H & W Doug

Thanks for the comments. Bald36: I would say it depends on how you define “strip scars”. I would say the average strip scar industry wide is not as good as this so no, “strip scars” are usually not this good. However not all clinics and surgeons are created equal and I believe doctors Hasson and Wong are as skilled as any at strip removal and closure. Over the last 15 years I’ve worked at the clinic I have seen many patients who have had their first strip surgery at another clinic before having one at Hasson and Wong. I would say at best one in every ten I would see would even come close to this one. Dr. Hasson weighs in on your Question: “At Hasson and Wong we have always gone to great lengths to ensure our strip closures are as close to perfect as possible. So this patient has what we would consider a good Scar and probably 50% of our patients would achieve this or something close. The healing characteristics of patients do however vary but we would say 90% of our patients achieved scars of 2 millimeters or less.” Here are more examples of well healed strip scars from our clinic: https://hassonandwong.com/hair-transplant-surgery/hair-transplant-scars/ As far as part 2 of your question, I don’t believe he has lost much if any hair in the crown since his first procedure. The first surgery was to restore the front and mid scalp and work back as far as possible. Some light crown coverage was also able to be achieved. While this served him very well for several years it was always his thought to add to the crown at some point. The timing as mentioned was right to achieve the added coverage and density to the crown on this 2nd procedure.

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This was the original write up from a previous post back in 2014: “This patient from Vancouver had been thinking of hair restoration for some time. The goal was to try for 4,000 grafts to restore the frontal zone working into the mid scalp as far back as possible. He loosened his scalp for 2 months prior to surgery and Dr. Hasson was able to harvest 4435 follicular units in one session. 694 were single hair grafts, 3023 were doubles and 713 were 3 to 4 hair grafts. The donor area was medium to high density and the caliber of the hair was fine. Dr. Hasson also was able to provide coverage in the crown while still delivering the adequate density up front. The patient was very grateful and pleased with the result which, especially considering his fine, hair worked out quite well. These photos were taken a little over 3 years post-op.” The light coverage in the crown as a result of his first procedure served him well over the years but now having some time off he decided he would like added density to that area. The combination of his scalp being tight, the previous scar being so good and the thought of having a quicker recovery all factored in to his decision to have FUE for his second smaller procedure. Considering all factors, I believe his decision to opt for FUE this time around was a good choice. As you can see in the pics, the scar from the first FUT procedure was very minimal, he can probably go almost as short as if he would have had FUE in the first surgery. Photos are pre-op, imed post op, 1 day po and 6 days po. 187 – s 1123 – d 683 - 3-4 hair 1993 total grafts 4482 hairs, manual, punch size 0.8 The following photos are 15 days post-op I will update his future progress

Thanks for the comments and questions guys. Diffused thinning over a large area can often pose greater challenges. Many factors can be involved when determining the best course of action. We were one of the first if not the first to shave the recipient area to successfully transplant in between existing hairs. This allows for a greater field of vision and the angle and direction of the native hair can be determined with a much higher rate of success then without shaving which is critical in preserving surrounding hairs. Shaving in my opinion is a critical first step in being able to transplant large numbers with high densities successfully among existing hairs. A surgeon is able to transplant among existing hairs without the shave in some cases but this generally is reserved for smaller cases and where less density is acceptable. But you still run a higher risk of some transection. The skill of the surgeon and his technique are also factors of course. For a case such as this, Dr. Hasson would have determined that he could successfully transplant in between native hair with little or no material damage to them. If he felt there was too much risk, he would not perform the surgery. This would likely be the case if this patient had come to see him years earlier and the overall potential cosmetic result would have not warranted the risk of surgery. In other words, he would have had too much hair, the loss was not that noticeable, some damage to native hair would be likely and surgery was not going to make a worthwhile difference in his appearance. In this case the hair loss was far enough along to warrant surgery and safely navigating between the existing hairs was determined to be a safe bet. As far as whether medication would have been recommended before surgery, in some cases, yes. In this case, we know that the patient has an above average donor supply of above average quality. We know that while he may recover some hair in the top and crown on medication alone, he is not likely to recover enough or any significant amount of hair in the front to make him happy and give him the styling options he desires. In some cases we would just do to the front and top, maybe 4,000-4,500 grafts and leave the crown to medication. Factors such as donor reserves, final hair loss pattern, the patient’s desires and goals all play a role in determining the best approach. When a patient has these donor reserves, he can have just about anything he wants within reason. For this patient, money was not a factor, he wanted the most hair he could get, he choose not to see how well the medication might respond to his crown and was excited about the prospect of getting maximum coverage and density in one session. If he could improve some of the native hair on the medication that would be icing on the cake but maintaining his existing hair was the reasonable goal. I suspected that any of his native hair that fell as a result of temporary shock loss starting growing back at the same time as the transplanted hair. I have reached out to him to help answer a few specific questions. He has been on medication for about 14 months and has not noticed any improvement of the native hair, maybe stable at best. He reports the shocked native hairs grew back rapidly but it was not until around 6 months post op that he felt very confident without a hat. He was worried during the shock loss period but reports that everything Dr. Hasson said would happen did, including that he would have a great head of hair. He may try and post here with further information when he gets a chance as he is presently traveling.

Transhair, Over the years I have seen many cases similar to this where growth at the 4 month mark is very good and a considerable cosmetic improvement is already taking place. However, the average patient generally may not reach this level of growth until the 5 to 5.5 month mark.

This patient in his late 30's came from Australia to get as many grafts as possible. The aim was for 6,000 plus and we ended up with closer to 8,000. The area of need depicted in the photos at first glance does not look as extensive but the generalized thinning encompassed the entire top, front to back. Only finer miniaturized hairs were giving the illusion of coverage. This is more evident in the some of the progression pics. He was not able to style the hair properly and sun exposure to the top was always a concern down under. He had 3318 singles, 4170 doubles and 374 3-4 hair grafts. The quality and quantity of his donor hair was good. Medium to coarse in texture. He has an estimated 5,000 grafts left in reserve. The first 3 photos were taken at the clinic, the rest were sent in by the patient.

Dutchie, It has been a pleasure to have you as a patient and we look forward to seeing you again should you decide on round two next year. You are in good hands either way, FUT or FUE. The hair gods may be smiling on you but give yourself credit for doing your research, you helped make their job a lot easier:) HTsoon/Spidey, The transection rate on this patient in particular was very low. If I recall from the chart the percentage of what was planted versus what was extracted was high 90's%. I'm out of the clinic this week but when I return I'll see about getting the number.

Dutchie! I hope all is well. I plan to update this every few months and hope to have the 1 year update as well. HairLostyears: He has high expectations so it wouldn’t surprise me if he considered round 2. But I have told him to wait for the full result. For this case if we assume a total of 7,000 grafts, the patient would have very nice coverage and density and would essentially be done. If he continues to take Proscar he would not likely ever need another procedure. If he had FUT and 7,000, we can assume the result would be virtually the same. The only major differences would be with FUT he would have in theory another 3,000 or more grafts in the bank. With FUE he would be about tapped out. The factors such as medication, the scar, styling options, costs would all be considered. You can make a case for either method here. Graft survival with our FUE technology is quite high, rivaling our strip survival. For this patient in particular, I didn’t see any drop off with regards to what his yield would have been with FUT. You don’t need to call this a watershed moment but I would feel comfortable describing it as such. delancy: For the sake of this discussion let’s assume 7,000 grafts total in the donor reserves to start instead of 7377. If we assume the total number of grafts in the sides and back is 14,000 of which 7,000 can be used before it starts to look too thin, 7,000 would be left to create the normal appearance; we can then say his reserves represent 50% of the total grafts if I understand the question correctly.

HairLostYears, The powers that be suggest up to around 3,000 grafts left in the donor bank via FUE.

Thanks for the comments guys! mosd, the breakdown: Singles: 531 Doubles: 1887 3’s: 1893 4's: 66

This patient in his 30's from Vancouver wanted maximum coverage via FUE. He had a total of 4377 grafts over 2 days. He was wearing his hair very short on his last visit and I encouraged him to let it grow a little longer. It is still quite short in these photos. I believe with a little more length it would have been even more impressive at this stage. I'll up date hopefully again with his 6.5-7 month pics.

Hi Guys, thanks for the comments. Yes he is thrilled and the transformation has been life changing as you can imagine. You can read his story in the blog section of our website. RadioRunner: We do occasionally post scar pics but in virtually all cases the scar is not the focal point. This patient had previous scarring from his first procedure at the other clinic. Dr. Hasson did remove some of his old scar and also went above with a new scar to take as many grafts as possible. The sides were previously untouched so the scar in the photo is the result of the last two surgeries in an area exclusively harvested by Dr. Hasson. densedream: Due in part to the high placement of the previous work, Dr. Hasson was able to transplant in and around the old grafts and completely camouflage without having to remove any of them. While not pretty on their own, the old work does provide some value as far as adding density to the "hidden" areas of the frontal zone.

future-ht, I meant to get back to you on your question sooner. Yes, Dr. Hasson usually does a higher density in the frontal zone than in the mid scalp and crown. He feels the front has to have a certain density to look natural and provide the best result. All things otherwise being equal, a patient with 4,000 grafts placed in the frontal zone and mid scalp will likely have the same density in the frontal zone than a patient with 5,500 grafts placed in the frontal, mid and crown. Both may have approximately 3,000 grafts placed in the front 1/3 of the scalp. Once the frontal zone is reconstructed, the number of grafts he has to work with will dictate how much density and coverage can be achieved behind the frontal zone.

voxman, You're correct, no regrets. The scar was a non issue as is the case in our experience with most of our patients. He could not find the scar and didn't pay any attention to it. He could proably go quite short in the back but what are the chances ?

This musician from Calgary came to visit us based on a recommendation from an acquaintance. Dr. Hasson was able to harvest 5761 grafts to address his extensive hair loss in one session. He had 1344 single hair grafts, 4024 doubles and 393 3-4 hair units. Strip size was 30cm x 1.5-2cm. Above average donor hair with average hair caliber. He started topical Finasteride at the time of surgery. These photos sent in by the patient were 8 months post-op. As you can imagine he is very pleased so far with the result and this bass player/singer once again looks the part. He will be making a trip out to Vancouver this summer where we plan to take photos and video. We will update his case in the coming months.

fortune11, you hit the nail on the head. When this patient walked back in the clinic 1 year post-op I had to do a double take. I thought I'd hopped in the DeLorean back to 1983 and saw Jerry Reed from Smokey and the Bandit walk through the door............

Here's a couple more shots

Thanks for all the comments, I agree, quite the transformation. delancey: Dr. Hasson did indeed classify this patient as a NW6

Many prospective patients focus on the donor area scarring. Any type of surgery whether it be fut or fue will result in some degree of scarring in the donor area. While it is important to consider the impact the procedure will have on the donor region, often times too much emphasis is placed here and not enough on the final result and how the recipient area will look. Hasson and Wong perform countless repair surgeries every year so I've seen many bad strip scars as well as bad fue scarring from other clinics over the years. Just because it's fue doesn't mean there are no scars. In fact, the actual square centimeters of scar tissue is larger per graft in fue than in a typical strip scar from our clinic. For the sake of this discussion, we'll focus on donor area strip scarring and more specifically as it relates to our clinic. The two key components in achieving minimal scarring in the donor area are knowledge and skill of the surgeon and the individual patient's healing characteristics. When the two components are favorable, the result is a fine liner scar. If a patient has very good healing characteristics but the surgeon had done a poor job of removal and closure, the resulting scar can be less than desirable. If the patient heals poorly and the surgeon is highly skilled, the resulting scar can be less than ideal but likley much better than in the first scenario.In most cases, the surgeons role can have the greatest impact. Below is a link to a video we've put together showing strip scars from Hasson and Wong patients. These are patients with good healing characteristics. One other thing to consider is that the size of the surgery and width of the strip has no bearing on the resulting scar if done properly. Many incorrectly assume the bigger the surgery size the bigger the scar, not so. You'll see the 8400 graft 1 session result has virtually no visible scar. Keep in mind these are Hasson and Wong patients and not all surgeons are created equal.

Thanks guys. The strip size was 31.5 cm x 1.5cm. He started Proscar around the time of surgery.

This Vancouver area patient in his late 20's came to Dr. Wong for as much coverage as possible. He has average overall donor hair and supply. 4720 grafts were used comprised of 1190 singles, 3,000 doubles and 530 3-4 hair grafts. A little over 3,000 grafts were used to rebuild the hairline and frontal zone. A few were scattered in the mid scalp were there was less need for work and where the finasteride would be relied upon. Approximately 1500 were used in the crown. The after photos were taken 13 months post-op.

Thanks for the comments. HairStudmuffin/californian, A lot of patients who have lost a fair amount of hair in the front and top cut the sides quite short to balance the look. This patient also wore his hair this way most of the time after the loss became quite noticeable. On the day of surgery Dr. Hasson shaved down a little more but essentially the look was similar prior to his pre surgery shave. The photos on the left are the way he wore his hair most of the time before surgery and before his pre surgery shave. On the right are of course the result with the hair grown out. Only the areas with existing hair that are going to be transplanted are probable shave zones. The sides and back don't need to be shaved for the surgery, that option lies with the patient. But if the hair is already very short the day of surgery, the entire head is likely to be shaved. Many of the patients from Europe specifically Italy don't mind the entire head being shaved. Many from North America will opt for the sides and back being left long. I hope that helped answer your questions.

Thanks for some of the positive comments. Home1212: This approach is not for every young patient and 25 years ago it may have been deemed unethical to perform this surgery. But with the technology and medication of today, many more patients can have a long lasting result that was not possible years ago. Every patient must be evaluated based on several factors including age and final hair loss pattern. While it is often true more caution is exercised with younger patients, if they are committed to medication, it is working for them, they have a good donor supply and their final hair loss pattern can reasonably be defined, the long term risks are minimal. When Dr. Hasson evaluates a patient and puts together a plan, he is also looking well beyond the near term and into the distant future. He explains to patients their result must look good next year,next decade and into their golden years. There are many factors involved in this process, some too complicated to discuss here. There is always a rick/reward associated with any surgery.In this case in particular, the reward far outweighs the risk. For the record I did not state he was 20 or in his "early 20's". Fue2014: The age at which one can reasonably determine the final hair loss pattern varies from patient to patient.The more aggressive final hair loss patterns tend to show up fairly early, sometimes even in the teen years. KO: I'll see if there are any more pre-op pics when i get back to the clinic You can call me Lorenzo if you like but I prefer Doug :-) Loags79: We try to be consistent with the before and afters. Some photos were taken with different cameras due to trying a few different options to get the right camera and settings. Oddly enough, these before and after pictures were taken with the same background. Also at certain times during the day the color can change due to the daylight coming in. I believe we are as consistent and transparent as anyone and our photos are among the clearest and most revealing. Also, we have not used flash in about 10 years. We NEVER use flash as it can distort the result making it look better than it really is. snell1234: I think this is a good idea in theory, many patients see a result and think they can have the same but they can't because their donor hair is not the same. The photos may not always reveal the true nature of the donor hair so maybe it would be better to describe the donor area, coarse,dense etc. maybe a combination of both. I didn't expect some of these reactions from this result. Tough crowd, I should have let Garageland post this one :-) I've see this up close and personal at it's the real deal. I'll need to get him in for a video I guess :-)

This patient in his 20's was particularly bothered by his hair loss as often is the case with young patients. When evaluating a patient for surgery, Dr. Hasson not only assesses the cosmetic benefit but also what the overall effect can be on a persons life who is suffering emotionally from his or her hair loss. In this case not only was the physical transformation quite remarkable but maybe even more impressive was the positive impact getting hair back had on this patient's life. These types of cases are often the most rewarding for Dr. Hasson as he is able to make such a profound life altering impact. Cases such as these are one of the main reasons Dr. Hasson choose to get into the hair restoration business. This patient with his renewed confidence and sense of well being is now thriving in his new career. The first surgery consisted of 5245 grafts with 1491 being singles, 3321 doubles, 433 3-4 hair grafts. The significant cosmetic impact was realized after the first surgery but as sometimes is the case, the patient after seeing the result wanted to take his result to the next level. The second surgery slightly lowered the hairline while adding a little density to the mid scalp and crown. This consisted of 3119 grafts of which 869 were singles, 1977 doubles, 273 3-4 hair grafts. This result depicted with styling products in the hair is 8 months post-op from the second procedure.

This patient in his 60's from San Diego was looking to restore his facial proportions and turn back the clock through hair restoration. After seeing one of our patients in person he was impressed and knew immediately his decision to have surgery at Hasson and Wong would be an easy one. Dr. Wong restored his hairline, frontal zone and mid scalp working towards the crown. These photos sent in by the patient are one year post-op. 3378 grafts of which 731 were singles, 2128 were double hair grafts and 519 were 3 and 4 hair grafts. He is very pleased with the result and the impact it has had on his appearance. He plans to come back next year to add coverage to the crown.