Dr. Thomas Nakatsui

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

Hi, This is a patient who came in last week and who had received 4647 grafts approximately 15 months ago. He received 1177 single grafts, 2438 double grafts, and 1032 big grafts, for a total count of 4647 grafts. Interestingly, he had a widow's peak that was offset to one side and therefore we followed this. He was very happy with the results. Dr N PREOPERATIVE PHOTOS OUTLINE OF PLAN WITH LOWERED HAIRLINE IMMEDIATE POSTOP 15 MONTHS POST OP

This is a patient who had his crown done about 5-6 years ago and was very happy with the improvement. However, over the last 5 years, he has noticed some thinning around the edges of the transplant, particularly the right frontal edge and returned to me this past week for consideration of further transplantation to fill in the thinning areas. He was aware of this possibility prior to the first transplant. His first transplant involved 276 single grafts, 520 double grafts, and 186 big grafts, for a total count of 990 grafts. I think this case demonstrates that a very natural result can be obtained and that the patient must be made aware of the potential and likelihood of future hair loss before embarking on the first transplant. Dr N PREOPERATIVE PHOTOS POSTOPERATIVE PHOTOS

This is a patient who had thinning of the temples, mid scalp, and crown who wanted to fill in the temples and mid scalp. We left the frontal forelock area alone for the time being as the hair was still strong there. He received 379 singles, 1151 doubles, and 563 big grafts for a total of 2043 grafts in 2010. He returned just recently to fill in the crown as well and I will submit these photos as well once they have had a chance to grow. Dr N PREOPERATIVE PHOTOS IMMEDIATE POSTOPERATIVE PHOTO POSTOPERATIVE PHOTOS

This patient received a hair transplant about 6 months ago and returns today for consideration of an additional transplant. He received 1037 singles, 1788 doubles, and 500 big grafts, for a total of 3335 grafts. He has already had excellent growth for 6 months (as it usually takes 12 months or more to achieve full growth), and hence more growth can be anticipated over the next 7-9 months. Dr N PREOPERATIVE PHOTOS IMMEDIATE POSTOPERATIVE PHOTOS 6 MONTH POSTOPERATIVE PHOTOS

Hi Mustard, Good questions. Firstly, in these post-operative photos, he has not yet had a second session. These results are from 7 months after his first session of approx 3000 grafts. Secondly, transplanted hair can initially grow in coarser then slowly soften over time. The wiry nature goes away as the hair softens. Hope this answers your questions. Dr N

This is a patient with significant hair loss who wanted to restore his hairline. Based upon the number of grafts he wanted to use and his scalp laxity, we decided upon a conservative hairline and decided to use the grafts in the frontal half of the scalp. He received 1072 single grafts, 1675 double grafts, and 291 big grafts, for a total count of 3038 grafts. Interestingly, he had very few 3 hair grafts and a relatively large number of single hair grafts. He was very happy with the early results and recently returned to my clinic interested in filling in the mid scalp. His hair will likely gradually thicken a bit more with time. Dr N PREOPERATIVE PHOTOS POSTOPERATIVE PHOTOS

Future_HT_Doc, Thanks for the comments! Dr N

This is a patient who came in two weeks ago as he wants to do more transplantation behind what we did previously. Before seeing me, he had received some punch grafts and wanted to make them look more natural. We discussed several options, including cutting out the old grafts versus transplanting around them and we decided to transplant around them. Approximately two years ago, we transplanted 340 single grafts, 742 double grafts, and 239 big grafts, for a total count of 1321 grafts. He is very happy with the results but would now like to transplant into the area behind the previously transplanted area. Thanks, Dr N PREOPERATIVE PHOTOS IMMEDIATE POST-OP PHOTOS TWO YEARS POST OP PHOTOS Dr Nakatsui.

Hi Bill, Thanks for your comments. Fortunately for this patient, he does not have a family history of significant hair loss so the odds seem to be in his favor at this point. I did discuss finasteride and minoxidil with the patient at his initial consultation, as I do with virtually all patients. I cannot recall whether he is on either of these medications at this time, but he is aware they may be helpful in delaying further hair loss. Thanks, Dr N

Thanks for all the comments. I appreciate the positive feedback and the patient is indeed very happy with his results. Further to the question regarding potential risks, I think that TommyLucchese addressed this very well. In general, the more aggressive (i.e. youthful) the hairline desired, the more risky it is to have it done. Firstly, aggressive hairlines use up a lot of grafts that you can never get back. Secondly, people who maintain dense, youthful hairlines generally have good hair all over and look odd if they have thinning of the crown in the presence of a low frontal hairline. On the other hand, if they have a dense but less agggressive/youthful hairline, they can get away with thinning of the crown without much difficulty. If there is minimal future hair loss, there is no real difficulty in touching this up. However, if there is significant future hair loss, this can be a problem if the patient has insufficient donor numbers, density, or laxity (although FUE may be a way around insufficient laxity). This is the gamble that patients face when lowering the hairline at a (relatively) young age. Don't know if this is clear or not, but this is how I think about it. Thanks, Dr N

Hi all, This is a patient who recently came in for follow-up a little over one year post op. He was a young man in his 20s who was concerned about hair loss in the temples and temple points. This is the type of patient that I am very cautious with as there is a risk that transplanting these areas can eventually lead to an unnatural appearance that cannot be fixed. In this case, this patient was very concerned with his hair loss. He always wore a hat and avoided situations where he would have to take his hat off. It was affecting how he lived his life. He did have a lot of things going for him as there was no family history of significant hair loss and the rest of his hair was great with good density and coarseness of the hair throughout the rest of his scalp. After discussing the potential risks of doing this transplant in detail and after giving this considerable thought, he decided he wanted to proceed with the procedure. We performed a transplant of 440 single grafts, 874 double grafts, and 217 big grafts, for a total count of 1531 grafts. He was extremely pleased with the results and remains comfortable with the risks. I have attached his photos below. Dr N FRONTAL VIEWS RIGHT SIDE LEFT SIDE VIEWS TOP VIEWS ADDITIONAL IMMEDIATE POST OP VIEWS

SADbutTRUE, Future_HT_Doc, and Ireland78, Thanks for your comments! I do appreciate them. Dr N

This patient came in last week for a refill on finasteride. He had a transplant in 2009. He is still extremely happy with the naturalness of the results and I thought I would show his results. He had a transplant to the frontal hairline and vertex. He received 542 single grafts, 1405 double grafts, and 668 big grafts, for a total count of 2615 grafts. Dr N PRE-OPERATIVE PHOTOS POST-OPERATIVE PHOTOS FINAL PHOTOS

Hi, This patient came in last week for a refill for some medications. He received a transplant in 2008 for restoration of his temples. He received 220 single grafts, 489 double grafts, and 93 big grafts, for a total count of 802 grafts. His hair was coarse and his transplant has done well over the last 4 years. Dr N PREOPERATIVE PHOTOS IMMEDIATE POST OP FOUR YEARS POST OP

TakingThePlunge, Thank you very much for your comment. Although many patients come in with extensive hair loss, there are many who are interested in smaller procedures, such as temple restoration. Dr N

This is a patient who didn't like the recession of his temples and had a transplant about 6 months ago. He had fine hair and he received 94 single grafts, 412 double grafts, and 173 big grafts, for a total count of 779 grafts. In the future, he may proceed with further transplantation but he is very happy with the improvement so far. Dr N

This patient had received two transplants elsewhere using multi follicular unit grafts (MFUGs or minigrafts) to the frontal hairline. He was not satisfied with the results and wanted to improve them. For a variety of reasons, we decided to merely thicken what was there rather than lower the hairline slightly so we could completely camouflage the previous grafts. Despite this, I think we were overall successful although there are still a few thicker grafts visible near the hairline. These could be removed via FUE if desired (or the hairline could be lowered slightly) but he is very happy with the results and is no longer self-conscious about his appearance. He had the surgery done 2 years ago and received 366 single grafts, 543 double grafts, and 225 big grafts to the frontal hairline. Dr N PREOPERATIVE PHOTO POSTOPERATIVE PHOTOS

Levrais, Slickers, Cantdecide, and JustOne, I very much appreciate your comments! Thank you. Dr. Nakatsui

BadBeat and chrisdav, Thanks a lot for your comments. Dr. N

This is a patient who came in for follow-up a few weeks ago. He had wanted to thicken up the frontal scalp. Two years ago, he received 810 single grafts, 784 double grafts, and 242 big grafts, for a total count of 1835 grafts. Dr N FRONTAL VIEW LATERAL VIEW

cant decide, Thanks for your comments! Dr N

Hi, This is a patient who wanted some thickening of the frontal scalp and a little in the crown. We transplanted 703 single grafts, 1687 double grafts, and 810 big grafts, for a total count of 3200 grafts in one session. The postoperative photos were taken about two years after the transplant. Dr N PREOPERATIVE PHOTOS IMMEDIATE PRE-OPERATIVE PHOTOS WITH PLAN IMMEDIATE POST-OPERATIVE PHOTOS TWO YEARS POST OP PHOTOS Thomas Nakatsui, MD FRCPC

This is a patient who came wanting some thickening of the frontal scalp. He had some thinning hair and wanted to thicken it up so that it didn't become bald over the next few years. We did a small transplant comprised of 332 single grafts, 705 double grafts, and 246 big grafts, for a total count of 1283 grafts. He had a cowlick in the right frontal hairline that we kept as he had too much preexisting hair to ignore it. Attached are the preoperative and postoperative photos. The last photo is a closeup that demonstrates that the newly implanted hairs can be transplanted without injuring the preexisting hairs. Dr N PREOPERATIVE PHOTOS POSTOPERATIVE PHOTOS