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Dr. Michael Beehner

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Everything posted by Dr. Michael Beehner

  1. This 61 year old male presented to our clinic in 2014 and received his first transplant surgery that same year. We placed a total of 2493 grafts ( 2023 FU and 470 DFU's) which totaled to 7154 hairs, due to his greater than average hair density in the donor region. He had a second session three years later in 2017 and then received another 2495 grafts (2145 FU's and 350 DFU's). The "after" photos are one year after that second session. A third session to dense-pack the crown is planned.
  2. This 70 y/o gentleman presented at our clinic in mid 2017 with longstanding hairloss, especially in the vertex and in receding of the front hairline and temple regions. He had two transplant sessions performed by myself one year apart. These "after" photos were taken one year after his second session. Our plan is now to put additional density in the rear crown region, and he will have 1500 FU's placed there next month. The emphasis these first two sessions was on creating a fuller look in the front. We did, however, scatter around 350 FU's each time to begin the process of having "light coverage" back there. Mike Beehner, M.D.
  3. This then 56 year old male was first operated by us in 2006 and had the most recent transplant 4 years ago. He received a total of 7200 FU's, divided into four HT sessions. No DFU grafts were used, only FU grafts, harvested from a strip. His before and after photos make it look almost like he's a different person. I believe he may have had a face lift to make the face look more youthful. And, obviously, hair coloring helped make a difference also. My associate, Dr. Keimun Slaughter, recently performed an initial PRP treatment for him, which is too early to judge now. The two photos with the patient wearing the dark blue jacket were taken the day of his initial consultation visit. One photo shows the densely packed FU sites 10 days after surgery when he came in for his suture removal. He is presently 72 years old and delighted with his results. Mike Beehner, MD.
  4. This then 25 year old male presented to us first in 2013 and a 1569 grafts "Forelock" type pattern was used, to be conservative in case he balded a great deal later on. He had 3 medium-sized sessions in all and was seen 2 months ago, at which time the "after" photos were taken. He is 31 now. If his fringes on the sides remain high as he gets a little older, then we can be more aggressive about filling in his vertex/crown with more density later on. Mike Beehner, M.D.
  5. The two flaps of hair that you see coming in from each side in the front are what were called "Elliott Flaps." They came from the hair on the side of the head and back above the ears. This was then twisted slightly and directed in toward the front to look like a dense front hairline. For the life of me, I can't figure out why there is a full-thickness scar across the front. My hunch is that the surgeon at that time thought and hoped that the two flaps being brought into the front would actually meet each other and constitute an intact hairline, but that it didn't work out as he hoped. Flaps of hair in hair restoration surgery are virtually extinct now. There was a group in California that last performed them, and I'm not aware if they still offer them. They, along with most people that made flaps, most commonly used the TPO flap (temporal-parietal-occipital flap). They kept intact the full length of the artery on the side of the head to make sure this long flap (twice as long as the ones seen on my patient) kept its blood supply. The biggest fault with the flap approach to hair restoration is that it is a terrible waste of the precious donor supply. So many hairs get used in such a small area, whereas with FU transplanting we can spread that same amount of donor hair over a large area and visually create much more overall fill and density. Mike Beehner, M.D.
  6. This 54 year old man was treated for his hair loss with a collection of bizarre surgical procedures on the scalp. He has been very self-conscious of his appearance, and, although well educated, he has been restricted to menial jobs where he can wear a hat all the time. He was limited financially, but we worked out a plan that in a single session would at least make him feel better about his appearance. One of the photos shows the various zones we decided to transplant with the limited donor hair he had available. He received a total of 1340 grafts, of which 1040 were FU's (30% 1-hair; 60% 2-hairs; 10% 3 hairs.) and 300 were small round 1.3mm diameter MFU sites in the large front-central area delineated on the photo showing his plan. He hopes to return for a second session in the coming year. The "after" photos were taken almost exactly one year after his surgery. His initial off-shore surgery was performed 25 years ago. Mike Beehner, M.D.
  7. To review how we refer to grafts larger than being a single follicular unit graft, anything larger than a single FU graft (which usually consists of 1, 2, or 3 FU's) can be referred to in shorthand as a "MFU graft." If someone wants to be more precise, you could name a MFU graft as being either a DFU (double FU) or a TFU (triple FU). In the old days before 1990, these size grafts were just "sliced and diced" under very minimal magnification and were referred to as "mini-grafts." In contrast, a MFU graft by definition is dissected from a strip under 10x power magnification with a stereomicroscope (one which shows three dimensions to the user). That means that, in dissecting out a 4-hair MFU which consists of two 2-hair FU's near each other, that the technician cuts around those two bundles in their natural state, with the exact same distance between them as existed originally on the donor scalp. The hole or slit in which they are then placed must easily accommodate that grafts being placed there. By that, I mean that there should be no compression or "scrunching" of the two bundles so that they are forced to be closer than existed on the scalp. I usually only use these size grafts on first and second HT sessions, and never on a third or fourth, if they end up being performed on a given patient. I only place MFU grafts in the front-central area of the recipient scalp. In multiple research studies performed by myself and others, MFU grafts usually survive at around 100%, as opposed to a 90% average survival of FU grafts. The reasons for this superior survival rate are two: One, there is more tissue around the FU bundles, thus making them less vulnerable to drying or trauma in handling. And second, there are often hidden telogen stage follicles in the tissue that is in between the two bundles, and these often sprout out a hair later that one could not see at the original planting. There are several things I like about using MFU grafts in this front-central area behind the hairline FU grafts. Most importantly, I think they add density and block light from hitting the scalp. The predictable 100% yield which I see is another reason, plus the fact it saves my patients money, since our charge for a 1-hair FU is the same charge as for a 4-hair MFU. Another term which you will see used occasionally is "micro-graft." In the old days, this referred to usually a 1-hair graft which resulted from the non-microscopic "slicing and dicing" of tissue to make grafts. Today, there are still a couple of indications for cutting a 2-hair or 3-hair FU into 2 or 3 separate 1-hair grafts. One is for creating eyebrows transplants. I find that 1-hair micro grafts enable the surgeon to make 150-200 tiny needle puncture openings for the grafts and obtain a more natural result than if larger sites were made and filled with 2 or 3-hair grafts. The second reason for perhaps cutting 1-hair grafts off from larger natural grafts would be if the patient had very few natural 1-hair hair bundles in the donor area and there were not enough of these natural 1-hair grafts to create a fine, natural edge to the hairline in front, where only 1-hair grafts should be used. A 2-hair or 3-hair grafts at the front of the hairline takes the risk of looking "pluggy" and unnatural. I hope the above helps clear up some of this for you. Mike Beehner, M.D. Saratoga Springs, New York
  8. This 41 y/o male presented to Saratoga Hair Transplant Center 2 years ago, and had a single hair transplant session performed by Dr. Keimun Slaughter. The front 2/3rd of the scalp was filled in utilizing a total of 1583 grafts (4427 hairs). Dr. Slaughter has worked at our clinic now for three years and, after a one year unofficial fellowship with myself, was a good learner and possesses a true artistic sense with transplanting hair. I reduced my work load to half-time around 18 months ago and have no plans to retire from performing the surgery I love doing. I discussed this with Bill S at the Network and, in light of Dr. Slaughter’s goal to become “recommended” on this Network, he encouraged us to submit some of Dr. Slaughter’s results as these patients come back after a suitable amount of time passes after surgery. Dr. Slaughter is a facial-plastic surgeon and conducted his fellowship with Dr. Ed Williams in Albany, NY. He spent previous years in surgery residencies at Duke Univ. and the Univ. of North Carolina. Mike Beehner, M.D.
  9. This 35 year old male who lives a few hundred miles away happened to be driving through the Albany, NY area and stopped by the office on a day I wasn't there. He was delighted with his result, and my office manager managed to take the two photos I have attached here. He received 1800 grafts, 450 of which were DFU grafts and the rest were FU grafts. She also noted that his scar was difficult to even find by her (He had a strip harvest). He intends to have a second session for increased density.
  10. This 24 year old male was first transplanted back in 2008, and had subsequent sessions in 2009 and 2015. He visited our office the other day, at which time these "after" photos were taken, and are set next to his original photos in 2008. Many of the men in his family are all bald, which is what I think he would be today, had he not gone the hair transplant route. "Combination grafting" was used in his first two sessions with a total of 660 MFU grafts comprising part of the total 5400 grafts, the rest of which were all FU grafts. In all he received 4740 FU grafts to go along with the MFU grafts. In all, 13,358 hairs were placed in the frontal and midscalp regions. Mike Beehner, M.D.
  11. This 37 year old male presented for his first hair transplant procedure in August of 2017. In total, he received 470 MFU grafts (which were placed in the central area) and 1255 FU grafts, which added up to 4735 hairs. He is returning for a second transplant session for further density in two months. 620 of the FU grafts were placed along the hairline in the first half inch or so, and in front of the MFU grafts. Michael Beehner, M.D.
  12. This 65 year old man over the past 4 years has had three hair transplant sessions. He has an advanced Norwood Class VI or a borderline Class VII pattern of hair loss with an enormous bald area in need of coverage. Overall, he has received 4801 FU grafts and 831 MFU grafts (4-5 hairs each) for a total of 12,067 hairs. Although it is impossible to totally fill in this size of a vertex (crown), I sought to plant "light coverage" through out that area, with the hairs directed in a natural "whorl" arrangement, spinning off of the centerpoint. He has enough strong hair up on top and toward the front, that he is able to style his hair so that many of them are brought backwards over a large part of the crown.The lighting of one of the photos is a little too bright to make out all the detail of the FU's placed back there. He uses a small amount of Toppik also in his styling regimen and says that, when he is done, it looks like a full head of hair from all angles. He plans one more session of around 1500 FU's, which we will mainly place in the crown area in back. Mike Beehner, M.D.
  13. Sean, With follicular unit transplanting cobblestoning and elevation of the scalp in the transplanted area is much more uncommon. The closest case to that description that I recall is this man who many years previous to seeing me had large minigrafts placed across his entire front hairline. Over a few months he said that the whole area raised up and made the very obvious grafts even more unnatural. Because he had a little space in front of this hairline to do something, I was able to place FU's in a relatively dense pattern both in front of and behind the area that featured this cobblestoning and elevation. I will try and attach some photos of his before and after appearance. Mike Beehner, M.D.
  14. In answer to your question about how the previous use of flaps, scalp reductions, and scalp lifts were harmful to the patient's scalp, there are several key issues. Regarding scalp lifts, in order to lift it up as high as this patient's procedure was done, it was usually necessary to cut the occipital arteries and nerves in the back of the head in order to free the scalp up. Obviously, after the scalp is all undermined by the surgeon doing a scalp lift, the bald scalp on top is largely excised away, which is the whole purpose of the procedure, namely to reduce the bald area and move hair up there in its place. All of these scalp procedures, which I listed above, thin out the layers of the scalp, which puts a great strain on the arterial blood supply to the scalp. Probably the most important negative regarding these procedures is that there is a thing called "stretch back" that occurs. What this means is that I may reduce the side-to-side distance of bald scalp on top from 12 cm wide down to 7cm wide, and the photos right after the procedure look wonderful and almost miraculous. However, when the patient comes back in 6 months, the distance across will probably be around 9.5cm, which makes the accomplishment on top a lot less. Scalp flaps are procedures which take a long strip of scalp and it is left attached up near the front upper temple area, swung around and then sewed into place in an area cleared out near the hairline. It uses up too much precious donor hair and puts it in a relatively small area, where instead that amount of donor hair could be cut up into several thousand small grafts and help cover a much larger area. Also, where the flap came from at the side and back of the scalp leaves a fairly wide scar, since the flap is much wider than the typical donor strip, which can be brought together with minimal detection. The other negative on scalp lifts is the large bare area of scalp that now is created above the ears and just behind them. This is obvious in the photos above of my patient. Another big, big negative of all these procedures, is that after you complete them and then want to transplant the bald area that remains, the survival of the grafts is not nearly as good as when they are planted into full thickness scalp that has not been stretched out. I hope the above is helpful. Mike Beehner, M.D.
  15. This 60 y/o male presented to us several years ago, having previously had two scalp lifts/reductions, which raised the hair on the side of his head way above his ears (see two last photos). He also had two transplant procedures with several hundred pluggy grafts each time. Because of the scalp lift, these grafts grew very poorly. He had very little donor hair. Over two procedures three years apart he had 805 FU's the first procedure and 1020 the second procedure. At this latter surgery I obtained half of the grafts using FUE (Safe II system with 0.9mm punch. I spaced the grafts so they would obtain enough blood supply to survive. Mike Beehner, MD.
  16. This 32 year old male who had been wearing a hairpiece for the previous 4 years first came to us several years ago and had three sessions of transplants using both DFU grafts and FU grafts. He continued to wear the hairpiece until the third session grew in 3 years later. It is our policy in our practice for these patients to not wear the hairpiece the first week, since some of the patients that do this have slightly poorer growth for unknown reasons. In the "after" photos, he is not wearing the hairpiece. Mike Beehner, M.D.
  17. Recent photo from above of this 68 y/o patient, plus rear vertex photos from before any HT's, 3 years later (light blue backdrop), and recent photo from same view (light green backdrop). Mike Beehner, M.D.
  18. Sorry about the bad math. It should have read 2880 grafts in total. At that time in my career I did use a lot more DFU and TFU grafts, so that, besides the 1270 FU's listed, multiplying the 1610 MFU's times 2.5 (equal ratio of triple FU and double FU grafts) would give 4025 FU's, for a total of around 5295 FU's. Over the past 10-15 years around 70-80% of the grafts placed are individual FU grafts and 20-30% are MFU grafts (mostly DFU's). Since I have difficulty in adding photos to an add-on message, I will post the following four photos in a new post. I will post a photo of the patient from the top and also a photo from the rear when he first came to me, another photo (blue background) of him around 3 years later, and finally (with light green background) a recent photo from the rear, which definitely shows enlargement of the vertex region. Mike Beehner, M.D.
  19. This man presented to our clinic in 1997 at the age of 47, and had three procedures done at the time totaling 2400 grafts (1270 FU's and 1610 DFU's). It is now 21 years since his first session and 18 years since his last one. He is from the western United States and returned recently to bring his son in for his first hair transplant. It gave us the chance to take some photos of how his hair has held up over those 21 years. We presented him a few years back in the "show-and-tell" portion of the annual ISHRS convention to the doctors attending the meeting in San Francisco that year. The photos with the light blue background were taken around 2 years after his last session, and the photos with the light green backdrop were taken just a couple of weeks ago. Mike Beehner, M.D.
  20. This 25 y/o male has extensive baldness for his age and is now almost a Norwood VII. The only plan that I will use for someone this age and with this much hair loss is an oval frontal forelock pattern. The main goal is to frame the face and take away the tall "ski hill" of bald skin going up from the forehead which makes many men look older than they really are. It also has a devastating effect on the self image these men have of themselves. We performed his procedure at the Orlando Live Surgery Workshop of the ISHRS 2 years ago. We placed 1280 grafts, of which 980 were FU grafts and 300 were MFU grafts (multi-follicular) for a total of 3274 hairs.The patient returned to see us around 7 months after his procedure, which can be viewed in the "after" photos here. In the next couple of years he will most likely have a second procedure of about the same size. His hair will become more full appearing in the next 6-8 months also. I tell these patients that the best styling pattern is to take the hair back and to the right corner. Two prominent politicians who were transplanted who style their hair this way are Joe Biden and Jim Baker. Also, small "humps" were drawn in his plan, in which downward pointing hairs are placed to help blur the area between the forelock and the side fringes. The crown/vertex in the rear will only get larger as he ages, so there is a very limited amount of donor hair available. The most important thing of all is to make sure nothing is done that would make his appearance freakish in any way for the rest of his life. Mike Beehner, M.D.
  21. This 59 y/o male with longtime history of Lichen Planopilaris presented to our office. He initially had test grafts, which grew well, and was then transplanted with a single session of 1348 grafts, consisting of 1078 FU grafts and 270 MFU grafts. At the time of the "after" photos, he was back for his second session to increase the density further. He had coarse hair and his FU distribution was 80% 2-hair grafts, 15% 3-hair grafts, and 5% 1-hair grafts. Hopefully, his condition is "burned out" after being the same for the past 6 years. I always warn these patients, however, that, should the condition re-activate, that they should get right in touch with their dermatologist so that the flare-up can be treated right away and avoid losing any of the transplanted hair. Mike Beehner, M.D.
  22. This 42 y/o man had had three sessions widely spaced over the past 9 years. Of the 4192 grafts he received, 3448 were FU grafts and 744 were MFU grafts. 10,740 hairs were added to his head from these grafts. His hair was of a very fine nature. Mike Beehner, M.D.
  23. This 29 y/o patient had a single surgical session last year with 1087 grafts, consisting of 867 FU's and 220 DFU grafts, for a total of 2629 hairs. Mike Beehner, M.D.
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