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Dr. Michael Beehner

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Everything posted by Dr. Michael Beehner

  1. This now 35 y/o male first came to our clinic in 2011, when my associate, Dr. Chris Pawlinga, did a first session of 2319 FU's packed into the frontal area. I performed a second procedure on him in early 2014 of 1281 FU's into the "cracks" of the first procedure's work. Mike Beehner, M.D.
  2. I agree with everything David said. It's important that a hair surgeon approach a 21 year old male a lot different than a 31 year old. There are two major reasons for being conservative and going slow, which includes for most of us - being a little reluctant to perform surgery on men under 23. Reason #1: Male pattern baldness is PROGRESSIVE throughout a male's life. You can never look at a man in his 20's and say you know how far his hair loss will extend to. Virtually all Norwood IV's and V's go on to become Norwood VI's, and a sizeable percentage of young men with Norwood VI pattern go on to become a Norwood VII with the side fringe located somewhere down the side of the head. There is a large risk for turning that young man into a freak later in life. This can lead to a reclusive life-style, depression, and rarely even to suicidal states. The decision to transplant a young man in his late teens or early 20's should be taken very seriously. The surgeon is making permanent marks on that person's head that he will have to live with the rest of his life. Reason #2: Many young men from 18 up to the late 20's have not really psychologically accepted the fact that they are going to be bald later. Many are very angry about it and feel cheated at this loss of their self-image. At our clinic I have informally adopted a rule to try very hard not to perform HT surgery on anyone under 23. There have been a handful of exceptions, in which I judged the patient to be mature beyond his years and missing the framing of his face in the front-central portion of the scalp. In such cases I have started the front part of a "forelock" type of pattern in order to restore this "framing." Mike Beehner, M.D.
  3. This 33 y/o male presented for filling in the crown, midscalp, and frontal regions. He had two sessions performed prior to the "after" photos shown here. 3660 grafts were given in total over the two sessions which were 17 months apart. 2878 FU's and 782 DFU's were placed, for a total of 8844 hairs. He is scheduled for his third and presumably last session to increase the density throughout a little bit more due to the fine caliber of his hair. Mike Beehner, M.D.
  4. I would guess around 350 square cm. He was 16 cm from one side to the other at the level of the parietal fringe and he had a deep "scoop" of baldness in the back. Mike Beehner, M.D.
  5. This 45 y/o male presented to me in 2012, having had a single session 12 years ago of 800 grafts, which were somewhat abnormal in appearance and thinly distributed. He came for two sessions totaling 3889 grafts, of which 555 were DFU's and 3334 were FU's. He had a gigantic balding area, so I emphasized trying to create density in the front third of the scalp and then a lesser, natural looking density behind that. He received 8812 hairs in all. Mike Beehner, M.D.
  6. In answer to your question, he said that his hair loss, both in the receded fronto-temporal areas and the moderate thinning in the crown, was very gradual over the past several years. The classical teaching I have heard in lectures on finasteride is that for most patients there is an increase in "hair mass" (determined by hair shaft diameter and length of hair, the latter factor obviously dependent on how long a patient lets the hair get before cutting it) for around 4-5 years, and then there is a very gradual downhill loss of hair mass over the next several years and onward into the future, and staying on the drug, even after those 4-5 years is still beneficial, since going off the drug would bring a much steeper curve of hair loss. Obviously, this is not true for every patient, but I have pretty much seen this in the most of the patients I have treated. Mike Beehner, M.D.
  7. This 52 year old male had his first HT in October of 2012 with 1652 grafts (1192 FU's and 460 DFU's) for a total of 4161 hairs. A year later he underwent a second procedure, receiving 1614 grafts (1172 FU's and 342 DFU's) equal to 4022 hairs. Overall, he received 8183 hairs in the 3266 grafts. At the time of these "after" photos being taken, he was setting up his third and hopefully final procedure to achieve his final density. He has been on a quarter of a 5mg finasteride tablet daily for 8 years also. The area transplanted included the entire top of his head, not just the frontal region, because on magnification there was a good amount of miniaturization throughout the scalp, and it was obvious he was heading for "horse-shoe" baldness (Norwood Class VI) eventually. Mike Beehner, M.D.
  8. This 50 year old male with very fine hair was first transplanted by us in 1997. In each of the three camera angles shown, the first photo is his "before" shot. The second photo is 8 years later (2005) after having received 2223 grafts (1443 FU's and 780 DFU's). The third photo in the series is four years later in 2009, with an additional 1043 FU's having been added at his 2005 surgery. The last photo (green backdrop) was taken recently, when we performed a final session of 1510 FU's. His totals at the time of these most recent photos are 3947 grafts (3167 FU's and 780 DFU's). The photos from the top of his head only show the "before" view, the 2005 one, and the most recent visit. Over those 17 years, he obviously lost all of his original "native" hair, and there was probably some degree of thinning of the early transplanted hairs also. The other factor is that, as hair grays and becomes whiter, it has a tendency in photos to "disappear" somewhat to the viewer. Mike Beehner, M.D.
  9. This 42 year old man with fine textured, light-colored blond hair returned three years after his first hair transplant session of 1600 grafts. It was understood from the initial consultation that two, and possibly three, sessions would be necessary to achieve the final look he would be happy with the rest of his life. I placed 1132 FU grafts and 468 DFU grafts for a total of 4201 hairs. This early demonstration of hair growth is only to show the dramatic effect even one session has on how a man's face is framed. Mike Beehner, M.D.
  10. Thanks for your kind comments. I have been doing HT surgery for 25 years, and in the first 15 years it seemed like I saw one of these "pluggy" results once a week. They are much more unusual now, and I'm not sure if they all got fixed or if they gave up and are recluses in hiding. Using the modern techniques we have now for partially or wholly removing these old grafts and recycling them, we are able to accomplish some amazing transformations. They are a fun challenge to take on also. Mike Beehner, M.D.
  11. This 24 y/o male was transplanted by us with a plan of performing two separate "oval forelock" patterned procedures. We placed a total of 1261 grafts (971 FU's and 290 multi-follicular grafts (DFU's and TFU's of 4-6 hairs each). He plans to come back for a final second procedure in two years. When his native hair is completely gone several years from now, it is likely that a third session would finish things up for him and give him a density he would be happy with. We moved a total of 3320 hairs. His FU's were comprised of 25% 1-hair FU grafts, 70% 2-hair FU grafts, and 5% 3-hair FU grafts. In a forelock pattern of this type, the front two-thirds of the scalp are addressed, with the main goal of "framing the face." The rear crown-vertex is not filled in at all, as we have no idea how bald he might become later in life. A forelock pattern tries to capture a stage of hair loss that many men naturally pass through on the way to balding, and thus it looks natural and doesn't look abnormal, no matter how bald he may become later on.
  12. This 41 year old man who first had hair plugs 20 years earlier came in for correction of these grafts and filling in of the top of his head. We placed grafts in three sessions over the past 8 years throughout the top of his head. In total he has received 5005 grafts, of which 4182 were FU's and 823 were MFU grafts, for a total of 12,501 hairs. We used a 2.25mm punch to remove the very forward-placed plugs he had. The three photos with lines drawn show small blue circles where we did the excisions of old plugs These were closed over with a fine absorbable suture to make the final result undetectable. Mike Beehner, M.D.
  13. I agree with the one commentator that the NUMBER OF HAIRS is a truer representation of how much hair - how much "HAIR MASS" was moved. It is my experience that , with normal styling, 12,000 hairs moved to the top of the head creates enough mass to look like a "full head of hair". The exception, of course, would be if the man had a huge, bald vertex/crown in the rear. With todays techniques and using various size grafts of 1,2,3,4, and 5 hairs each, this can easily be accomplished in two sessions in most patients with at least average caliber hair. For this particular patient the goal was two-fold: One, we lowered his hairline an inch to give him a smaller bare forehead, and two, we saw that he would eventually be a Norwood VI on top and we pre-emptively placed a lot of hair within the horseshoe-shaped area of eventual baldness so there would be hair there for the future. Mike Beehner, M.D.
  14. This 49 year old gentleman presented to our clinic with a several year history of gradual hair loss. He had very fine caliber hair. We transplanted the entire frontal and midscalp areas (per the photo showing the outline of the area transplanted). 1707 grafts, comprising 4556 hairs, were placed. Of these 470 were DFU grafts of 4-6 hairs each and 1237 were FU units, with 20% 1-hair grafts, 75% 2-hair grafts, and 5% 3-hair grafts. The patient presents on the days of the "after" photos for his second and hopefully last procedure. Mike Beehner, M.D.
  15. Thanks for your comments. Regarding your questions about when I decide to use MFU grafts and how I decide which type of recipient site to make, I'll try to answer. First of all, I will list those situations in which I use ONLY FU GRAFTS: a) Small frontal area is the only area in need of filling in b) Crown/vertex filling in c) If patient's hair "characteristics" are not favorable. A good example is a man with very coarse, dark hair set against a pale scalp. d) All temple work e) All females with mild to moderate level of hair thinning When do I like to use "COMBINATION GRAFTING" (70% FU'S AND 30% MFU"S) a) MOST MALE PATIENTS WHO APPEAR LIKELY TO ADVANCE TO A U-SHAPED NORWOOD VI PATTERN. When a man has a clear-cut, classical "U-shaped" or horseshoe-shaped area of hair loss (which covers an awful lot of the men who come to me), I like to use these 4-6 hair grafts in the inside portion of the frontal and mid-scalp regions. They give wonderful visual density. I only use these when I am confident that the patient intends to come for two sessions, as this level of density makes it relatively undetectable. It is important, when using these grafts, to angle them acutely so that they shingle over each other, magnifying the density effect. They have to be small, usually averaging around 5 hairs per graft, and they have to be close to each other. Using depth-control in making the sites is important, to insure that the skin's blood supply is not damaged. Their distribution has to be what I term "regular irregularity". This basically means that they do not appear in any way to be in "rows," and yet they are equidistant from each other. Three years ago I did an overall review of all studies done to date on FU and MFU graft growth, and came up with 40 of them, with 6 featuring MFU grafts and the rest FU's. The FU's averaged out to 89.3 % being present around a year later. The MFU grafts averaged near 100%, and one study that looked only at the fate of third-session grafts placed in between the grafts placed previously, showed a 94% survival of these. Their growth is very predictable and you can count on it. FU's can be less predictable, and every hair surgeon I know has admitted this that I am aware of. Occasional poor growth is a fact of life with FU's. The other reason is that they save the patient money. I charge the same amount for one of these grafts as I do for a 1-hair FU graft. As I said, I use MFU grafts mostly to cover a lot of the square area in the frontal and midscalp area, excluding the "crease" areas, the front hairline zone, and the crown border in back. So a typical Norwood VI patient at his first session would receive 600 FU's in the hairline, 200 FU's along each crease, and 400 FU's at the rear border for a total of 1400 FU's. I then usually place between 450 and 500 MFU grafts in the large inner area. With moderately severe or shiny bald scalps, I prefer to use small 1.3mm wide round recipient sites. If I am concerned about damaging any native hair present in the area, then I use "sagital" slits, usually 1.9mm in length. For females I almost always use these slit sites. The hairs within these grafts are exactly in the relationship they are on the person's scalp. They are not compressed within the site, but have room to exist as they did before. For the slit sites, we cut the grafts so they are somewhat long and thin in contour, when viewed from the top - to prevent compression. In real tight scalps, slits don't work as well, and removing a small amount of the scalp to allow them room is often necessary. The final answer is that, to fill in the front 3/4 of the scalp with hair, I have the choice of performing around 1800-1900 grafts (4500-5500 hairs, depending on density and number of hairs per FU) OR my other choice to the patient is to place 3500 FU's. The first choice is half the cost and moves almost as many hairs. Almost all patients of most doctors end up having a second procedure, whatever the method used. And in the final analysis, I find that two sessions (sometimes three) of the MFU grafts blocks the light from the scalp better than all FU grafts. There is less of a "see-through" look. This is my personal experience. Incidentally, I always offer an all-FU option to every patient. I think it's important to understand that each hair surgeon is an artist, and he or she will have his own approach that yields the most natural and dense appearing result on his patients. This has worked for 24 years for me. It's predictable and I can count on good growth. Most of my patients are middle-class and can afford this approach better. It is stress-free and creates happy patients. You mentioned something about whether MFU grafts are detectable if they later wear their hair very short. All transplants are basically creating the "illusion of density." We don't restore the original density they had when they were 10 years old. If someone says they intend to buzz their hair down to a "flat top," I would probably tell the patient he should do all FU's and he would need at least one extra session (and hopefully has a lot of useable donor hair) to create very high hair numbers on the top of his head to make up for the lack of shingling. Mike Beehner, M.D.
  16. This man in his mid-30's presented with slightly below average density in the rear scalp area and even less density along both of the side donor areas over the ear. He had two sessions of "combination grafting" (FU's and DFU's) over a two year period and presented for his third session the day these "after" photos were taken. 2620 of his grafts were FU's and 501 were DFU's. A large part of our goal was to create some density in the "frontal core" so that a viewer could not "see through" his hair. He was pleased with the results of the first two sessions and recently had 1286 FU's placed, with some of these coming from FUE from the rear occipital area where the density wasn't as low. Mike Beehner, M.D.
  17. This 57 year old man who had been "shiny bald" most of his adult life and was a Norwood VII balding pattern, underwent three modestly sized sessions averaging around 1500 grafts per session using a "combination" of DFU and FU grafts. In total he had 4404 grafts, of which 3794 were FU's and 605 were DFU/TFU grafts for a total of 11,967 hairs. His first session was in May of 2011, second January of 2012, and the third December of 2012. He chose to color his hair after he was transplanted which helped the new hair stand out better than if he had let it remain gray/white. One of the photos shows the schematic layout of his forelock pattern, which included a lateral "hump" on each side. The "forelock pattern" is one which is used when there is not enough donor hair to fill in the top area side to side, and thus a front-central area of density is created to frame the face, and then a gradient of thinning hair is created to all sides to mimic a natural state of partial hair loss that many men go through. This particular patient still has some useable donor hair left and is coming next month for a final session of around 1500 FU grafts. Mike Beehner, M.D.
  18. This 50 year old man presented to me two years ago for his first hair transplant session. He had past trauma to his scalp requiring plastic surgery, and also had recession due to hereditary hair loss. We placed 1229 FU grafts and 440 DFU grafts within the front two-thirds of his scalp, which includes both the frontal and midscalp regions. He is having a second session of the same size and in the same region, in order to double the density. This simply shows that he is off to a good start with only his first session. Mike Beehner, M.D.
  19. This 24 y/o presented with the complaint of a high frontal hairline and increasingly worse fronto-temporal recessions. On examination of his midscalp and vertex, there was no miniaturization at this time. He had a single session of 1559 FU grafts, equal to 3118, hairs, that were dense-packed into the recessions and along the front hairline. His FU grafts were composed of 30% 1-hair grafts, 50% 2-hair grafts, and 20% 3-hair grafts. He had coarse hair which contributed to this type of result after only one pass. Mike Beehner, M.D.
  20. In answer to the person who asked how Lichen Planopilaris is diagnosed, the clinical picture and a biopsy are the usual ways to do so. It is thought to probably be of an autoimmune etiology. It can sometimes overlap with Alopecia Areata in its clinical appearance, but usually is more "splotchy" with multiple,small patches irregularly spread all over the head, including in the donor area. It leaves a "scarring alopecia" result, which means that in each of these little bald patches there are no pores or follicular elements of any sort. We usually wait at least two years after any sign of disease activity (enlarging, redness, scaling) before considering transplanting. Some hair surgeons will then perform a repeat biopsy to make sure there are no lymphocytes present around nearby follicles near the edge of these lesions before transplanting. When the diagnosis has already been confirmed before a patient reaches me, I will often give the patient the choice between re-biopsying or doing test grafts, which this patient chose to do. The good news about this diagnosis, as opposed to alopecia areata, is that it often will "burn out" and remain inactive for a long time or for that patient's life span. I have transplanted around 10 of these patients and have only had one re-activate. The treatment is steroid injections in the scalp in the area affected. Frontal fibrosing alopecia, which affects mainly the front hairline, beard or eyebrows is thought to be a sub-type of LPP. Mike
  21. This 61 y/o male was diagnosed 12 years ago with hair loss caused by Lichen Planopilaris, which causes a "scarring alopecia." He had an acute flare-up 5 years later in 2007, and claims it has been "dormant" since 2011. As a precaution we did "test grafts", which are seen in the last three photos. The bare area we did the testing in is first shown, and then the recipient sites being made there, and finally, the growth of hairs in that study box. He had his first session performed by myself in July of 2012. He had very good growth from the transplant. He was in the other day for a second session of 1218 grafts to increase density. His first session consisted of 1348 grafts, comprising 4127 hairs. 270 MFU grafts and 1078 FU's were used. Usually, but not always, Lichen-planopilaris "burns out" and stays that way. Sometimes it can come back, in which case it is important for a patient who has been transplanted to get into his dermatologist for immediate treatment to calm things down and save the grafts. Steroid iinjections into the lesions is the treatment of choice. It is thought to be an auto-immune condition. Mike Beehner, M.D.
  22. I certainly agree with Jotronic that following your doctor's individual advice is a good idea. There are many ways to "skin a cat" and different approaches can get equally good results. The one thing I would caution against is putting a thick coating of any ointment (Neosporin, Polysporin, Bacitracin, or even vaseline) on the grafts right away, as this can interfere with the necessary coagulation that occurs at the interface of the graft with the recipient site. We had an eyebrow patient several years ago who reminded me of this fact: She came into the office the next day for a hair wash and check of things, and she swept her hand over the eyebrow area and 25 grafts just slid out of their sites like greased pigs. Before that we had always applied Bacitracin immediately post-op. No longer. However, starting the next day, using a thin coating of one of these (I prefer either Bacitracin or plain Vaseline, since they have the least sensitizing ingredients in them. Neosporin is the riskiest because of the Neomycin) over the graft area once or twice a day. It is messy and that's why not a lot of people do it. But I'm convinced that, if a man wants the scabs gone the quickest way possible, that a twice daily coating of an ointment vehicle is the best way to go. To clean it off, say, for the morning shower, I recommend applying some baby oil first to help liquify the ointment, and then use Dawn detergent to get it all off. Then whatever conditioner the patient likes could be used. Creams are a lot cleaner and easier to use, but aren't quite as efficacious in scab removal. Our "default" routine in our practice is to apply Vitamin E/aloe cream every night to the grafted area and simply shower and shampoo every morning. Around 20% of our patients elect to purchase and use the Graftcyte kit with copper peptide. Although I've seen a handful of miraculous healing from this kit, I'm not convinced that it is superior to simply spraying a saline mist on the grafts every hour of the waking day, which we also give to each patient. Mike Beehner, M.D.
  23. This man first came to our clinic at the age of 53 in 1999 and has had three sessions over that time, the last one being a little over one year ago. He would be a shiny-bald Norwood VI today had he not been transplanted. During those three sessions he has received 5537 grafts, of which 4467 were FU grafts and 1070 were MFU grafts. A total of 13,957 hairs have been moved during that time. Mike Beehner, M.D.
  24. This 55 y/o male was transplanted with a single "combination" hair transplant session in April of 2013 and presents for his second session now for increased density. He received 1801 grafts at that first session, which included 1351 FU grafts and 450 DFU grafts (average 4-5 hairs each). A total of 5426 hairs were moved in that first session and a similar number was moved in his second session. Mike Beehner, M.D.
  25. From the appearance of the one photo provided by the initial poster, it looks clear to me that a person with this pattern through the midscalp of hair loss is 99% of the time going to end up as a Norwood VI pattern later in life, which is the classic U-shaped (horseshoe shaped) zone of shiny baldness. Each man arrives there at a different speed over a different number of years. And, yes, while finasteride does help slow down this hair loss schedule, eventually the intended genetic outcome will occur. I usually tell my patients that it will give you an extra 10 years of hair before that day comes. Being in your 30's rather than your 20's is much more valuable in predicting where things are going to end up. With a patient in front of you in their early or mid-20's, the surgeon might as well have blindfolds on in predicting the future. The family history is helpful but can be very unreliable as a predictor. When a male patient is in his 30's, the one thing that I can predict more accurately than at a younger age is what the "safe" donor area is likely to end up being. That can allow me to be a little more aggressive, although I still stay out of the rear vertex/crown until after age 35. Mike Beehner, M.D.