Dr. James DeYarman

You appear young. I would do a FUE and keep the number as low as possible. The crown can give you concern on graft distribution but can be done.

This 42 year old man had 2000 follicular units transplanted to the front and mid-scalp. I have photos of his progression over the years and in 2008 started getting worse. Avodart was added to his treatment program and he responded very well.

Do either of you know the size of the punch your doctor used to extract the grafts. It would be interesting if the size of the punch would make a difference in post-op pain.

This 60 year man requested a crown transplant. My experience has shown that there seems to better growth in the crown if you do a FUE then a strip. I think it is because there is less trauma to the blood supply with a FUE procedure then a strip procedure. I am amazed how fast it heals. I used a .85 Harris punch and custom cut blades for the recipient sites. Note also I harvested up to the recipient area to help match the density with the donor area.

I posted a video on a discussion of the .8 verses the 1mm punch.

Spanker

I have been hair transplants long enough that I started out doing plugs and converted to strip. The large grafts grew in the crown better then follicular units do in the crown and I feel it is due to vascular damage when you remove the strip.

Shampoo

I depending on your age and the size of the bald spot would determine the amount. I have been using less grafts per square centimeter because there are a lot of multi-hair grafts. The second time you have to start balancing out densities between transplanted and un-transplanted hair. I have found 1500-2000 is needed the first time in the crown. I can do up to 2000 in a day and for 3000+ it is a two day procedure.

I think you are missing the point, the man is concerned about his bald spot and tell him not to treat means he is missing out on a good positive change. The trick is do the FUE procedure and not a strip procedure you will see a much better outcome.

I agree with Dr Beehner that the crown has to be treated with care. For the last several years people have been saying it is hard to grow hair in the crown. As you can see from Dr Beehner’s photo of the plugs, there seems to be no trouble with growth. The question is, why there was better growth back with the plugs and I think it is because there is was not as much destruction of the blood supply as with a strip procedure. I feel the best procedure is a FUE procedure with punches smaller then 1mm. Because of the small punch there is no vascular damage and the FUE grafts will have more hair giving more coverage. I start in the center of the whirl with ones and fan out following the patient hair direction. Finally you have to tell the patient there will most likely be another procedure in the future it will be obvious where to transplant as we are dealing with density. With the FUE you can match donor density to transplant density by thinning and transplanting, you cannot do this with strip procedure.

I think it is amazing the way the graft was compressed instead of the shafts being transected. I feel this is the result of the design of the Harris punch.

While doing a FUE transplant a 6 hair graft was created. The punch was only .8mm yet there was no transection of the hair. The punch used was the Harris dull punch which works on the principle of blunt dissection. I was amazed how the graft was only .8 mm and yet produced such a large hair number graft. The photo represent a photo without magnification and one with a 50 times magnification and if you look close you see the sixth hair to the side in the telegen state.

This 35 year old man had a FUT hair transplant 6 months ago. He also had PRP injected and Acell used in the donor closure. The patient is very pleased with the results and will continue to improve over the next several months. I will post his results at one year when he returns.

This 55 year old man had 3150 grafts transplanted 8 months ago. The patient does not take finasteride or rogaine. He did not elect to have PRP or Acell with his transplant. The patient is very pleased with the results.

This 32 year old man had his frontal hair line restored with 1500 grafts. Patient did well and very pleased with the results.

Swelling is due to the large amount of saline injected under the scalp during the procedure. I have my patient's apply a hot compress to the forehead then massage the forehead from the middle out to help get the fluid to migrate down the side of the face and into the neck. I have my patients massage the forehead once an hour for five minutes for the first 48 hours while awake. Since the swelling is due to the saline ice will make the swelling last longer. I advice my patients not to use ice on the face or forehead.

This 34 old man had one procedure of 2836 follicular units transplanted from front to back. The donor area was closed with a trichophytic closure and staples. The scar was not visible enough to photograph. The grafts were placed in .84mm slits. The patient is very happy with the results. The patient has also been on finasteride which has helped his situation.

Thanks for the kind words. What I really like about this result is when you look at his after you are directed to his eyes. The procedure has really enhanced his appearance.

DrD

Bill

Thanks for the kind words I will pass this on to the patient.

Question Man

I will attach of a profile photo with squares . There were about 50 square centimeters of area to treat. I usually transplant at 40 – 50 grafts per square centimeter and this will yield about a 50% density. After one year the patient wanted to add more density to the first procedure. If you would like to see these photos I can post.

As far as how many grafts he will have left I have found that most people you can get up to 10,000 follicular units from a donor area over at least 25 – 30 years. He has not wasted any grafts and if NW6 happens we will deal with it.

This man had a seesion of 2200 grafts and one year later had another 2000 grafts added to the same area for increased density. Theses after photos are 6 months since the last procedure. He had PRP and Acell in his treatment. The patient is very happy with the result and glad to share his experience

Augusta

I can photoshop this for you. Draw in with a black wax pencil where you would like your hair line. Have someone else take the photos. Have them take a front, profiles and top and email them to me. I will add hair and email it back to you.

My email address is drjbd@deyarmanhmedical.com

DrD

This 29 year old patient had one procedure of 3004 follicular units via strip with trichophytic closure. The grafts were placed in lateral slits from front too back. The patient is also on finasteride and very please with the results.

The photos posted are not comb over. In both views the hair is combed forward. I have attached a photo of the hair wet and combed back. I hope this helps

This patient had one surgery of follicular units of 5022 grafts plus PRP injected into area. I have posted his before plus ten day and one year later photos. I posted the 10 day photos to show how quickly the patient healed which I feel is due to the PRP injections. The patient is on no drugs and is very pleased with the result.

I'm sorry for not getting back to your question sooner. Rogaine was created from a drug called Loniten. It was a high blood pressure medication and the side effect was people would start to grow body hair. The strength of the pill was 100 mg. and started out at one pill per day. The active ingredient in Loniten is minoxidil and that is what was put into solution to create the first Minoxidil solution. The side effects from Rogaine can be skin rash, hair growth on the face and in some cases headache. Because of the amount being used it would be hard to get any lowering of the blood pressur using the medication topical. For minoxidil to be effective on the hair follicle it has to be massaged into the scalp and because of the small amount of minoxidil it is unlikly to have any affect on blood pressure. I hope this answers your questions.

If the area is red and feels warm I would notify your doctor as it could be infected.

Arrie

I transplanted the front two thirds @ 40 grafts per centimeter and the crown was transplanted @ 30 grafts per centimeter. Thanks for the question.