Dr. Thomas Nakatsui

This patient came in wanting a transplant into the frontal 1/2-2/3 of the scalp. I recommended that he should receive about 2400-2500 grafts and possibly more if wanted to transplant more posteriorly into the vertex. For a variety of reasons, he wanted to limit the transplant to about 1400-1500 grafts and we decided to spread out the grafts a bit to get more coverage with less grafts. This was done about 2 years ago. It turned out well and he was happy, although we have recently gone back and done a 2nd transplant into the left temple as he combs his hair from left to right and wanted to reinforce this area. In addition to the left temple, we reinforced his mid scalp and vertex. I will post photos when he returns for follow-up. I think this transplant shows that slightly lower densities can be suitable for many patients but there will be some patients that realize they want more density. In his first transplant 2 years ago, he received 336 single grafts, 829 double grafts, and 410 big grafts, for a total of 1575 grafts. Dr N PREOPERATIVE PHOTOS POSTOPERATIVE PHOTOS

RCWest and Dutch, Thanks for the responses. In general, women are more concerned than men about their hair loss, as it is more socially acceptable to see a balding man than a balding woman. Over the last 12 years in my practice, I have definitely seen a significant increase in the number of women getting hair transplants, although men still account for the majority of my patients by far. Thanks again, Dr N

We are seeing more and more female patients all the time. I tend to keep sessions smaller in women, usually no more than about 1200-1300 grafts to try to keep down the risk of shock loss, which is much more common in women than in men. She received 305 single grafts, 664 double grafts, and 350 big grafts, for a total count of 1319 grafts. Her results are about 11 months after her surgery. She was very happy as she no longer worried about the wind blowing apart her carefully combed hair. Dr N PREOPERATIVE PHOTOS POSTOPERATIVE PHOTOS

Badbeat, StaggerLee123, TakingThePlunge, Thank you for your comments. I do appreciate them. Dr N

This is a patient whom I saw in 2010 and he recently came in for follow up. We had placed 2671 grafts into the frontal scalp and these are his 2 year results. He had received 987 single grafts, 1413 double grafts, and 271 big grafts. He was very pleased with the results. Dr N PREOPERATIVE PHOTOS POSTOPERATIVE PHOTOS

hairthere and Cant decide, Thanks for the comments. I appreciate it. Dr N

This is a patient who wanted to reestablish his hairline and fill in the frontal scalp. He also had thinning in the frontal scalp and vertex but decided to focus on the frontal scalp. He had his transplant about 12 months ago. He received 467 single grafts, 1232 double grafts, and 796 big grafts, for a total count of 2495 grafts. He had fine hair but still did well. These are his photos. Thanks, Dr N

This is a patient who wanted to thicken up his crown. He did not want to take finasteride so we transplanted him back in 2007. He came in a few weeks ago for follow-up and he was very happy about his results. He received 499 single grafts, 662 double grafts, and 149 big grafts in between his native hairs, for a total count of 1310 grafts. Dr. N PRE-OPERATIVE IMMEDIATE POST-OP 4 YEARS POST OP

This is a patient we did about 7 years ago who came in for followup a few weeks ago. He received 707 single grafts, 1060 double grafts, and 696 big grafts, for a total count of 2463 grafts. Thanks, Dr N PREOPERATIVE PHOTOS POSTOPERATIVE PHOTOS

This is a patient that we did surgery on about 3 years ago who came in for followup last week. This a woman who just wanted to strengthen her frontal hairline. She felt that it was thinning and felt self-conscious about her hair. She received 1356 grafts to the frontal hairline and temples (357 singles, 795 doubles, and 294 bigs). Dr N PREOPERATIVE PHOTOS FOLLOWUP PHOTOS

HAIRIRI, I appreciate your comments. Glad you like it. Dr N

Cant decide, Thanks for the comments. I will post an immediate post-op pic for you. Dr N

This patient came in about 1 year ago and wanted to fill in the vertex and frontal hairline. He had quite a large area in the vertex that was very thin in addition to milder thinning throughout the midscalp. Ideally, we would have filled in the entire area but for a number of reasons, we were limited to about 3000 grafts. We decided to restore his hairline and thinly fill the vertex. In the future, he may return to fill in the mid scalp. We used 967 single grafts, 1471 double grafts, and 514 big grafts, for a total count of 2952 grafts. Dr Nakatsui

RCWest and alexdelarge, Thanks for your positive comments! I do appreciate them even though I only visit the forum infrequently. Dr N

Hi all, This a patient I transplanted about 3 years ago. He came in for followup last week. He received 288 single grafts, 886 double grafts, and 401 big grafts, for a total count of 1565 grafts. We transplanted his hair line and in particular the temples. I have a lot of closeup photos for you. Thanks, Dr. N RIGHT SIDE PRE AND POST WITH CLOSEUPS LEFT SIDE PRE AND POST PROCEDURE

I frequently get asked if transplanted hairs will grow well in scar tissue. This is a woman who came in several weeks ago to see me in follow up and she was 1 year post surgery. She had previously received several pluggy grafts many years ago and was unhappy with the appearance. Last year, she received 101 single grafts, 171 double grafts, 73 big grafts, for a total of 345 grafts. As you can see in the 1 yr post op photos, the grafts follow her natural hair direction and have grown well, and the patient is very happy that she no longer has to be concerned about that area becoming exposed to others. In the closeup, you can still see the scar tissue surrounding the transplanted follicles. The other option in this case would have been to simply excise the scar tissue but we decided to transplant it instead. I do warn patients that growth rates in scar tissue may be less than in virgin scalp, but that there is still excellent take despite the impaired vascularity of the tissue. Dr N PREOPERATIVE PHOTOS IMMEDIATE POST-OP (my apologies for the blur) 1 YEAR POST-OP PHOTOS

Blake, Thanks for the comments. It is very gratifying to see that his transplant has stood the test of time. He is very happy (as am I). Dr N

This is a patient I did in 2004. At that time, we did 1836 grafts into the temples and crown with the majority going into the crown. At that time, I was using a polaroid camera (hard to believe how things have changed) so these are the best photos I have. He has also colored his hair in the interim but I think you can see the results 7 years after the procedure. Dr. N Crown pre-op, 1 year post op. and 7 years post op Left temple pre and post Right temple immediate post op and 7 years post op

This is a patient who wanted to fill in his temples. He had finer hair so we wanted to pack in quite a bit to give density. In the after photos, he is about 10 months post op. As usual, you can click on the photos to see them in higher resolution. He received 154 single grafts, 441 double grafts, and 403 big grafts, for a total count of 998 grafts. Thanks, Dr N

Jotronic and TakingthePlunge, Thanks for the comments! Dr N

This is a patient who came in a few days ago. We did a transplant in 2007 and I unfortunately can't seem to find the OR report. I believe we did approx 3800 grafts, possibly 4000. I will continue to search and will post the grafts numbers if I can find them. I was pleased with the density given the fact that his hair is very fine. Dr N

This is a patient who just wanted to thick his temples and his vertex as he was becoming very self-conscious about the recession in his temples and the thinning of his crown. He received 323 single grafts, 806 double grafts, and 431 big grafts, for a total count of 1560 grafts about 8 months ago. He came in today for follow-up and here are his before and afters. His hair should continue to thicken over the next 6-8 months. Dr. N

This is a patient who wanted to strengthen the frontal scalp and re-establish his hairline. In 2006, he received 417 single grafts, 906 double grafts, and 509 three hair grafts for a total of 1832 grafts. Dr N. http://www.drnakatsui.com PREOPERATIVE PHOTOS POST-PHOTOS

The number of grafts depends upon how much of the area he wants covered and how dense he would like his results to be. I recommended 2400-2600 grafts to fill in the rest. Thanks for the question, Dr N

C, Sorry for the late reply. I did not realize I had not listed the graft numbers. Sorry. In 2005, he received 348 single grafts, 718 double grafts, and 623 big grafts. All the best, Dr N