine and short from his crown to the hairline.  As a result, the VOLUME of hair was low because of the hair's FINENESS and LENGTH, making it look so thin, not so much the NUMBERS of hairs yet. If the numbers of hairs was much lower at the time of transplant 8 years ago, I would have been able to transplant more densely giving a much thicker and longer lasting result but he also would have required many more grafts.

    I suppose an argument could have been made to transplant more densely and risk damaging the pre-existing hair because it looked like it was going to go anyways, but I don't typically operate that way. I would rather transplant safely and my philosophy is to not damage pre-existing hair. Also, an argument could be made that staying on finasteride despite it's lack of effectiveness for two years may have preserved the pre-existing hair, but the patient didn't feel like it was helping so he didn't stay on it.

    Keeping these limitations in mind, he has done extremely well. I also think if we combed his hair to shingle it, it would look much denser but he naturally keeps his hair this way, so we did not alter it.

    Thanks for the question and sorry for the long reply but I thought it would be helpful to explain my approach to diffuse miniaturizing hair.

    Thanks,

    Dr. N

    • Like 1
  3. foliically challenged and Gatsby,

    That is a good question. When I saw him, he had been taking finasteride 1.25 mg daily for 2 years without any benefit whatsoever. Unfortunately, he was not getting any results from the oral medication, and certainly a far cry from what he really wanted to see.

    Thank you for the question,

    Dr. N

    https://drnakatsui.com

     

    • Like 1
    • Thanks 1
  4. Hi everyone,

    This is a patient who came in for a transplant about 8 years ago and his results have been great. He never came in for followup until very recently. At the time of the transplant, he was developing significant miniaturization throughout his frontal scalp. The hairs were very fine and just wouldn't grow very long. We decided to proceed with 2961 grafts, comprised of 623 single grafts, 1430 double grafts, and 908 three hair grafts. This was done in one session using FUT.

    He is very happy with his results and feels the HT completely changed his looks. Over the last 8 years, he has lost much of the miniaturizing hair in the frontal scalp and would have looked much thinner than his pre-operative photos had he not had a transplant. Thanks to the HT, he has much more hair than he would have had.

    Dr. Nakatsui

    https://drnakatsui.com

     

     

    PRE-OPERATIVE PHOTOS

    spacer.png

    spacer.png

    spacer.png

    spacer.png

     

     

     

    EIGHT YEARS POST-SURGERY

    spacer.png

    spacer.png

    spacer.png

     

     

     

  5. Melvin, Dillpickle, Whereismymind, Steeeve, Shiba, Andy,

    Sorry for the late replies, everyone. Thank you all for your wonderful comments!

    On 1/1/2023 at 10:47 PM, WhereIsMyMind said:

    Im curious, in 2022/3 where most surgeons don't transect grafts, whats the benefit of doing FUT over FUE for such small amount of grafts? I'm still surprised some patients go that route. Is a slightly higher survivality really worth it in exchange for strip scar?

    This is a good question and I think Steeeve did a good job answering it. I always give patients the choice between both procedures as I am happy to do either procedure for the patient. As Steeeve said, for some who keep their hair longer in the back, the strip scar is not an issue and they actually don't want to shave their donor area down. On the other hand, if a patient likes a close fade in the back, FUE is the only way to go. There is also a difference in cost between the procedures, although it's not huge with this number of grafts. Even so, this can be a factor for some patients.

     

    On 1/9/2023 at 5:25 PM, andy_+_+ said:

    Great result doctor! You always seem to do more with less grafts. I'm curious if you could post some more pictures of larger cases and FUE.

    Being in Edmonton, I've been a fan for a long time of your work and it's also nice that your in my backyard.

    Thanks so much. I will indeed post  some larger cases and more FUE cases in the future. I also want to post more female HTs as well. I appreciate the comments. I wish I had more time in the day.

    Dr. Nakatsui

    https://drnakatsui.com

  6. This is a patient who came in for follow-up recently. He initially  came in wanting to restore his frontal scalp, which had thinned significantly. After going through the options of FUE and FUT, he decided to proceed with FUT. We transplanted a total of 1725 grafts to restore the frontal scalp approximately 1 year ago.

    He received 888 single hair grafts, 702 two-hair grafts, and 135 three-hair grafts via the strip technique. He is very happy with the results.

    Dr. Nakatsui

    https://drnakatsui.com

     

     

    52581762964_7b1a98640f_k.jpg

    52581037602_da69335c44_k.jpg

     

     

     

    52581935470_50f3cf7f66_k.jpg

    52581037557_f34b2fb41f_k.jpg

    52599249763_1ae3246956_k.jpg

     

     

     

     

    52581500336_8998a6e1dc_k.jpg

    52581037497_b66a82b7f3_k.jpg

     

     

     

     

     

    52582016948_c80c746cc5_k.jpg

    52581500291_1d553e3d0e_k.jpg

     

     

     

     

     

    52581037587_80510d0003_k.jpg

  7. Hi everyone,

    This is a patient who first came in because he was concerned about hair loss in the frontal scalp and to a lesser extent, the crown. We decided to fill in his frontal scalp with more density and fill in his crown with a lower density using FUT.

    We used 1029 single grafts, 2560 two-hair grafts, and 741 three-hair grafts in one session. His post-operative results are about 10 months post-op

    Dr. N

    https://drnakatsui.com

     

     

    52035915107_f40f61859d_b.jpg

    52037004043_ac7fff7b27_b.jpg

     

     

     

    url%5D,%20on%20Flickr52037474085_60565ed9b9_b.jpg

    52036952246_5987215007_b.jpg

     

     

     

    52037474030_2b8ba6cab6_b.jpg52037474035_de20fbe806_b.jpg

    52036952206_97d27192a1_b.jpg

     

     

     

    52037474015_83d9248688_b.jpg

    52037003918_7aa96b93a5_b.jpg

    • Like 2
  8. HI everyone,

    This is a patient who came in recently for follow-up. He is about a year out from an FUE procedure where 187 single hair grafts, 555 double-hair grafts, and 428 three hair grafts were transplanted for a total of 1170 grafts.

    His temples were receding quite a bit so we filled in the temples with a small amount to the frontal hairline as well. He is just about a year out from his FUE procedure.

    He is very happy with his results

    Dr. Nakatsui

    https://drnakatsui.com

     

     

    51853701033_afeb7f7fa8_k.jpg

    51853621846_2d985421e7_k.jpg

    51853621831_2b5ffd8233_k.jpg

     

     

     

    51852659012_fb3692abb2_k.jpg

    51853621761_db29dc541b_k.jpg

    51854280915_4c57a7a1a5_k.jpg

    51853621786_2c12581ba2_k.jpg

    51852659002_06de4f075e_k.jpg

    51853945104_86398d1e84_k.jpg

     

     

    51853945074_6ea7557037_k.jpg

    51852658912_e76ba3830c_k.jpg

    51853945089_63fd742127_k.jpg

    51853945099_f7859d5eef_k.jpg

    51852658892_6cb5e68409_k.jpg

     

     

    51853945054_6f944d9324_k.jpg

     

     

     

     

     

     

     

    • Like 1
  9.  

    This patient came in recently and we took follow-up photos from a procedure done 3 years ago.  He initially came in because he didn't like the recession he was starting to see in his temples. We did an FUT procedure at that time and transplanted 292 single grafts, 658 double grafts, and 209 three-hair grafts, for a total count of 1149 grafts to the temples. He is very happy with his results three years after his procedure.

    Dr. Nakatsui

    drnakatsui.com

     

     

    FRONTAL VIEW (Pre-->Post)

    51715156930_29360e24bc_b.jpg

    51714552018_156336262b_b.jpg

    51714551998_a114d3b588_b.jpg

    51715156935_8bcdd54729_b.jpg

     

     

     

    LEFT SIDE VIEW (Pre-->Post)

    51713498107_d7047f3e1e_b.jpg

    51714551978_63ff5f3c7f_b.jpg

     

     

     

     

     

     

     

    51714949424_b7143b901c_b.jpg

    51714949414_bf09c782a2_b.jpg

    51713498102_e45794d00e_b.jpg

    51714287646_c3a6b27d47_b.jpg

     

     

     

    RIGHT SIDE VIEW (Pre-->Post)

    51714551893_44c74a054a_b.jpg

    51714287621_9f18d2e013_b.jpg

     

     

     

     

     

     

  10. This is a patient who wanted to restore his frontal hairline. He came in for follow-up recently and had received 2959 grafts about two years ago. He had a FUT procedure and received 849 single grafts, 1628 double hair grafts, and 482 three hair grafts for a total of 2959 grafts. He had fine hair with no curl.  He is very happy with his results.

    Dr. Nakatsui

    https://drnakatsui.com

     

     

    51533874794_b615f9b0d6_b.jpg

    51534081655_bfc8642223_b.jpg

     

     

     

     

     

     

    51533874739_7a03acf385_b.jpg

    51533399518_516a06ed80_b.jpg

    51533154481_0f809a40b0_b.jpg

     

     

     

     

    51533874764_deceb8607e_b.jpg

    51532356787_1a41e4ec99_b.jpg

     

    • Like 1
  11. This is a patient who came in recently for follow-up from a surgery we did 9 years ago. He has been very happy with the results but wants to fill in the crown as that area has continued to bald over the last 9 years. The transplant has held up well over the last 9 years.  We used 819 single grafts, 1714 double grafts, and 610 three-hair grafts, for a total count of 3143 grafts into the frontal scalp and mid scalp.  I will update photos once we have the results of his approximately 3000 graft crown transplant.

    Dr. Nakatsui

    https://drnakatsui.com

     

     

    51349446084_c4db1ce4c5_b.jpg

    51347976852_1e52be0679_b.jpg

     

     

     

    51349728990_de3666cc9b_b.jpg

    51348931088_27761237f7_b.jpg

     

     

    51349446069_bc5cb4df28_b.jpg

    • Like 1
  12. Hi everyone,

    This a patient who wanted a transplant to reinforce his hairline and temples. We used 460 single grafts, 981 double grafts, and 390 three hair grafts, for a total count of 1831 grafts.

    Here are a few after photos taken 7 months after his hair transplant session. He should get more growth over the next 5 months as all of the new hairs start to grow. I will post some more photos of him when he comes back for follow up again.

    Dr. N

    https://drnakatsui.com

     

     

    51283165650_a49e643daf_b.jpg

    51283165640_fc50e7270c_b.jpg

    51283165620_e90a02c0ab_b.jpg

     

     

     

     

     

     

     

    51282318158_7a3a50c433_h.jpg

    51283165590_9832f37beb_h.jpg

     

     

     

     

    51281419752_11fe2e525a_b.jpg

    51281399672_a8af67de3b_b.jpg

     

     

     

     

     

  13. Hi everyone, 

    This is a patient who came in recently for follow-up. He had wanted to improve his hairline and we decided to do a FUT procedure. He received 655 single grafts, 692 two-hair grafts, and 44 three-hair grafts, for a total count of 1391 grafts. The after photos are taken approximately 11 months post-op. He is very happy with the improvement so far.

    Dr. Nakatsui

    https://drnakatsui.com

     

     

     

    51083487908_9f49a7701a_b.jpg

    51083487898_8b87febc8d_h.jpg

    51086943426_18a5e20a7d_h.jpg

     

     

     

     

     

    51083487883_111e786b97_h.jpg

    51083487873_6e09fc1c6b_h.jpg

    51087034012_c05d763c58_h.jpg

     

     

     

     

     

    51002016074_374628ca97_h.jpg

  14. Hi everyone,

    This a patient with fine hair who wanted to thicken up his frontal hairline and lower the hairline slightly, as well as thicken up the crown a bit. He came in recenty for follow-up approximately 11 months post-op. He received 1095 single grafts, 1981 double grafts, and 686 three-hair grafts, for a total count of 3762 grafts. He is very happy with the improvement, especially since his hair doesn't look so thin when wet now.

    Dr. Nakatsui

    https://drnakatsui.com

     

     

     

    50985779568_cb121c1cf4_h.jpg

    50985779533_1c2bb328cb_h.jpg

    50985779633_8860bcfc8d_h.jpg

     

     

     

     

     

    50985779403_8695869f8c_h.jpg

    50986486591_7a16b6bd9b_h.jpg

     

     

     

     

     

    50986593047_cfbe229daa_h.jpg

    50986593087_a8c7a057fb_h.jpg

     

     

     

     

    50985779203_cee174dc31_h.jpg

    50985779298_fd13f09871_h.jpg

     

     

     

     

  15. These photos are from a patient who came in recently for follow-up. He wanted to thicken up his frontal scalp as he was finding it too easy to see through his hair. He wanted to be able to cut his hair short so we chose to go with FUE. The frontal hairline was not transplanted but the areas of most significant thinning were targeted. The patient is extremely happy with the improvement so far, approximately 10 months from the date of surgery.

    He received 310 single grafts, 491 two-hair grafts, and 146 three hair grafts for a total of 947 grafts.

    Dr. Nakatsui

    https://drnakatsui.com

     

     

    50891964908_c266e70ede_k.jpg

    50891964888_15bc537e30_k.jpg

    50892792757_393f74c91e_k.jpg

     

     

     

     

    50892792662_b246830cdf_k.jpg

    50892677666_c8eb8e6ec2_k.jpg

     

     

     

     

    50892677696_bb0e041425_k.jpg

    url%5D,%20on%20Flickr

     

     

     

     

     

    50891964758_59b9fcd42d_k.jpg

    50892677616_f3532a364d_k.jpg50892792657_00a52aac02_k.jpg

    • Like 1
  16. This is a patient who came in recently for followup. He had a transplant approximately 11 months ago into the frontal scalp. He received 1232 single grafts, 1640 double grafts, and 428 three-hair grafts, for a total count of 3300 grafts.

    He is very happy with the changes so far. It is interesting to note that the transplanted hair is a bit darker than the surrounding hair and this is a relatively common occurrence in patients who are graying as the donor hair in the occipital area tends to gray or whiten later than the hair in the frontal scalp. If this is too pronounced, then the patient would need to color their hair to camouflage these color differences.

    Dr. Nakatsui

    https://drnakatsui.com

     

     

    50785837562_f08662ec9b_b.jpg

    50785737416_a2229847cc_b.jpg

    50785837537_466a509cd1_b.jpg

    50785737401_c2d19d4633_b.jpg

     

     

     

    [url=https://flic.kr/p/2knLG9p][img]https://live.staticflickr.com/65535/50785837527_a58d9a6494_b.jpg[/img][/url][url=https://flic.kr/p/2knLG9p]5[/url] by [url=https://www.flickr.com/photos/28308587@N07/]t_nakatsui[/url], on Flickr50785837527_a58d9a6494_b.jpg

    50785737381_2cdb9e9884_b.jpg

     

     

     

    50785737371_2d4db772d5_b.jpg

    50784980793_09db8e4456_b.jpg

     

     

  17. This was a patient who originally came in wanting to improve his hairline and frontal scalp. We transplanted 556 single grafts, 1252 double grafts, and 319 three hair grafts, for a total count of 2127 grafts. These photos were taken a few weeks ago and represent approximately 1 year post surgery.

    He is very happy with the results. We may consider doing more transplantation behind the work we have done already in the future.

    Dr. N

    https://drnakatsui.com

    50666591328_c4b5155137_b.jpg

    50667336416_21cd8a408f_b.jpg

    50667336431_8d37417306_b.jpg

     

     

     

     

    50667415622_b68d641b5e_b.jpg

    50667415612_d460ff1507_b.jpg

     

     

     

     

    50667416252_43a9c3d05f_b.jpg

    50666590868_34500e0caa_b.jpg

     

     

     

     

    50666590758_524e7bf1d0_b.jpg

    50666590743_bf5a5d9480_b.jpg

     

     

     

     

    50667355271_aeeb6da106_h.jpg

    50666590693_a7cefb0421_b.jpg

    50667415402_f0bd265ca7_b.jpg

    50667355246_658b683dbb_h.jpg

×
×
  • Create New...