Wen-Yi Wu M.D.

This patient had prior treatment with Finasteride. He stopped the medication because no obvious growth was noted. Still we put him back on mediciation after the procedure. Telling him the goal is to slow down the progression of hairloss since AGA is progressive over one's life time.

It must be emphasized that transplantation of the anterior temple is very difficult to perform naturally for a starting novice physician and must be avoided until the surgeon has observed the quality of one's hairline results over time.

When comparing with Caucasians, Finasteride is less effective in Asians. However, we still recommend Finasteride to our patients suffering from Androgenetic alopecia. We tell our patients that the goal of taking the medicine is to slow down the hairloss process and to decrease the amount of hairloss. We rarely tell our patients that there will be obvious regrowth of new hair. As we found out that many patients stopped taking the medicine when regrowth are told. Only a small percentage of Asians noted regrowth. When " NO CHANGE " are noted after one year, it means that the medicine is working.

Thanks for the advice and suggestions. I will post some of my works on other ethic groups soon. It is great pleasure and honor to be recommended on this forum.

In addition, if you have a strong temple hair, the lateral terminus can still point directly backwards without flare. This will also look good in either way. But never do a flare lateral terminus if there is recession in the temple hairline.

Follicular unit transplantation ( FUT ) performed on a 31 y/o Chinese patient: - One session of 3460 grafts were done. - Norwood Class V(a) patient - Donor density of 80 FU/cm2 at mid-occiput area, 68 FU/cm2 at the parietal area. - Hair diameter of 78 microns, black color, straight hair - On Finasteride before the transplant for hair loss prevention, but no obvious regrowth noted. - Patient expectation is to have hair covering frontal zone and the mid scalp. Will consider vertex transplant in the future Treatment plan: Recipient area: - total of about 100 cm2 balding area to be transplanted; 50cm2 in the frontal zone and roughly 50 cm2 in the mid scalp plus the upper arc of whorl - roughly 2000 grafts to the frontal zone and 1400 grafts to the mid scalp, upper arc of whorl -recipient site density of about 30 to 40 grafts per cm2; 40 in the front and 30 in the mid scalp. - start transplanting from the existing frontal hair line which is about 7 cm from the glabella - combination of sagittal and coronal incisions with gauge 21 hypodermic needle for the single hair and custom made 1 mm blade for the 2-hair and 3- hair follicles -Dense packing in the frontal hair line with about 50 single hair /cm2. -Frontal tuft receive 40 to 45 grafts/cm2 and the rest of the frontal zone 40 grafts /cm2. -mid scalp receive about 30 grafts/cm2 Donor area: -Total number of grafts harvested: 1403 single hair 1728 double hair 329 triple hair -Donor strip 29 cm X 1.6 cm was excised. -Donor wound closed in 2 layers. One layer with Nylon as retention suture and the other layer, superficial running suture with Vicryl -Trichophytic closure with trimming of the lower edge applied Remarks: - Asian scalps, in general, are tighter and have less hair density than Caucasian scalps; thus a larger strip needs to be excised. Asian hair, however, is thicker in caliber and, therefore, produces better coverage. - The majority of Asian patients have straight hair. - Because there is a strong color contrast in Asians between their black hair and pale skin, the all FUT procedure produces the most natural look. - - Average Asian follicles are 5-6 mm in length, whereas they are 4-5mm for Caucasians. There is higher risk of producing "transactions" when doing transplants on Asians because of longer hair follicles. - Asians have a higher ratio of single hair follicles. The survival of single hair follicles are lower than the 2 or 3 hair follicles Wen-Yi Wu M.D. FISHRS 吳文藝醫師 Fellow International Society of Hair Restoration Surgery 國際植髮醫學會 資深研究員 Diplomate ABHRS American Board of Hair Restoration Surgery 美國植髮醫學會 專科認證 Taiwan Hair Transplant 台灣萌髮診所 8F, 21 Section 3, Nanjing East Road, Taipei, Taiwan 台北市南京東路三段21號8樓 Telephone: 886-225011383 Email: wu@hair7838.com LINE ID: taiwanhair What's App: +886 972-978-333 Wechat ID: taiwanhair http://WWW.hair7838.com

Yes, we put the patient on Finasteride after the procedure.

Bell and round shape hairline: The bell-shaped hairline fits a narrower head , conserves grafts, and matches the arc of temporal recession. The round design is better suited for a wider head with mature , stable temporal hair, like this patient. The lateral terminus of the hairline can either end with the tail moving backward or with a slight flare. If the lateral terminus flares outward, i.e., curves toward the temples, and the temple hairline is not rebuilt, the surgeon will need to commit to rebuild the temple hair in the future since the hair-loss progression may move backward exposing the scalp behind the initial hairline and causing the entire hairline to look unnatural. Conversely, if the lateral terminus points almost directly backward, then the temple can progress in recession backward along this line and continue to look natural, this design is suitable if the temple is not planned to be transplanted at the outset. In either case, the temple may require rebuilding either at the initial session or in the future because a hairline that juts too far in advance of the temporal hairline looks unnatural like a bad toupee. This patient has a round head with a strong temple hair. We designed a round hairline with a flared terminal ends .

We charge 85 Taiwan dollars ( 2.80 USD ) per graft of FUT; and 150 Taiwan dollars ( 5.0 USD ) per graft of FUE. There is a sliding scale for grafts more than 2000 grafts. Thank you.

Another point of critical consideration is the hairline shape in racial differences. Generally there are two types of hairline shapes: Bell-shaped and round. The round design is better suited for a wider head with mature stable temporal hair.

There are five commonly accepted characteristics of hair that are important to consider. The surgeon must project mentally how these physical features of the hair will affect the transplant result. 1. caliber The caliber of the hair shaft contributes most to the final fullness and perceived bulk of the transplanted result. An increase in hair diameter of a mere 0.01 mm increases hair bulk by an astounding 36%. The hair caliber varies greatly from one individual to another. In general, Asians have a thicker hair caliber than Caucasians. 2. Color contrast with skin The less contrast between the color of the hair and skin, the less noticeable any alopecic gaps between hairs become. Put differently, the less the color contrast between hair and skin, the more even and the more natural the hair coverage appears to be, and, therefore, there is the illusion of more hair. Most Asians have black or dark brown hair, and this creates more contrast among those with light complexions, such as the Chinese, but would be less of a problem for darker skinned Asians, such as the Indian or Malay populations. This unfavorable color contrast of the Asians may be somewhat compensated by the larger hair caliber . 3. Curl 4. Wave The more curl or wave to the hair, the denser and fuller the hair appears to be. A natural wave to the hair not only increases the naturalness but also increases the apparent fullness and density. Most Asians have straight hair, whereas this patient has slight curly hair which is not common. 5. Frizziness Hair is said to be frizzy when it possesses a visibly irregular surface and, therefore, flows unevenly. The individual hairs lay "roughly " upon each other, with more space between them, and they thus give an appearance of increased density. In addition, the more frizzy the hair is, the more natural it looks, because alopecic spaces between hairs are blurred by the frizz. This patient has thick hair , slight curly and frizzy hair. All these contribute to a good outcome.

Patients with small bilateral fronto-temporal recessions usually leave the hair long enough to cover the 2 sides. Pre and post-op changes are not obvious when hair are long. Subtle pre and post-op changes can only be appreciated when the hair are trimmed short or combed backwards to expose the 2 sides.

This is a 43 y/o Chinese patient suffering from Norwood III recession. He has been on Finasteride for the past 2 years. One session FUE was done 16 months ago on the hairline. Total 1511 grafts were harvested, which consisted of 500 singles. Wen-Yi Wu M.D. FISHRS 吳文藝醫師 Fellow International Society of Hair Restoration Surgery 國際植髮醫學會 資深研究員 Diplomate ABHRS American Board of Hair Restoration Surgery 美國植髮醫學會 專科認證 Taiwan Hair Transplant 台灣萌髮診所 8F, 21 Section 3, Nanjing East Road, Taipei, Taiwan 台北市南京東路三段21號8樓 Telephone: 886-225011383 www.hair7838.com Email: wu@hair7838.com

Another point that needs special consideration. For the Chinese and most Asian patients, 4000 to 5000 grafts are needed to cover from the frontal hairline, all the way back to the crown for class V patients. However, you need much more grafts to cover the same area for most Caucasians,

These were the pictures taken after healing of the chin area . Basically the scars in the chin were not obvious if the punches used were small in caliber.

This Chinese patient wanted one session, as many grafts as possible. He has an average donor scalp laxity and hair density . He also has some beard, which is not quite common for most Chinese patients. We performed Combination grafting which consisted of 3758 grafts FUT from the scalp and 500 grafts FUE from the beard. The post-operative picture was taken 15 months after. Spliting of the grafts from FUT: 450 1-hair grafts 2102 2-hair grafts 300 3-hair grafts 906 cut to size grafts to fit in 19# needle FUE Beard 500 grafts Total number of grafts transplanted 4258 grafts Wen-Yi Wu M.D. FISHRS 吳文藝醫師 Fellow International Society of Hair Restoration Surgery 國際植髮醫學會 資深研究員 Diplomate ABHRS American Board of Hair Restoration Surgery 美國植髮醫學會 專科認證 Taiwan Hair Transplant 台灣萌髮診所 8F, 21 Section 3, Nanjing East Road, Taipei, Taiwan 台北市南京東路三段21號8樓 Telephone: 886-225011383 www.hair7838.com Email: wu@hair7838.com

On the other hand, this case shows that the Asian hair are thicker in hair caliber, but hair density are lower than Caucasians. The number of grafts needed for Asian patients are much lesser than Caucasians for the same size of baldness.

Yes , I agree. If the patient eventually develops into class 6 or 7, some of the grafts will be lost. It is important for the physicians to identify patients at risk of developing into class 6 or 7. Only a relatively small percentage of men ever develop hair loss that is more severe than Type VI . Norwood's study revealed that men aged 65-79 years, 16% or fewer developed Type VII MPB. Ominous signs that point to the possibility of Type VII are: (1) a father or maternal grandfather with a Norwood Type VII pattern or worse; (2) the presence of whisker hair, around the ears (3) the absence of dense fringe hair; (4) the presence of diffuse nonpattern alopecia (5) a repeatedly higher than average percentage of miniturized hair in potential donor areas; (6) MPB beginning in teenager. This patient does not have any one of these signs and is considered at low risk of future development of Type VII. Thank you very much for your comment.

Another view of the donor area in a more vertical position. This picture showed that the grafts harvested are confined to the occipital areas, not to the unsafe zones, which are very high or very low zones. In fact, different authors have different definitions of " SAFE ZONE ". The definition is in reality not definite. I will never go below the bony protuberance as the lower limit. The upper limit I always examine for the percentage of miniturized hair present. If there is abundance of thinning hair, I do not harvest any grafts from that level. Since we are cherry pick every single graft, I always harvest the hair that are thick in caliber and appear strong and healthy.

This 38 y/o Chinese patient suffered from Norwood III recession . The left side fronto-temporal recession was larger than the right side. There was also thinning at the widow's peak. 1021 grafts were transplanted by the motorized FUE. Spliting of the grafts were 410 single hair; 494 doubles and 117 triples. The pictures were taken 9 months post-ops. Wen-Yi Wu M.D. FISHRS Fellow International Society of Hair Restoration Surgery Diplomate ABHRS American Board of Hair Restoration Surgery Taiwan Hair Transplant 8F, 21 Section 3, Nanjing East Road, Taipei, Taiwan Telephone: 886-225011383 Email: wu@hair7838.com

This 38 y/o Chinese patient suffered from Norwood III recession . The left side fronto-temporal recession was larger than the right side. There was also thinning at the widow's peak. 1021 grafts were transplanted by the motorized FUE. Spliting of the grafts were 410 single hair; 494 doubles and 117 triples. The pictures were taken 9 months post-ops. Wen-Yi Wu M.D. FISHRS Fellow International Society of Hair Restoration Surgery Diplomate ABHRS American Board of Hair Restoration Surgery Taiwan Hair Transplant 8F, 21 Section 3, Nanjing East Road, Taipei, Taiwan Telephone: 886-225011383 Email: wu@hair7838.com

This 38 y/o Chinese patient is suffering from Norwood III bilateral fronto-temporal recession. There is recession in the 2 sides with the left side much bigger than the right side and thinning of the widow's peak. 1021 grafts were delivered by motorized FUE. Spliting of the grafts were 420 single hair, 490 2- hair grafts and 111 3-hair grafts. The post-operative pictures were taken 9 months after. Wen-Yi Wu M.D. FISHRS Fellow International Society of Hair Restoration Surgery Diplomate ABHRS American Board of Hair Restoration Surgery Taiwan Hair Transplant 8F, 21 Section 3, Nanjing East Road, Taipei, Taiwan Telephone: 886-225011383 EMAIL : wu@hair7838.com

Thanks for the compliments. We use motorized punches , both sharp and dull punch . The dull one is the SAFE system. The sharp one is a custom made machine. Implantation of grafts are done by forceps. We do not use the Choi implanter.

This is a 43 y/o Chinese patient suffering from Norwood III recession. He has been on Finasteride for the past 2 years. One session FUE was done 16 months ago on the hairline. Total 1511 grafts were harvested, which consisted of 500 singles.

This 35 Y/O Chinese patient had extensive thinning from frontal zone to midscalp and vertex. Persistent frontal tuft is noted. He is on Finasteride prior to the procedure. One session FUT 3372 grafts was performed 15 months ago. The areas to be covered are frontal zone, midscalp and the upper spin of the whorl ( vertex). The results are dramatic with one session. This case illustrates that for most Asian patients, roughly 3500 to 3800 grafts are enough to cover from front to crown in a class 4 or 5 patients.