Dr. Michael Beehner

I would certainly second everything Bill said above, and had a few comments to add. After 23 years of performing hair transplants and seeing many of my early patients return 15-20 years later, I can honestly say I have only spoken with two or three that wished they hadn't had hair transplants, and each of these were young men in their 20's at the time who did go on to become Norwood VII's. The hundreds of others that have come back to visit me were extremely grateful they had done it. Just this past week, I had three of my old patients from over 15 years ago visit me and each agreed it was "the best money I ever spent." The increase in self-esteem and return of a more youthful look that hair transplantation accomplishes for a balding man is a tremendous thing. The key thing we accomplish is simply framing the face. If this is done in an artistic, natural way - filling in the front half, 90% of our job is accomplished. For those men with lax scalps, extra money to spend, and lots of donor hair who want more than that done, the back half often can be filled in, which is just icing on the cake for the patient. It is important that you seek out an experienced hair surgeon who makes allowance for where you at your age are likely to end up. I find that after the age of 35 it really is a lot easier to predict where things will end up as a worst-case-scenario for a given patient. For men in this age group, when there is a comfortably medium to large amount of donor hair available, it is almost always possible in 2-3 sessions to give him a "full" look in the front two-thirds of the scalp. Like all surgeons who have been at this for awhile, I am certainly more conservative in transplanting young men in their 20's than I was 15-20 years ago. For a man in his middle 20's who shows some signs that he might progress to a Norwood VII pattern (the definition of the Norwood VII pattern is that the side fringes are down the side of the head and not up at the top), a "forelock" pattern can be done which will always look natural and can be expanded upon later on if the "worst-case" baldness progression actually doesn't come to pass. It is certainly true that the transplanted hair does thin some over the years, although this varies from one patient to another. 30-40% look as thick as they were 10-15 years before, while the rest are a little thinner than decade or two ago. My own transplants were done around 30 years ago and my wife, who is my barber, tells me that my hair has thinned over that time span. But so has the hair on the sides and back of my head. The other nice thing about getting older is that the hair takes on the multi-hued look of "salt and pepper" with gray hair mixed in, and of course many go on to a totally white head of hair. Simply because a lot of these hairs "disappear" against the backdrop of the light-colored scalp, we sometimes will think the hair isn't even there or has thinned more than it actually in fact did. I always tell the men who come to me in consultation that they do have to be committed to leaving the hair on the sides and back of their head one-half inch in length to make sure the donor scar doesn't show. I also tell them that, if they want to wear their hair shorter, when the required sessions are done to their satisfaction, there are a few things that can be done to greatly minimize the scar (excision, FUE grafts into the scar, and tattoo dots). Regarding the fear expressed by the writer of the question to Bill, that donor hair would be depleted by one or two sessions, I would reply that that is extremely rare. Almost everyone has enough donor hair to have three good donor harvests done and with a reasonably thin scar left when it's all done. The stretchability of the scalp is amazing and is the reason we can do what we do in hair transplantation, and, with skill, we can almost always make sure that that "stretching" occurs in the hair-bearing scalp above and below the scar and not in the scar itself. With the addition of FUE later on in the areas above or below the scar, we have even more versatility and capability to obtain even additional hair if needed. In the past five years, I find that two sessions satisfy the majority of our male patients. The principal areas where hair surgeons and patients get in trouble is in being overly ambitious filling in the crown/vertex in back or over-flattening out the normal recession at the frontal-temporal angles to each side. These errors most commonly occur in the instance of the young man in his 20's or early 30's who wants to look exactly like all of his peers, with no thought of how much he may actually later go on to bald. A relatively conservative approach, good artistic surgery, and honest communication between the doctor and patient go a long ways to avoiding later regrets and disasters. Mike Beehner, M.D.

This 57 y/o man came to our clinic for his first procedure 9 years ago. He has had 3 HT sessions over that time totalling 3834 grafts (12,856 hairs). He has extremely fine hair, which over that time period went from a reddish-brown to an almost whitish-blond color. His 3 sessions were comprised of 1163, 1242, and 1287 grafts at each session, with MFU grafts of 4-6 hairs making up 330 of the grafts at the first session, 146 at the second, and 150 at the third. These grafts were placed primarily in the front-center area. Note on the one face-forward photo taken 5 years ago after 2 sessions, that he had a "flat-top" style of haircut at that time, which doesn't offer any shingling of the hair over each other. Most of the photos show the final results of the three sessions. He recently had an additional session of 996 FU's added, which was the limit we could harvest due to a tight donor scalp and our wish not to create a wide scar. Patients with hair this fine, in my experience, require an additional session than most patients do, in order to achieve cosmetic density. It also helps greatly if they let their hair grow a little longer in order to take advantage of the shingling effect of overlap visual fullness. At the time of the consultation with these fine-haired patients, we try to mainly show them results of other patients with similar hair, rather than show them those of patients with coarse hair, which would create an expectation we couldn't achieve. Mike Beehner, M.D.

In answer to the question posed by "Newhairplease" regarding whether the MFU grafts (ave. 4-5 hairs per graft) later "stick out" or are noticeable if the patient only came for that one transplant surgery,the answer is as follows: We try to approach every surgery with the understanding that whatever we do that day would "look natural" for the rest of his life even if he never chose to have another surgery; and WITH NORMAL STYLING these grafts are almost never noticeable in the patients we do them in. Remember that we only use them in the central areas and never at the visible borders of the area being transplanted. Also, if a patient has hair characteristics such that we do feel the grafts would be noticeable, then we refuse to use MFU grafts and we instead insist on using FU's exclusively. This occurs at least a couple of times a month. However, if someone had only one session with the "combination" approach and then later went on to lose all of his native hair on top where the grafts were placed, and someone was handed a magnifying glass in a well-lit room and was allowed to stand over the top of patient's head and put their hands through the hair and look into the center, then, yes, an observant person would be able to see very small clumps of hairs together. To be honest , you can even pick up 2 and 3-hair grafts in this manner also if you look with a trained eye I have spoken several times on the art and skill of using MFU grafts appropriately. If not done correctly and in the right places and on the right patients, they do have the ability of detracting from the transplanted result. But if done correctly on the right patients in those front-central areas, they have, as I said above, the wonderful ability of blocking light to the scalp, of surviving at a percentage higher than FU grafts, of being very consistent from one patient to another of always growing and giving you the density you expect, and, finally, of saving your patients some money and allowing you to attack most of a Norwood VI patient's bald area with 1500-1700 grafts, rather than the 2500-3500 it would take with all FU's. That's a difference between a $7000 procedure and a $13,000 one, and the "combination" result actually ends up looking fuller in my hands. Other fine points in using MFU grafts in those selected patients are that they must be small and not large (as in the early "minigraft" days), they must be irregular in distribution and not in rows, they must be quite close to each other, and, most importantly, they must be angled acutely so that they "shingle" over each other giving a dense appearance to the hair. If they are put perpendicularly like Christmas trees, then it is a disaster, which also applies to FU grafts as well. I hope the above once again clearly states my philosophy, one that has worked well for me these past 20 years and has consistently given me patients happy with their results. Mike Beehner, M.D.

Andrew and readers, Sorry I didn't respond earlier, but I have to confess this is one of the sections I don't check up on (patient photos. etc). I'll do my best to explain it from my point of view. I do appreciate Andrew's situation, being a new patient and never having gone through this before and also feeling bad about his ongoing hair loss. For this reason we do hand out clear patient instructions for afterwards and a separate page called "expectations," in which we try and give the patient an idea of what to expect. As I explained to Andrew in his consultation visit, he has vertex balding, which to my observation expands forward like an "ice cream cone" shaped area, eventually coming up right behind the front hairline. I have had a lot of success in creating density on the rear horizontal-plane area of the midscalp by using multi-FU grafts in this region, which are angled forward and will overlap each other when they have grown out to even one inch in length. At the consultation I gave Andrew, as I do all patients, the choice between having 800 grafts placed, with around 250 of them MFU grafts in the top-central area, or using an all-FU approach with around 1200 FU's. As in every consultation, I tried my best to point out the advantages for each technique and the drawbacks. I always emphasize that, if we use MFU's in the plan, that it is important for them to be committed in their mind to coming at least twice. If I have any reason to suspect that the patient will only be doing this once, I always insist that an all-FU approach be used. I have done this in many Forums before, but will repeat it here for those who may not have read my previous comments: MFU GRAFTS: These are cut under the stereoscopic microscope very carefully and are cut in such a way that two adjacent FU bundles of at least 2 hairs each (total of 4 or more) are circled with the dissection process and cut out as a single graft with the intervening tissue present. I use either 1.9mm sagital slit sites or, more commonly in males, small 1.3mm round sites in which the tissue is removed within the site. Advantages: Research studies show 100% survival of the hairs. Cost is less. When these grafts grow out, they block light from hitting the scalp better than FU's in my opinion. Some of the follicles which are in the telogen phase are better preserved than with FU dissection, as they are often located in the tissue between the two FU bundles within the MFU graft. Disadvantages: It takes around 2 weeks for the scabs to disappear, so they are slightly more noticeable those first two weeks, but appear very normal thereafter. Also, when they first start growing out, even though the hairs come out at different time points, lending a natural look to them, on close inspection they can appear to be slightly detectable until they reach past an inch in length. We often recommend Toppik or Dermmatch to get past this phase. FU GRAFTS: Advantages: More natural looking on close inspection. If transplanting a small area, such as frontal recessions or temples, one can "dense-pack" these grafts and obtain wonderful density with one or two sessions. Disadvantages: More costly. Often can't do large areas with the above-described density, as it may endanger the scalp's blood supply and often not enough donor square area of hair can be harvested at one time, due to either lack of laxity or lack of density in the patient's donor area. Sometimes FU grafting alone gives a "thinner," more "see-through" look than does 2-3 sessions of MFU grafts in the central areas. I assure you that all of the MFU grafts on the upper crown and rear midscalp area have the hairs all directed in their natural direction toward the front. The FU grafts, which certainly by now are hard to see and have mostly fallen off (the scabs, that is) are in somewhat of a "whorl" arrangement, with the ones at the upper portion directed forward, and the ones beneath that directed in various directions as is appropriate in that whorl. Because of his age, we had an understanding that in the very rear half of the vertex in the "downhill" portion in the back, I would not be planting with very much density, as he is young and we don't know how large his vertex will be. He accepted this. Besides the 255 MFU grafts, he received 673 FU grafts, which were placed all along the sides and behind the MFU grafts. It is impossible to judge the quality of the results based on photos taken 3 and 4 days after surgery. I certainly hope we all get the chance to see pictures a year from not as to what this area looks like. I am confident it will have the beginning of density and look very natural. I am attaching a before and after photo of 5 different patients, who had MFU grafts placed in the rear aspect of the midscalp area along with some fine sprinkling of FU's in the downhill vertex area. The first 4 patients have only had one session; the last patient had two sessions. Also, bear in mind that all of these men at that first surgical session primarily had work done on their front hairline and the entire top of their scalps also. Putting some grafts in the rear crown was done primarily to make the rear border blend in and appear natural. On our website we have many close-up photos with much detail of our surgical results. I hope the above helps explain my philosophy for transplanting and I hope I can over time improve my skills at explaining to patients the varied way grafts can look on day 3 and 4, so they don't overreact. One final note that I certainly want Andrew and any other patients considering our practice to be assured of, and that is that we will fully stand behind our work and make sure you are happy with the final result, no matter what it takes to accomplish that. Mike Beehner, M.D.

This Asian descent male in his mid-50's presented with a very large area of balding, equivalent to a Norwood VII pattern, and with only moderate donor supplies, but who wanted very badly to have transplanted hair spread out over his entire balding area, rather than have me create a strong gradient in front. Reluctantly, I did as he wished. The enclosed "after" photos are taken after an initial session of 3050 FU's and a follow-up session 10 months later of 2400 FU's. On the top-view "before" photo, you can see an eliptical drawing on the rear right (patient's right) of his scalp, where there was a suspicious dark lesion which we removed along with his first transplant procedure. It came back benign. Mike Beehner, M.D.

This 49 y/o male presented wanting his hairline lowered, his recessions filled in, and his temples made stronger and brought forward with temporal points. 2657 FU's were placed. He had a good number of 2 and 3-hair FU's which allowed us to placed 6643 hairs in that small area. The sites were made with 0.8 m, 1.0mm, and 1.1mm lateral slits. The operative photos showing the recipient sites are slightly dark since we used methylene blue to help color them, to show us where we needed to make additional slits and also to help me and the assistants in placing a graft in every site. This dye fades away within 3 days usually, and so is sometimes valuable in patients who aren't returning to work for a week and in whom dense-packing is used. Regrettably, only one "after" photo was taken, as he dropped by a year later while traveling and this was the only shot our front office person took. He is due back in three months, when he is accompanying his brother, who is coming for a HT. Mike Beehner, M.D.

This 50 y/o male with an advanced Norwood VI pattern of hair loss and some miniaturized hair on top, presented wanting the entire top of his head filled in with exclusively FU grafts. 3063 were placed at the first session. The "after" photos here were taken one year later, at which time he had 2500 FU's added to his previous work. He had 30% 1-hair FU's, 60% 2-hair FU's, and only 10% 3-hair FU's. His hair was of a fine caliber also. Mike Beehner, M.D.

This patient is the first in a series of 4-5 that I will bunch together to go along with my application to be included in the Coalition of Independent Hair Restoration Physicians. A few words about our general philosophy: For patients with a relatively small area of hair loss that needs filling, such as with this man I am presenting here, my first choice is dense-packing FU grafts. I let the patients know that we will be trying for a "home run," that is, to accomplish satisfactory density with only one pass. Obviously that judgement is subjective and different patients will only be satisfied with certain levels of density. We tell them that they have about a 25% chance of that occurring, but much more than likely, we will have to "go between the cracks" with a second session to get the density that will match that of the hair behind it so it looks uniform. For that large group of patients who are clearly heading for a Norwood VI pattern of hair loss, which is the typical U-shaped area of hair loss on the entire top of the head and scooping down the back in the vertex, I am most comfortable using DFU's in the front-central area in order to create a better gradient of density. I feel these grafts block light better, they survive at a higher percentage (100% in all research studies to date), and are more economical for the patient. We usually use 1000-1500 FU's in addition to these at each session, so that all visible borders are filled in with FU's exclusively, with all 1-hair FU's at the front and rear edges. We also, even for these Norwood VI patients, tell them they have the option of having all FU's, usually in the 2500-3500 range. I will be including in this group of presented patients two who had fairly substantial hair loss and very large bald areas on top, who did ask us to use all FU's and over 3000 were placed. Most of the all-FU cases I do in the 2500+ range are men with a fair amount of visible hair on top who are starting to miniaturize and want to catch it early and fill it in before it thins further, and so we will put around 2500 FU's all through the top of the scalp. Obviously, the photos of such men aren't very dramatic and are hard to appreciate any change, so I won't bother including any of them. This male in his late 30's presented for filling in of the deep recessions and bringing the temple hair forward and creating strong temporal points. He had a coarse caliber of hair and lots of 2-hair and 3-hair FU's. Grafts were placed in 20g, 19g, and 18g needle sites. He was pleased with the density of one surgery and did not feel the need presently to pursue any further transplanting. The "after" photos were taken 11 months after the surgery. Mike Beehner, M.D.

This 62 year old lady who had experienced progressive hair loss since her mid-20's, presented to our office a year ago for her first hair transplant procedure. Just last week she had a second procedure to add even more density. She was immensely pleased with the difference the first session made. She received a total of 1227 grafts, comprised of 806 FU's and 421 DFU's. Special attention was placed on creating density in the front hair line and just behind it and also along the left half of the midscalp, since she syled her hair from left to right. At her second surgery, we were able to place quite a few back in the crown area, which was also a concern to her. A total of 3080 hairs were moved. Her FU donor density was very good on the flat rear occipital region of the scalp, but fell off dramatically as we turned the corner toward the area behind the ear. In the photos, I have tried to alternate the before and after photos. Mike Beehner, M.D.

This 62 year old woman presented for her first hair transplant session of 1565 FU's in October of 2008, and had a second session of 1496 FU's in December of 2010. The after photos are twelve months after this second session. Her FU's were distributed as follows: 1-hair FU's 30%; 2-hair FU's 60%; 3-hair FU's 10%. Her hair was very fine in caliber. Mike Beehner, M.D.

I hate to be a wet blanket, but I think, at the age of 29, it would be a mistake to transplant your entire crown area presently, especially using maximal density, which I am sure is what you probably would want. In looking at your "top-down" photo, I can see obvious thinning in a 9-10cm diameter circular area in back. At 29, you likely have 50 years of life ahead of you in which male pattern baldness is going to progress. And unfortunately, the square area of the crown/vertex does not increase in a linear fashion, but rather in a logarithmic way. The great majority of men at your age with your degree of hair loss do in fact eventually go on to the classical U-shaped pattern of a Norwood VI pattern. With such a future likely, the top of your head will always be the number one priority to save donor hair for. You mentioned that you have already had some work done in the front. I have seen at least a dozen men over the years who had the crowns filled in when they were younger, and who came to see me 10-20 years later with a 1-2 inch wide "halo" of bald skin around the dense hair in the center, giving it the appearance of a "bulls-eye". And, unfortunately, this "halo" area couldn't be filled in because the donor hair supply was exhausted and had shrunk dramatically with the advancing baldness. One other word of caution is that you have been on medication, which is a good thing and I'm sure you look better now because you have been on them. My hunch is that, if you had not taken medication, you would see quite a bit more hair loss presently and actually have better insight into what is going to happen in the future. So these treatments, which are great for helping delay the eventual balding pattern, do in fact "mask" what would really be going on now otherwise, and thus can make you a little more over-confident now that everything can be filled in densely and cover your bald area for your lifetime. I'm simply saying that, for the great majority of men who are going to eventually be Norwood VI patterns, the center of the crown/vertex is not where you want a bunch of dense hair. Two final points: For many men with a thinning crown your age I will fill in whatever is on the horizontal plane, which often is almost 80% of the circular crown area, as seen from that top view, but I preserve a concave curve at the rear of this transplanting (as seen from the back), so that if the "bottom drops out" with a large area of balding beneath it, I am not committed to chasing after it. The final point is that I think, at 29, some light coverage with low density 1-hair and 2-hair FU's is ok to do at this time in your entire crown, because that will never look freakish later, should you bald to a Norwood VII or advanced VI, and it doesn't take that much donor hair to likewise transplant in a similar fashion to the area in which baldness advances. My cutoff for transplanting the rear vertex is 35. After that, I feel it is possible to make a pretty good assessment of where a given male is heading and being able to see if there is a comfortable "cushion" of donor hair available, so that the top and the vertex can both be filled in. As always, the goal is to be as helpful as possible for the patient, but not to create short-term happiness now for misery and deformity later in life. Mike Beehner, M.D.

With the size of cases we routinely do today, it is impossible for the physician to do everything, even apart from the dissecting of the grafts under the microscope. Once a fair number of grafts have been cut and prepared, it is absolutely necessary for two pair of hands to get busy placing grafts. One of them can, and often is, the physician. If only one person is placing grafts, the grafts will be out of the body too long, and past research shows that after being out of the body over 8 hours, the percentage that survive starts to decrease. The issue brought up by one of the commentators about fatigue is an important one. It's important for everyone on the team, including the doctor, to take periodic breaks to rest the hands, arms and shoulders, and also your psychological state. On a few occasions I have cut grafts for a couple hours straight, and that is too long. You need a break away from your task every 30-40 minutes in order to keep the quality of your work top-notch. If I see the girls on the scopes too long, I will encourage them to all take five minutes to rest or walk around the block. In our own clinic, I do all of the planning, the nerve block and local anesthesia, the harvesting of the donor area and suturing it up, and then the placing of all the incision sites where the grafts are going to go. This last task, if done conscientiously, can sometimes take 1 1/2 to 2 hours to do, making sure the size of each site matches the different size grafts (1-hair, 2-hair, and 3-hair grafts) and that the angle is just right and that native hairs are not damaged. My routine is then to start placing grafts along with one of my experienced assistants until all the grafts are prepared. I then let one of the girls take my place after they have had a break between those two tasks. I always save out around 50 grafts, usually half 1 and 2-hair FU's, which I then at the end of the case will put in where needed in the hairline area, using the "stick-and-place" method. This gives me a final chance to "fine tune" the hairline and get it exactly the way I want it. So don't look for a clinic where the poor doctor takes on all of the tasks. If it's a 300 graft case, which doesn't exist anymore, then it might be ok Rather, look for a clinic where the doctor carefully supervises the quality of the work of the technicians and in which the whole team cares as much about the grafts surviving as the doctor does. Gentle handling, care to keep the grafts moist at all times, and proper rotation of the graft within the site as relates to the curve of the hair are all crucial and you want a staff that takes pride in doing each of these things right, not an assembly-line operation, where the goal is to get the case done as fast as possible. Mike Beehner, M.D.

I would agree with what Aaron said. That is how we prescribe it at our practice, and also direct them to Wal-Mart for the cheapest price, since they have this "one-price-for-all-generic-meds" policy, and their wholesale source is a reliable manufacturer of generics. Some of the doctors who still insist on prescribing Propecia in its brand-name, 1mg form will say that the amount in each quarter of the mg tablet broken up will be different. But it doesn't matter, because, while each quarter averages 1.2mg (more than the 1mg in the Propecia tablet), Merck's own studies showed a significant decrease in DHT with only 0.2mg a day dose, which is less than one-sixth of a quarter tablet's med, so, even if there is some slight variation from quarter tab to quarter tab, there is a huge cushion that insures you get enough. The medication works for around 3 days in the body, so my routine has been to recommend a quarte tablet every other day for men under 30 and Monday-Wednesday-Friday (3 days a week) dosage schedule for those over 30. I don't tend to push it for men over 50, but will if they ask about it. Mike Beehner, M.D.

Dear Newhairplease, There are two important pieces of information that need to be known before a hair surgeon could give you the best answer to your question: 1) How old are You? 2) Is there miniaturization on top to suggest you are someday going to be a typical Norwood VI bald man? If you are in your 20's or early 30's and/or there IS miniaturization on top, then they should be left alone and re-evaluated several years down the line, when it is clearer where you are going to end up with your hair loss. The two reasons NOT to go charging into restoring temple points if either/both of the above apply in your case, are first, you may be using up precious donor hair in the temple area that is best kept to use on top, and second, if you go on to an advanced stage of baldness, then those grafts way out front there are going to stick out like a "sore thumb" and be unsightly. If we took a best-case scenario that you are 35 years old and that there is virtually no miniaturization on top, then I would certainly agree to do a patient like yourself, but would probably only come out to a point around 1/4 inch back from where you have some hair at the point now, so that the result would look age-appropriate as you get older. I will try to add a couple of photos of a man in his 40's who did have weak temple points restored and had plenty of donor hair to do so. Mike Beehner, M.D.

This 55 y/o male presented to me two years ago and has had two procedures, with the "after" photos being taken one year after the second procedure. The entire top of the head and the side/front temple areas were all filled in. At the first session, 2216 grafts (6410 hairs) were placed, using 1796 FU's and 420 MFU grafts. At the second session a year later, 2109 grafts (5448 hairs) were placed, using 2009 FU's and 100 MFU's. A third final session is set up for this coming fall. Mike Beehner, M.D.

I really don't know the percentage of hairs that are present today that are in the exact same location they were when he first presented to me. I would guess somewhere between 40-50% are still intact where they started in the large plugs. The "Lucas technique" uses a 2.0mm or 2.25mm diameter electric punch and cores down through the firmed-up large graft. This firmness is created by "tumescing" the tissues around the graft with saline solution which is injected prior to doing this. The way I approach this is that, at the first repair session, I remove several hairs from the large grafts near the periphery (front, back, and sides) which appear most "tree-trunk-like" and then a year later at a second surgery, I again look through the patient's hair from the four views and then again will core out with this punch a portion of those grafts that appear this way. Mike Beehner, M.D.

His first two procedures were done only a couple of years apart, and the next couple a few years later, and then the touch-up a couple of years ago. The answer to your question is twofold: the first two procedures effectively removed the pluggy look enough to get rid of the hairpiece, and the second reason was spreading it out for financial reasons. He was 36 when he first came in 1998 and is 48 now. I hope that clears up that point for you. Mike Beehner, M.D.

This 36 y/o male first presented to me 13 years ago, having undergone multiple transplants with large plugs, which decimated his donor area and left him very unhappy with his appearance. He was wearing a hairpiece when I first met him. Every 3-4 years he would come in, and we would perform the "Lucas Technique" on his old grafts, coring out some of the hairs within them and then replanting them as FU's and micrografts where needed. He had his most recent procedure in late 2009 and recently returned for me to evaluate the results, at which time these photos were taken. Our goal was to gradually soften his old plugs and at the same time place FU's in the spaces between the old grafts. He has received a total of around 4000 FU's during those procedures, the most recent one having been 565 FU's. His "before" photos are first listed, followed by the recent ones I took. Mike Beehner, M.D.

Dear Bepzzz, The advice given above is all right on target. My response to your question would be that if your present hairline height was truly high - say, in the neighborhood of 9cm above a line across the top of your eyebrows, then there is an awful lot of forehead showing and I would certainly be willing to do some transplanting to make the height at which the face is framed a little lower. But, usually when a fellow your age comes in wanting a hairline lower, it is presently at a height that is probably appropriate for when you are 40, 50, 60 yrs of age later on. The temptation is great at your age to want the hair restored exactly the way it is in your non-receding peer group members. So I would have to say that nine out of ten times, I also would refuse to transplant someone 24 yrs old making that request. My guess is that your hairline is probably 6-7cm above the eyebrows and that you would like it at around 5cm (just a guess). The other problem with your situation is this. You probably have dense hair behind wherever your hairline is now, and, for it to look good, the transplanting out front of the hairline has to be dense, so it matches the hair behind it. Let's say that you are destined to bald behind your receding hairline some day into a Norwood VI stage of baldness. There may not later on be enough donor hair to continue the density that was started in the front and it could look unnatural and unbalanced because of that. Also, extreme dense packing now in a small area out front may consume a lot of your valuable donor hair, leaving inadequate amounts later to finish the transplant. My personal philosophy is to help young men over 23 frame their face in the front center area if it is really thinning out and rising - in other words, help them frame their face. Beyond that, I think the hair transplant doctor is taking big risks if he or she fills in the side temples and other peripheral projects that often go with filling in the hairline. Mike

This 35 year old with fronto-temporal recessions a thinning frontal tuft of hair, presented for the first time 8 years ago for his first session in the frontal region, and a few years later had another similar sized session in the same area. In all, he has received 1919 grafts, of which half were FU's and half were double-FU's (DFU's), for a total of 6597 hairs. He recently came back for a final touch-up of 600 FU's along the front hairline and just behind it.

This 65 y/o female who had "over-plucked" her eyebrows when much younger, came in seeking eyebrow hair restoration. She has been using an eyebrow pencil the past 30 plus years and wanted a more natural look. 13 months ago she had her first session of 175 1-hair grafts to each eyebrow, placed in 22g needle sites. She returned a few days ago for her second and final session, at which time we placed around 130 into each side. The photos shown here are as follows: a) Four photos showing her almost complete absence of eyebrow hairs b) The outline made just before the transplant surgery began. c) Shows the surgical sites made on the first pass, which are about to be filled with the grafts. After they were placed, "stick and place" technique was used to place an additional 30 grafts on each side. d) Shows the patient at the completion of the procedure. No dressing is applied and the slight swelling you see here is usually all gone by morning. e) Next five photos show what she looked like the other day with her first session grown out. Mike Beehner, M.D.

This then 39 y/o male presented to our clinic in 2002, having had two previous large transplant sessions at another clinic and noted at that time to us that he thought his scar was wider than he liked. He then proceeded to have three transplant sessions with us to finish up and give him the density he desired on top, and we were able to each time excise a small amount of the donor strip width along with harvesting a strip of hair for a total of 3500 new grafts we gave him (80% FU's and 20% DFU's). At that point, he wanted us to do what we could to eliminate or lessen as much as possible the visible impact of the scar, especially on the right corner area. In 2004 we then proceeded to excise around 5-6mm of the widest part of the scar, but it returned to being almost as wide as before due to the elasticity of his scalp. We then over the next few years did three FUE sessions into the scar with 912 FUE grafts (mostly 1 and 2-hair FU's) obtained from 0.9mm FUE sites using the manual SAFE method of Dr. James Harris. He dropped in the other day for the first time in two years to let us see the result and noted that he had the barber cut his hair unusually short this time. You will notice he has a broad swath of white hair along his temple area and across the bottom of his scalp. He was quite pleased with the final results. The second photo shows the wide scar area before our treatment of it. The photo on either side of that photo is a close-up of his final result with FUE's. The two more distant views were taken the same day. Note that he had the barber cut his hair very short just prior to the visit. Mike Beehner, M.D.

Sean, I think you got your facts mixed up. I don't know where you ever heard that 10% of patients don't have growth from their HT's. Rather, in many studies roughly 10% of the hairs are not accounted for at hair counts 8-15 months out from the time of the HT. But there is substantial growth, sometimes near 100%, in virtually ALL of the patients. You would have to have an active autoimmune disease going on to not have growth, and most experienced HT docs are able to recognize conditions such as lichen planopilaris and lupus and not perform a transplant in those situations. Mike Beehner, M.D..

Thanks for the kind comments. As to the question of where the MFU grafts of 4-5 hairs each were placed, if you look at the overhead shot of his head before surgery where the lines are drawn in, that entire central area is filled in with these DFU's and occasional TFU's. I find that if you angle these grafts, place them randomly and not in rows, and place them fairly close together, they block light wonderfully and add greatly to density. I only use them when the patient tells me he is committed to having two sessions, as they are very difficult to detect, even upon close examination, if two sessions of these grafts are used. Also, studies on follicle survival have shown that these grafts survive at 100% compared to around 90% for FU's in most studies. We only use the MFU grafts in patients with large areas of hair loss. For those with small frontal areas of loss, we prefer to dense-pack FU's. Mike Beehner, MD.

This gentleman first came to see me for consultations in 1999 and 2006, and then, with increasing hair loss, decided in 2008 at the age of 51 to have a hair transplant procedure done by myself. We filled in the entire top of the head except for the downhill vertex in the rear. He received a total of 1502 grafts, made up of 1092 FU's and 410 MFU grafts for a total of 4466 hairs. His "before" photos are a little red-tinted due to some problems with the "white balance" on our new digital camera at the time. I assure you he is not a redhead. On top of that color change, he also lost around 20 pounds, which gave him an entirely different appearance from the last time I saw him. I find it common that men who get their hair restored start working out and losing weight and doing other things that go along with an improved self-image of themselves. He came to see me, inquiring as to getting some more grafts sometime later this year. At that time, we plan to scatter around 800-900 FU's into the vertex, along with filling in the top also. Mike Beehner, M.D.