Louise

This 42 year old man came in for a follow up and is very happy. He had a NW3 thinning pattern and his hair was black, curly and average in diameter. 9 months ago he had his anterior hairline conservatively lowered and his frontotemporal recessions reconstructed with 1833 FUG’s. His grafted area blends nicely with his preexisting hair and it is difficult to see where his transplant stops and his own existing hair begins. His hair’s natural characteristics helped to make his hair look fuller. Dr. Simmons performed a 1-layer trichophytic closure with undermining of both edges, but now routinely uses 2-layer closures without undermining. Nevertheless, it was difficult to find his donor scar.

Each clinic has developed what works best for them and for their patients. Dr Simmons does not recommend that patients shave the recipient area prior to surgery. Having longer existing hair helps camouflage the area afterward. We routinely use a stick-and-place technique that allows us to work between the existing hairs. It also allows us to keep the incisions small and the grafts "chubby".

This 52 year old female was concerned about her frontal hairline and wanted more volume. She has a Ludwig 2 thinning pattern and has experienced gradual hair loss for the past 10 years. She has brown, wavy, average diameter hair and her donor area was average in both flexibility and density. She usually wore her hair parted above her right eyebrow. 2458 FUG’s were transplanted to her front, her forelock and right part. Her hair was dyed darker when she came in for her follow up which helps to camouflage her grey hair. Her darker hair has also helped to make her hair look fuller. These photos were taken 1 year postop.

Hi Mick, Fantastic!! This patient must be absolutely thrilled!! Dr Simmons and I really enjoyed meeting both you and Dr Farjo in Boston.

Don't worry waveskier....Absolutely normal as TTP also mentioned. The reassurance of one or more people may help you feel better. So again, don't worry. The hairs may be whispy (finer) at first and then will thicken in diameter as they grow and mature. This will be a very exciting time for you. You will see lots of little hairs beginning to sprout. Be patient though, sometimes when a 3 haired graft is transplanted, initially one of the hairs may sprout before the other 2, but rest assured, the others will soon follow. I hope you keep us updated with your progress.

It sounds like your healing is progressing as it should. Seeing small hairs within the scabs (crusts) as they shed is common and can begin 5 days postop. Oftentimes, the newly transplanted hairs remain after the scabs (crusts) have shed - grow a bit and then shed - or even nicer, remain and continue growing. Doesn't seem like you have anything to be concerned about, but if you are, it wouldn't hurt to give your physician a quick call. I hope this helps.

Hi Mick, Having the hair direction/recipient sites made to follow the direction of the patient's whorl pattern will look great when it grows in. I hope you keep us updated with his progress.

This 42 year-old man wanted to restore his receding hairline so he would look younger and feel more confident. He had a Norwood 3-3A thinning pattern and his natural hair was dense. He had finer than average, brown, salt-and-pepper hair, which he dyed brown. We transplanted 2681 FUG’s to his frontal area with an irregular hairline and a soft transition between the transplanted hairs and his existing hair. Dr. Simmons performed a routine trichophytic closure and his resulting scar is narrow. He began using Propecia a few months after his hair transplant surgery to preserve his existing hair. He is happy with how his hair looks and can wear his hair in different styles with confidence.

Hello RCWest, Thank you for your comments. This patient had incredible donor hair characteristics! Having such good hair characteristics allowed us to transplant his hair at a lower than average density - preserve his donor hair - and obtain a nice result. David...Thank you for the feedback. This patient is truly happy with his hair.

Our patient first noticed his hair loss at the age of 19 and had a Norwood 4A-5A thinning pattern at 24. He had average diameter, black, wavy-curly hair. He had dense donor hair and good scalp flexibility. He had the usual number of 2s but had more 3s and 4s than 1-haired grafts. Minoxidil and Finasteride were started at his consultation but it was clear that they would not bring back his hair in front. At his consultation, Dr. Simmons discussed fully the risk of developing a Norwood 7 pattern and that he would likely require more hair transplantation in the future. He could run out of scalp donor hair, while still having a bald crown. Once assured that our patient understood his long-term commitment, Dr. Simmons agreed to a conservative plan for hair transplantation now. We transplanted 3277 FUG’s to his frontal area. His hairline started 9 cm above the glabella and was higher than a usual mature hairline. Dr. Simmons gradually reduced the density while working further back from the hairline, knowing that the curl and larger follicular units would help the cosmetic effect. That allowed us to transplant further back than the marked (minimum) area. His donor strip was 26.9 cm long and 13 mm wide in the back and 10 mm wide on the sides and the closure was very easy. Dr Simmons performed a trichophytic 1-layer closure with routine undermining of both edges. (He usually uses a 2-layer closure without undermining now.) These photos were taken at 14 months. He is very happy with how his hair looks now and accepts that he may lose more hair and require further hair transplantation in the future. He is currently taking Finasteride and uses Minoxidil regularly and hopefully the combination will keep him out of the hair transplant chair for many years.

Hi Johnny1386, There have been many improvements in hair transplant surgery since your previous surgery. The results are more natural appearing and the donor scars are better and more comfortable. It sounds like 4000 grafts may be a bit excessive for the area that you have described, but it is hard to say for sure without seeing some recent photos. Dr Simmons is located in Toronto and you could contact him for a personal consultation - which is always best - or you could forward some recent photos to him for an email consult. I should mention that I work for Dr. Simmons. His profile is here: Dr. Cam Simmons - hair restoration surgeon. Dr Rosenberg is also a recommended physician in the Toronto area and Dr Rahal is recommended in Ottawa - you can view their profiles and results and can also send photos for an email consultation to see what they recommend. I hope this helps.

This 54 -year old lady came to see Dr Simmons with the goal of restoring her eyebrows and filling the central area of her scalp – her mid-frontal forelock. She had suffered from Trichotillomania in her teens but her husband confirmed that she had not pulled her hair for many years. She had extensive hair loss over most of her scalp and in her eyebrows. She could conceal most of her hair loss by wearing a pony-tail but the middle looked weak. She had fine, light brown, wavy hair. Her hair was sparse on the sides but she did have some donor hair available on the back of her head. We transplanted a total of 681 single haired FUG’s to her eyebrows and 962 FUG’s to her forelock. She now dyes her hair slightly darker to match the colour of her eyebrows and trims her eyebrows every 3 to 4 days. She could have a second session to make her eyebrows denser but she is happy as is. These photographs were taken 9 months post op.

Hello Jdhillon, With usual genetic hair loss there is a safe zone on the sides and back of the head where the hair follicles are resistant to the effects of DHT. The transplanted hairs should last a lifetime as long as they come from this safe zone and not from above or below it. At each consultation, Dr. Simmons personally examines everyone's donor area to make sure that the hairs are safe for transplantation. When one becomes "much older", they may notice some general thinning of hair all over the body but the genetic patterned hair loss will not come back. I hope this helps.

Dr. Rahal in Ottawa and Dr. Simmons in Toronto are Coalition members and Dr. Rosenberg in Toronto is a recommended physician. You can view their profiles and results and can send photos for an email consultation to see what they recommend. I should disclose that I work with Dr. Simmons as a hair transplant technician. I hope this helps.

Thank you David and Mick. Hello Surfarosa....Great observation!! The grafts were placed at 56 - 49 FUG/cm2, which are higher than we would use for a younger man with more extensive hair loss.

Hi Mick, Really nice for 5.5 months!!! I hope you keep us updated with his progress.

Hi Zac, I am glad you found the information helpful and reassuring. Happy healing!!

Hello Happy, FUT has reliably low transection rates. Including strip removal and microscopic dissection the transection rate is less than 2-3%. The transection rates for FUE vary from patient to patient and get lower with more experience. Dr. Simmons does a maximum of 1000 FU extractions per day because he has to work slowly to get good grafts. He pretty much only uses Dr. Harris' Safe System because so far it is the only method that he feels gets reliable low transection rates in his hands. He has not tried powered FUE yet. In our first all-FUE case in 2007 of a whopping 357 grafts, our patient had splayed follicular units, tough skin, tethered grafts, and a transection rate of about 33%. (He was almost our last case!) In our last FUE case, 2 weeks ago, there were 45 transected hairs in 803 grafts (2.5%) BUT she was a Chinese lady with straight, coarse hair and fantastic skin. I check the grafts under the microscope and in our last cases, the transection rates have all been 5% or less Dr. Simmons does not do a lot of FUE because he thinks that, at least right now, FUT is more reliable and less expensive for patients. For people with a lot of ground to cover, FUT makes a lot more sense. He has learned FUE because there are some situations where it is a good option. His main focus is on doing the best quality FUT he can but he wants to be good enough at FUE that he can do it when appropriate.

Hi Zac25, Don't be too alarmed. Most patients experience some degree of post operative swelling. Some patients experience minimal or no swelling at all, others may experience a significant amount of swelling. Dr Simmons tells his patients to, "hope for the best, but be prepared for the worst". The good news - swelling usually peaks on the 5th day and then starts to go down. The worst is likely behind you. You should notice that your swelling will go down over the next few days and should be gone by the weekend. I hope this helps.

This 44 year old patient of Caucasian and Asian heritage came to see Dr. Simmons with the goal of lowering his hairline. He has average-coarse, dark brown hair with a touch of grey and a Norwood 3 thinning pattern. We transplanted 2113 FUG’s in one session. We designed a lower but mature transplanted hairline that would still look natural after he aged. Although it may be harder to appreciate without seeing his whole face, his rounder hairline suited his head and face shape. He began taking Finasteride just before his surgery. Dr. Simmons performed a 1-layer trichophytic closure with undermining of both edges but now routinely uses 2-layer closures without undermining. His scar is barely visible. These photos were taken 13 months post-op. This patient is very happy with his results and continues to use Finasteride.

Hi Huangdong77, Using Dr Harris' SAFE System ("an advanced method of follicular unit extraction"), the transection rate would be much lower than what was used as an example above. We check all FUE grafts under the microscope before being placed into the recipient area. Only viable hairs are transplanted. If a hair is transected below the bulge region of the hair follicle, we believe that it should be removed from the graft as it can't keep producing new hairs and can increase the risk of pimple formation. I hope this helps.

Hi Mick, Thank you so much for taking the time to post your thoughts. I guess it is true....you just never know who you will bump into!! I hope you all enjoyed Amsterdam, it sounds like you had a really good time.

Our 30 year-old patient felt that she was born with a “high hairline” or “big forehead” and that she had not had any hair loss. She always wore bangs to conceal her high hairline and hide her temporal recessions. She had finer than average diameter, brown hair, which she dyed blonde. Her natural hair was quite dense. We aimed to transplant 2600 FUG’s but her donor hair was even denser than expected so we transplanted 2947 FUG’s with a distribution of 21% single - haired grafts, 54% two - haired grafts and 25% three- haired grafts. With her finer hair, smaller grafts, and dense natural hair behind the transplanted area, we used higher than usual transplanted densities with 64 FUG’s/cm2 in her frontal hairline and 56 in her temporal hairlines. These photos were taken 12 months post-op. She is very happy with how her hair looks. She stopped wearing bangs and has changed to a right part and even feels confident wearing her hair pulled back or in a pony-tail.

Hi denardspanrealog, From what you have described above, it sounds like your hairline is probably fine where it is. You may just be losing your "boyish" hairline and developing a man's mature hairline. Applying Rogaine 1cm or 2 cm below your natural hairline would not achieve the results that you are looking for. You are 22 years old and you may or may not lose a lot more hair in the future. Coalition doctors, like Dr. Simmons, would likely not offer you hair transplantation now as it may not be a safe long-term plan.

This 34 year-old man had experienced gradual hair loss over the past 3 years. He has a Norwood 3A-4 thinning pattern with a persistent forelock. His hair was black, coarse, and wavy. We transplanted 2056 FUG’s to his front, excluding his forelock. Dr. Simmons created his initial hairline using single haired grafts and then achieved this density by placing grafts with varying densities from 56 FUG’s/cm2 to 42 FUG’s/cm2. If and when he loses the hair in his midfrontal forelock, he knows that he will need more hair transplantation. These photographs were taken 18 months after his surgery. He hasn’t lost more hair since his surgery and continues to take Finasteride. He is happy with the overall density and his new hairline.