Dr. Thomas Nakatsui

This was a patient who came in last week for follow-up. We did a transplant on him about 5-6 years ago and what he wanted at the time was to repair a previous transplant done several years prior by another physician. We touched up his hairline with 391 single grafts, 780 double grafts, and 101 big grafts, for a total count of 1272 grafts.

He still has some pitting from the mini-micrografting he had received previously but this is much less noticeable than it was before. We could have transplanted in front of his previous multi-follicular unit grafts (and still could) but he is happy with where his hairline is sited. Another option today might be to extract the pitted grafts.

At this time, he would like to thicken up the area posterior to the grafted area as this has started to thin a bit.

I also have some immediate post-op photos if anyone is interested.

Dr. Nakatsui

PREOPERATIVE PHOTOS

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POSTOPERATIVE PHOTOS

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This patient came in last week for follow-up. When I saw him about 10 months ago, he was interested in thickening his hairline but he was most interested in thickening his temples because that is where he noticed the most thinning and recession. We used 226 single grafts, 455 double grafts, and 222 big grafts, for a total count of 903 grafts.

Dr N

PREOPERATIVE PHOTOS

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IMMEDIATE POSTOPERATIVE PHOTOS

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POSTOPERATIVE PHOTOS

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David,

Thanks for the comments. I believe he is not taking Propecia at this time.

Dr N

In all patients, we need to consider the possibility of progressive hair loss and this is especially the case in the vertex as hair loss can occur around the entire 360 degree border of the transplanted area. In my office, we discuss this possibility with every patient, particularly those contemplating a hair transplant into the crown area.

In this case, the patient wanted to fill in the crown area and we used 434 single grafts, 865 double grafts, and 228 big grafts, for a total count of 1527 grafts. I had not seen him in many years but he came in a few days ago and told me that it grew in great but has started to thin at the edges. As you can see from the photos, even though the patient had fine hair, the transplanted area filled in nicely but he has had some thinning around the periphery of the transplant over the years.

At this point, the patient is happy with the current state but understands he may very well have to return at some point to fill in the periphery.

Dr. N

PREOPERATIVE PHOTOS

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IMMEDIATE POSTOPERATIVE PHOTO

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POSTOPERATIVE PHOTOS

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Loags79 and David - TakingThePlunge,

Thanks for the comments!

Dr N

Unlike many patients who require a large number of grafts, this was a patient who didn't want to change his hairline very much. However, he felt that his hairline was thinning and wanted to fill in the thinned areas of the frontal hairline and temples.

He received 204 single grafts, 466 double grafts, and 214 big grafts, for a total count of 874 grafts

He is very happy with the improvement in his hairline and is about 10 months postop.

Dr. Nakatsui

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IMMEDIATE POSTOPERATIVE PHOTOS

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TEN MONTHS POST-OPERATIVE PHOTOS

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This is a young woman who always had a very weak area in the mid frontal hairline. She had never been able to pull back her hair without exposing the weakness of the frontal hairline. She came to me requesting a widow's peak and wanted to get rid of her "cowlick". In the preoperative photos, you can see that her hair direction is predominantly directed backwards as opposed to forwards in the mid frontal hairline.

Following or opposing a cowlick is sometimes a difficult choice. If a lot of strong hair persists, one might have to follow the cowlick but then the patient would permanently retain the cowlick direction. In this case, we decided to oppose the cowlick as per her wishes.

We did a small transplant of 150 grafts: 70 singles, 70 doubles, and 10 bigs to the frontal forelock and directed the grants predominantly forward in the area of concern.

Here are her 8 month results. Of note, the transplanted hairs are a little darker than some of the pre-existing hairs. She may have to lighten some of these hairs to match the rest for the time being. Over time, these hairs may also become a little finer as newly growing hairs often come in coarser for a while.

Dr. Nakatsui

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POSTOPERATIVE PHOTOS

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This is a patient who wanted to fill in his frontal scalp. He had retained his frontal forelock quite well but lost a lot of the rest of the hair on the front on his head. He was particularly unhappy with the U-shaped bare area behind his frontal forelock.

We transplanted 99 single grafts, 982 double grafts, and 537 big grafts, for a total count of 2218 grafts. We did not touch the frontal forelock as he merely wanted to fill in the U-shaped area behind the forelock and wanted the hair to blend in. The results are 9 months after the surgery.

Dr. Nakatsui

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9 MONTHS POST OP

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This patient received 806 single grafts, 1381 double grafts, and 718 big grafts, for a total count of 2905 grafts approximately 12 months ago. He came in for follow-up this week and told me the hair transplant has definitely changed his life. He feels so much better in the morning when he looks in the mirror. Although many men prefer that no one knows about their transplant, he tells me he is not shy about telling others about it.

Dr Nakatsui

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POSTOPERATIVE PHOTOS

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This is a patient who was complaining of thinning around the frontal forelock area. His frontal forelock itself was strong but the area behind and around it was thinning. I treated him with 379 single grafts, 1151 double grafts, and 563 big grafts, for a total count of 2043 grafts. You can see in the immediate post-op photos where he was transplanted.

I took photos 8 months postop and again 2 years after the procedure. When he came back two years postop he had noticed further hair loss in the vertex area and we recently transplanted the vertex for him.

He is very happy with the improvement and is looking forward to growth in the vertex.

Dr Nakatsui

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IMMEDIATE POSTOP

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EIGHT MONTHS POST OPERATIVE PHOTOS

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TWO YEARS POST OPERATIVE PHOTOS

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Spanker,

Thanks for the comment!

Dr Nakatsui

This is one of my patients who came in recently for a refill on his finasteride. Five years ago, we had done 256 single grafts, 603 double grafts, and 287 big grafts, for a total count of 1146 grafts to the temples and a little to the area just behind the frontal forelock. He wanted to fill his temples in but didn't want to lower them too much. He is very happy with the results and is happy that it continues to hold up well over the years.

Dr N

PREOPERATIVE PHOTOS

PREOPERATIVE PLAN & IMMEDIATE POSTOP

FIVE YEARS POSTOP

This is a patient who came in last week. Several years ago, he had wanted some minor work on his temples. He had a procedure in 2012 and received 154 single grafts, 321 double grafts, and 125 big grafts, for a total count of 673 grafts.

He is very happy with the results and is aware that he may need to return in the future if he should lose hair behind the transplanted areas.

Dr. Nakatsui

PREOPERATIVE PHOTOS

IMMEDIATE POSTOPERATIVE PHOTOS

TWO YEARS POSTOPERATIVE PHOTOS

Thanks for the comments!

As you say, he definitely has a lot of donor hair available for future transplants if necessary but is content for the time being.

Dr. N

HI,

This is a patient who had hair rrestoration surgery in 2006. He wanted to fill in the crown and the frontal scalp with minimal thickening of the midscalp. He received 2095 single grafts, 1901 double grafts, and 423 big grafts, for a total count of 4419 grafts.

His transplant has held up very well over the last 8 years and he is very happy with his results.

Dr. Nakatsui

PREOPERATIVE PHOTOS

8 YEARS POSTOPERATIVE PHOTOS

This is a patent who came in for follow-up last week. He had his transplant approximately 2 years ago. He wanted to thicken up the frontal scalp and was not so concerned about the crown.

He received 1186 single grafts, 1693 double grafts, and 777 big grafts, for a total count of 3656 grafts.

He is very happy with the results. Eventually we may consider thickening up the lateral humps--he already has some grafts here but he may lose more hair in this area over time.

Dr Nakatsui

PREOPERATIVE PHOTOS

IMMEDIATE POST-OPERATIVE PHOTOS

POSTOPERATIVE PHOTOS

Hi all,

This is a patient who came in last week for follow-up. When he initially came in, he wanted to thicken up the frontal 2/3 of his scalp. He received 869 single grafts, 1714 double grafts, and 610 big grafts, for a total count of 3143 grafts. He is currently over 10 months out and is doing very well.

Thanks for checking out the photos.

Dr. N

This is patient who came in last week. He had a transplant 4 years ago in the temples. He was in his 20s and was troubled by the recession. After discussing the issue of progressive hair loss in detail, we decided to proceed although he was aware of the risks of future hair loss.

He has been very pleased by his new hairline. He received 336 single grafts, 407 double grafts, and 224 big grafts, for a total count of 967 grafts as you can see in the photos.

He is now experiencing some thinning of the frontal forelock area and I expect that we will eventually have to fill this in for him. However, for the time being, he is very happy and is very grateful for the increased confidence this has given him for the last 4 years.

Dr N

PREOPERATIVE PHOTOS

IMMEDIATE POSTOPERATIVE PHOTOS

4 YEARS POSTOPERATIVE PHOTOS

This is a patient who was thinning a lot in the frontal scalp. We transplanted 663 single grafts, 1066 double grafts, and 395 big grafts, for a total count of 2124 grafts.

He is very happy with the improvement he has had. He is about 10 months post-op in these photos and should expect additional thickening over the next 4-6 months.

Dr N

PREOPERATIVE PHOTOS

POSTOPERATIVE PHOTOS

This is a patient who wanted to fill in his temples quite a bit and effectively wanted to square off his frontal hairline. In many patients I am reluctant to do this too aggressively as we cannot always predict the extent of future hair loss. However, this patient presented in his early 40s with fairly localized, defined areas of hair loss with absolutely no weakness of the hair elsewhere. As a result, I felt his chances of future aggressive thinning was low and I decided to fill in his temples as he desired.

We transplanted 449 single grafts, 861 double grafts, and 693 big grafts, for a total count of 2003 grafts into his temples. His after photos show his hair growth after 6 months. His newly transplanted hair has already grown quite a bit, although we can definitely expect more growth over the next 6-8 months.

As many of you are aware, the new hair often grows in a bit coarser and wavier than usual, but this usually settles over time. I think there is a small area of weakness that has yet to grow in well yet along the right frontal hairline, but there are still many months to go and this hair should eventually wake up.

Dr N

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IMMEDIATE POSTOPERATIVE PHOTOS

SIX MONTH POSTOPERATIVE PHOTOS

This is a patient who came in about 5 years ago wanting some general thickening of his hair. He wanted to spread the grafts out over a fairly wide area as he felt his hair was progressively thinning and he didn't want to go bald before doing something about it.

Unfortunately, he never came back after one year for follow-up so I do not have those photos. He now returns as he notices it is starting to thin again and may want to thicken up some areas.

Five years ago, he received 1127 single grafts, 1644 double grafts, and 736 big grafts, for a total count of 3507 grafts.

Dr N

FRONT VIEW--BEFORE AND AFTER

RIGHT SIDE VIEW-BEFORE AND AFTER

TOP VIEW-- BEFORE AND AFTER

IMMEDIATE POST-OPERATIVE VIEW

This is a patient who came in recently 9 months following his surgery.

He had fine hair and he wanted to lower his hairline and fill in his vertex. We did a transplant consisting of 689 single grafts, 1447 double grafts, and 703 big grafts, for a total count of 2839 grafts.

His 9 month results are shown here and his results should continue to improve over the next 6-9 months. Although he is already very happy, I think he will be even happier once it has fully grown in.

Dr N

PREOPERATIVE PHOTOS

PLAN AND IMMEDIATE POST-OP

NINE MONTHS POST OP

Thanks for the comments!

Dr N

This is a patient who came in this week for followup. He had received his transplant in 2005 and received 716 single grafts, 781 double grafts, and 353 big grafts, for a total count of 1850 grafts. He was particularly unhappy with the two horns of hair he had and wanted to restore his hairline.

He is still very happy 8 years later and I think the transplant has held up very well.

Dr N

PREOPERATIVE PHOTOS

EIGHT YEARS POSTOPERATIVE PHOTOS

Thanks for the comments, everyone!

Dr N