Dr. Thomas Nakatsui

This was a patient who was noticing loss to the temple areas, as well as thinning of the frontal scalp. He wanted to thicken up these areas and we did a small FUE session to fill these in.

He received 135 single grafts, 632 double grafts, and 79 three hair grafts, for a total count of 836 grafts. He has very well so far for a relatively small procedure. Attached are his before and after photos.

Dr. Nakatsui

https://drnakatsui.com

FRONTAL VIEW

RIGHT SIDE

LEFT SIDE

TOP VIEW

This is a patient who really wanted to thicken up his frontal scalp. We transplanted 2362 grafts (561 single hair grafts, 1353 two-hair grafts, and 448 three-hair grafts) to the frontal scalp.

He is extremely happy with the improvement in the appearance of his hairline.

Dr. Nakatsui

Hair Transplant Surgery Clinic located in Edmonton, Canada

andy_+_+,

Sorry for the late reply but thanks for the feedback!!

https://drnakatsui.com

This is a patient who wanted to thicken up the frontal scalp. He came in last week for follow up and is currently 7 months post surgery. He is exceedingly happy with the rapid growth and can expect more growth in the coming months.

He received 810 single grafts, 1251 double grafts, and 450 three hair grafts, for a total count of 2511 grafts.

There are also photos of the thin scarline at the end of the photos. Thanks!

Dr. Nakatsui

https://drnakatsui.com

SCARLINE PHOTOS

Thanks for the comment and sorry for the late reply!  I agree he has thinned out more, which is to be expected over time (in this case, 5 years). He has thinned around the periphery of the transplanted area, as well as the pre-existing hair that was present prior to the transplant. 

At this point, I do not think he wants to add more density. He is comfortable with a mildly thinned look for his age. He just did not want to look bald in the vertex area, which he would have had he not done a transplant.

If we were to thicken the surrounding hair and the transplanted area, I think 1500 grafts would be a good number.

Thanks again for the comment.

Dr. N

Spanker,

Thanks for the comment! Sorry for the really late reply. He is very happy with the increased density of the hairline.

Dr. Nakatsui

https://drnakatsui.com

This is a patient who had thinning of the vertex of his scalp (i.e. the crown) and he wanted to restore it so that it looked better although he didn't want it too thick so that it looked odd when the hair eventually thinned around it. We transplanted the crown for him using 406 single grafts, 555 double grafts, and 209 three hair grafts, for a total of 1170 follicular unit grafts. In the photo showing our plan, you can see we first mapped out the hair direction and angle, as well as the primary area of hair loss.

The hair grew in well but in the post op photos, you can see that his hair has turned white over the last few years, except for the transplanted hair. If it were not for this difference in hair color, it would be difficult to tell he had a hair transplant. This also illustrates the concept of donor dominance as the donor hair was taken from the occipital scalp, which usually turns white later than the rest of the scalp. As a result, hair transplant patients should expect that the transplanted hair will usually turn white later than the surrounding natural hair.

In this circumstance, patients will often color their hair until the hair color evens out.

Dr. Nakatsui

Hair Transplant Edmonton

This is a bit of a different case than I usually present but this is a man who had very extensive hair loss, Norwood 6, and who wanted to restore some natural looking hair to his head. If I recall correctly, he had previously worn a full hair system but no longer wanted to do so. However, I informed him that we could not give him high density and cover all of his head as I was certain he did not have enough accessible donor hair to fill in all of these areas from frontal hairline to vertex, particularly if he wanted a lower hairline, as the balded vertex area was very wide and would have required a very large number of grafts. I informed him that (1) we could try to fill in everything at low density (which I did not think would look good as it would be spreading the paint far too thin, so to speak), (2) we could fill in the frontal scalp with high density (and possibly a lower hairline) and leave the rest (requiring him to use a hair system for the remainder of the bald area as it looks odd to have a thick frontal hairline and bald vertex), or (3) we could do something called a frontal forelock pattern for the frontal scalp where he may or may not decide to wear a hair system to cover the remaining bald area.

Some of you may be aware of this pattern but for the sake of others, a frontal forelock pattern consists of a thicker frontal forelock area to provide density. As we go laterally from the frontal forelock, the density diminishes before gradually increasing as it approaches the temples and temporal humps. This pattern emulates a pattern of hair loss that exists in nature so it still looks natural while not requiring large numbers of grafts. In his case, he liked this idea as he was willing to consider wearing a hair system in the vertex area to keep that area covered if he wanted.

Just under one year ago, we did his frontal forelock transplant and used a total of 694 single hair grafts, 1583 double hair grafts, and 524 three hair grafts, for a total of 2801 grafts. We considered lowering his hairline more but it would have required a minimum of 1000 grafts to do so to any significant degree and we decided not to use/spend any more precious grafts to do this as he might want to use any additional grafts to go more posteriorly in the future.

He came in last week and has had quite a significant improvement. He is very happy with the result!

Although this is not the typical case we do, it shows how sometimes a patient may not go for high density throughout and/or may not go for a low hairline as there are many factors that need to be considered. In some cases where there is insufficient supply to meet the demand, we sometimes have to selectively choose areas where lower density will still look natural.

If you analyze the photos, you can appreciate the difference in density between the more densely transplanted frontal forelock and the thinner areas lateral to the forelock. I think that when using this pattern, it is important to dense pack the forelock to make that area look thick. In my opinion, it really does not look as good if the forelock looks thin. In addition, we also had to thicken up his temporal humps a bit as they were showing some definite weakness, particularly posteriorly.

Dr. Nakatsui

This is a patient who came in a few weeks ago and it has been over six years since his hair transplant. It is great to see how well these hold up over the years. He had a transplant to the frontal scalp and vertex and he received 689 single grafts, 1447 two-hair grafts, and 703 three-hair grafts, for a total of 2839 grafts.

He is very happy that the transplant has done so well and lasted so long.

Dr. Nakatsui

This a patient who came in recently for follow-up. He initially came in wanting to thicken up his frontal hairline. He is now about 11 months post op and had received a total of 1612 grafts to the frontal hairline. We transplanted 421 single grafts, 773 double hair grafts, and 418 three hair grafts. He is very pleased with his results so far.

Dr. N

This is a patient who had fairly diffuse thinning from the vertex to the frontal hairline. His primary concern was his frontal scalp and hairline, so we transplanted 3461 grafts to the frontal scalp. He received 939 single grafts, 1958 double grafts, and 564 triple grafts. Of interest, he also had a cowlick along the right hairline that we ended up following.

He came in for follow-up last week and these are his photos approximately 16 months post-op. He is very happy with the results and now wants to do the rest of the thinned areas and he has sufficient donor area to do so.

Dr. N

This is a patient who came in recently for his one year follow-up. He had wanted to fill in the crown and the temples and we did a strip transplant, using 777 single grafts, 1294 double grafts, 496 triple grafts for a total of 2572 grafts.

He is very happy with the improvement.

Dr. N

Hi everyone,

This is a patient who came in last week for follow-up. He had a transplant a little over one year ago and wanted to fill in the frontal scalp. We transplanted 1041 single grafts, 1667 double grafts, and 498 three hair grafts, for a total count of 3206 grafts.

He is very happy with the results so far.

Dr. N

This is a patient who came in last week for follow-up, approximately 2 years after his hair transplant. He had wanted to thicken up his frontal hairline and after deciding on the hairline he wanted, we transplanted 455 single grafts, 859 double grafts, and 554 three-hair grafts, for a total of 1868 grafts.

Here are some pre-operative, post-operative, and two year photos.

Dr. N

This is a patient who first came in concerned about his frontal scalp and we transplanted him about 2.5 years ago. We used 483 single grafts, 1226 double grafts, and 474 three hair grafts, for a total count of 2183 grafts.

He was very happy with the results and we did his vertex and some of his mid scalp about 1 year ago, transplanting 753 single grafts, 1455 double grafts, and 450 three hair grafts, for a total count of 2658 grafts.

He came in about 2 weeks ago for follow-up and we took photos of his current results.

Dr. N

This is a patient who came in a week or two ago for his one year follow-up. He came in concerned about the thinning of his frontal hairline, and in particular, the temples. We transplanted 334 single grafts, 918 double grafts, and 302 triple grafts, for a total count of 1554 grafts into the temples and hairline.

It's not my normal procedure but in this case, I took photos of the slits that I made prior to insertion. I also dyed them with methylene blue to make them easier to see and measured the slits with a ruler. You can also see the change in hair direction on the right frontal hairline as it sweeps quite a bit to the right as he naturally had a cowlick in this area.

He is thrilled with the improvement in his hairline.

Dr. N

This is a patient who came in two years ago for a transplant to the frontal scalp. The total loss of hair in the frontal scalp bothered him and he wanted to rejuvenate his look. We transplanted 745 single grafts, 1596 double grafts, and 571 big grafts, for a total count of 2912 grafts.

He is very happy with the improvement and is considering additional transplantation to fill in posteriorly.

Dr. N

PREOPERATIVE PHOTOS-----------------------------------------------------------------

POSTOPERATIVE PHOTOS----------------------------------------------------------------

** Please note that I have edited my original post because some of the background information on the patient's case was incorrect. I apologize for any confusion. The background information is now accurate.**

This is patient who first came in about 11 months ago. He had already had three hair transplants from another physician using multifollicular units (i.e. mini-micro grafting) and he wanted to improve the look of the previously transplanted areas. He had a tight donor area from the previous three hair transplants, making it difficult to perform a large session. He also had slightly finer hair.

After going through the options, we decided to try to camouflage some the minigrafts and thicken up the frontal scalp behind the hairline.

As a result, we did a small session and placed 460 single grafts, 657 double grafts, and 263 big grafts, for a total count of 1380 grafts just behind the hairline.

He just came in last week and is happy with the progress. For the time being, he is content with the hair being thinner in the areas behind the recently transplanted areas but he may return in the future if the thinning worsens and if his donor area has enough laxity at that point.

Dr. N

PREOPERATIVE

POSTOPERATIVE PHOTOS

This is a patient who was starting to thin in the vertex or crown region and wanted to address it before it got too bad. We decided to fill in the thinning areas of the crown before it got too bad. In this case, we decided to moderately thicken the crown aream ensuring that we followed the natural hair direction.

He received 283 single grafts, 550 double grafts, and 152 big grafts, for a total count of 985 grafts and he is very happy with his progress at 11 months.

Dr. N

This is a patient who came in recently for follow-up, approximately 10 months postop. He had wanted to fill in the frontal scalp and we transplanted 916 single grafts, 1214 double grafts, and 348 grafts. As with most Asians, the number of larger follicular units was relatively small.

He is very happy with the results thus far.

Dr. N

This is a patient who came in a few weeks ago for follow-up. He had wanted to fill in the frontal scalp and we placed 3097 grafts in one session. He received 750 single grafts, 1738 double grafts, and 608 three hair grafts, for a total count of 3097 grafts.

He is very happy with the results so far.

Dr. N

Please excuse the difference in color between the pre-op and post-op photos!

This is a young woman who had some trauma to her scalp a few years ago at a hair salon. Since that time, she always felt uncomfortable as she was so self-conscious about this area and she was afraid that it would be exposed.

We did a small transplant to the area. She received 213 single grafts, 332 double grafts, and 121 three-hair grafts. Despite the scar tissue, the grafts grew very well and she now no longer worries about this area.

Dr. N

This patient received a transplant about two years ago and I previously posted some of his results about one year post transplant. His transplant has continued to mature and thicken and he continues to be very happy with the results but a few weeks ago, he returned and I filled in the mid scalp and crown. I will post those photos when he comes in for follow-up once the hair has had a chance to grow.

To recap, he received 1121 single grafts, 1265 double grafts, and 391 three-haired grafts, for a total of 2777 grafts into the frontal scalp.

Dr. N

TWO YEAR RESULTS:

This patient came in a few weeks ago for follow-up. We had done a transplant on him about 2 years ago. He had wanted to fill in the frontal area as he was developing two horns of hair in the front and was not happy with that situation. We put in 636 single grafts, 1012 double grafts, and 565 big grafts, for a total count of 2213 grafts and he is very happy with the results.

Dr. N

PREOPERATIVE PHOTOS

POSTOPERATIVE PHOTOS (2 YEARS)

pt102_08 by t_nakatsui, on Flickr[/img]

Hi everyone,

This is a patient who came in and was concerned about the progressive thinning of his hair. We decided to fill in the frontal scalp as it was this area that concerned him. He received 596 single grafts, 1440 double grafts, and 536 big grafts, for a total count of 2572 grafts. He is ecstatic about his results so far and his post op photos are about 11 months out.

The funniest part of the story is that his brother also had a hair transplant somewhere else around the same time and received what sounds like a "long hair" transplant where the recipient site was not shaved and the grafted hairs were left long so that you could see the results of the transplant. The brother ribbed my patient about how good his "long hair" transplant looked compared to the short stubble of hair my patient had.

In the end, though, my patient's hair has grown in substantially better than his brothers and you can imagine who is receiving the ribbing now!

FYI, the patient's preoperative photos show that his hair is dyed brown. We had asked him to do this so we could make the recipient sites without damaging his pre-existing, very, very white hair.

Dr. N

PREOPERATIVE PHOTOS

POSTOPERATIVE PHOTOS