Dr. Thomas Nakatsui

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

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

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

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 EIGHT YEARS POST-SURGERY

Melvin, Dillpickle, Whereismymind, Steeeve, Shiba, Andy, Sorry for the late replies, everyone. Thank you all for your wonderful comments! 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. 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

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

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

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

Melvin, JC71, follically challenged, digi23. Thanks so much for your comments!! Dr. Nakatsui

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) LEFT SIDE VIEW (Pre-->Post) RIGHT SIDE VIEW (Pre-->Post)

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

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

Melvin and JohnAC71, Thank you so much for the comments! Dr. N

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

JohnAC71 & Gatsby, Thanks so much for your comments. Much appreciated! Dr. N