Hairtechnician

This patient came to Dr. Keene with a Type V hair loss pattern in his late 20s.  The photos here are from before and after a consecutive day surgery session of 4000 plus grafts.  He is very happy to have his hair style back the way he likes it!  Will add the graft breakdown later.

This 40 something gentleman came to Dr Keene to make his hairline more natural after he had a scalp flap surgery (done elsewhere).  Dr. Keene prescribed Finasteride to help him retain his hair, and provided a range of grafts for him to choose from depending on whether he wanted to include both the hairline and temporal area.  He opted to include both, and Dr. Keene softened the hair line as well as filled in the temporal area and scars with a session of 1750 FUT grafts, restoring a natural appearance.  He opted to further add more density a few years later with a 2^nd procedure, this time opting for FUE for the donor removal method.  The photos are from before, after 1750 FUT, and after an additional 1000 FUE.  He is pleased with his results, and mentioned that the results make him feel more confident.

Here is the graft breakdown:

FUT Surgery 2014                                            FUE Surgery July 2017

1s) 397                                                                  1s) 31+

2s) 542                                                                  2s) 498

3s) 600                                                                  3s) 328

4s) 211                                                                  3s) 143

          Total  1750                                                        Total  1000+

This 29 year old came to Dr. Keene with the goal to stabilize his hair loss, and restore his hairline. Dr. Keene prescribed Finasteride to help prevent further hair loss, and he is aware of the risk of further hair loss, which is diminished with the use of Finasteride. He opted for the FUE donor removal method as his preference.  Dr Keene filled in his hairline with just over 1800 FUE grafts, using the WAW FUE donor removal method.  The photos are from before, and 18 months post surgery. 

Here is the graft number breakdown by numbers of hair per graft:

1s) 200+

2s) 612

3s) 768

4s) 292

Total 1800+

This 30 something gentleman came to Dr. Keene with the goal of restoring his hair line.  The photos are from before and 18 months after 2250 FUT grafts.  He and his wife are very happy with his results!  He told Dr. Keene his choice to have surgery was one of the "best things I've ever done."

Here is the graft number breakdown by hairs per graft:

1s) 232

2s) 790+

3s) 850+

4s) 378

Total 2250+ grafts + indicates where we got additional grafts-we include the numbers based on the amount patients paid for, but will always place any extra grafts we obtain.

Total Hairs:  5874+

This 35 year old patient came to Dr. Keene to restore his front hair line.  Since he likes to wear his hair buzz cut, he chose FUE for his donor removal method. There is no completely scarless donor removal method, but FUE blends better with buzz cut hair than FUT, especially in someone with high color contrast, so FUE was chosen.  These photos are from before and 8 months after.  Some patients take longer to grow in but he appears to have his complete growth.  Now that he has turned back the clock on his hair loss, he remains on Finasteride to help stop further hair loss.

Here is the graft break down:

1s) 175

2s) 584+

3s) 645

4s) 96

Total 1500+

Where we obtained some additional beyond what he paid we include a plus sign.

This Type III pattern young man came to Dr. Keene due to noticing temporal recession. His father, grandfather and uncles are all class IV, so his hair loss could progress if not addressed. He was started on Finasteride, and took that for 12 years before he decided to also fill in his temporal recession with surgery. The Finasteride was effective in stabilizing his hair loss. Clearly he didn't rush into this choice, but his temporal recession bothered him and since the Finasteride was working to prevent further hair loss he opted to proceed with a hair transplant. These photos are from before his surgery of 1800 FUSS grafts to fill in the temple area, and 3 years post surgery. He continues to take Finasteride to prevent further hair loss and maintain his youthful hairline.

This gentleman in his 60s had not noticed his thinning until he was just over 50. He chose not to just let nature have its way, and came to Dr. Keene. Dr. Keene recommended between 4000 and 4600 grafts as the minimum amount she would recommend for excellent cosmetic result. These photos are from before, and after he had FUSS with 4000 grafts.

Here is the graft breakdown:

1 haired grafts=298+

2 haired grafts=1442+

3 haired grafts=1484+

4 haired grafts=776

Total 4000+

We typically do not include all the extra grafts in the counts we provide when we get extra because we know patients compare and we don't want someone to be disappointed if they don't get as many as someone else.

This 30 year old gentleman came to Dr. Keene to fill in his hairline especially were he was receded in his temple area. Dr. Keene prescribed Finasteride to help him retain his existing hair, and recommended 1800 to 2300 grafts to fill in his hair line based on his goals. He opted for 1900 grafts, just above the minimum she recommended. He chose the FUE donor removal method to assure he would have the option to wear his hair very short on the back and sides where the donor is removed, but he does wear it with some length in the front which gives him the advantage of layering to help create a dense appearance. The photos are from before and 1 year after 1900+ FUE grafts. He is wearing hair gel in his post op photos which gives him the wet look. He is very pleased with his results!

Here is the graft breakdown:

1s) 283

2s) 603

3s) 643

4s) 419

Total 1900+

This patient in his mid-30s had front and crown hair loss that could have progressed to a type VI or VII pattern (like his father) without intervention. Dr. Keene recommended 4500 grafts initially, but adjusted it lower to provide the minimum number of grafts for cosmetic coverage. These photos are from before, and 11 months post-surgery. The surgery provided a nice thinning coverage that fits his hairstyle, and the patient has the option to return for additional grafts in the future if he decides he would like to add more density.

Here is the graft break down:

1s) 455+

2s) 1337

3s) 816

4s) 192

Total 2800+

Thanks Ontop and Mania1! I added a couple of photos of 1 week post surgery because a lot of patients like to see that.

This young man (in his mid 20s) came to Dr. Keene about 2 years ago with his main concern to stop his hair loss--he felt that his hairline was okay where it was. His father, uncles and grandfather on both sides have type V and VI hair loss patterns and he did not want to follow in their foot steps. After discussing his options, he opted to start on Finasteride at that time. After 8 months on the medication, he felt his hair loss had stopped, and decided he would also like to fill in his hair line. Dr. Keene advised a conservative number of 1500 grafts, and he opted for the FUE donor removal technique. The photos are from before (on the day of surgery) and 18 months post surgery. He is happy with his results, and still has plenty of donor for the future should he decide to augment more, especially if he loses more hair. He is continuing to take the Finasteride to prevent further hair loss with no indication of further hair loss at this time. The photos of the donor are from before, 2 weeks post surgery, and 18 months post surgery.

This 30 something patient came to Dr. Keene with the goal to stop his hair loss and add some to his frontal area. Dr. Keene prescribed Finasteride to help combat futher hair loss and possibly strengthen his existing hair, and he opted to undergo an FUE hair restoration procedure with 1000 grafts focused on the frontal area. This was an average of about 30 grafts per sq cm, though fewer were placed in area where he had thinning. The photos are from before and 1 year after surgery of 1000 FUE grafts.

Here is the graft breakdown:

1s) 200

2s) 248+

3s) 327

4s) 225

Total 1000+

(+ indicates where we did a few extra but we don't include the extra in the count)

This young man wanted to restore his front hair line including the temporal recession he had experienced. The photos are from before and one year later with 2100+ grafts. Here is the graft break down:

1s) 239+

2s) 853+

3s) 758

4s) 250

Total 2100+

This 20 something patient came to Dr. Keene for recommendations on what he could do to restore his hairline and crown. Dr. Keene recommended he take Finasteride to strengthen and retain his hair, and recommended against surgery in the crown area until we saw what the Finasteride could do to strengthen the area, because sometimes strengthening the vellus hair (which is the very fine in caliber), when it is present, will be enough to add significantly to the appearance of density. The hair in that stage is often at the end of its final growth cycle but can sometimes be saved by taking Finasteride. In the front hairline, we knew that he would not regrow hair where it was completely gone,, so she recommended 1400 grafts for that area. These photos are from before, and 1 year post surgery with 1400 grafts. He started Finasteride around the same time. His hairline has grown in nicely, and he has experienced enough regrowth of hair in the crown area so that he doesn't feel he needs more density there at this time. He is very happy with his current results, and has plenty of donor left to add more in the future should he need it--depending on whether he stays on the Finasteride, and its continued effectiveness at retaining his hair. Here is the graft breakdown:

1s) 272+

2s) 594

3s) 413

4s) 121

Total 1400+

This 20 something patient came to Dr. Keene to restore his front hairline to one that better represented his youth. He was referred by his father who had had surgery years before with Dr. Keene and wanted his son to catch his hair loss early. Dr. Keene prescribed Finasteride for him, which he has continued to take to keep his existing hair, and he opted to have surgery to restore his hairline. The photos are from before and 2 years post surgery of 2200+ grafts. Below is the graft breakdown by hairs per graft:

1s) 300+

2s) 700+

3s) 879

4s) 371

Total 2200+

Note: The plus sign indicates where we got some extra, but we include only the number of grafts a patient paid for because the number extra will vary, and we don’t want patients to be disappointed if they don’t get as many extra as someone else.

This gentleman first came to see Dr. Keene in his 40s. He opted to undergo a procedure in 2003 which was about 2400 grafts. He lost some additional native hair over the years, and also wanted to augment his density, so he returned for a second procedure in 2015. Now in his late 50s, he looks younger than his age. The photos are from before his first procedure, and 9 months after his most recent procedure, which was about 2300 grafts.

Here is the graft breakdown including both surgeries:

1s) 943

2s) 2406

3s) 1127

4s) 224

Total 4700

This 60 something gentleman (who looks more like 40 something now ) came to Dr Keene to restore his front hair line, particularly focusing on the temporal area. These photos are from before and 2 years post surgery. Here is the graft break down:

1s) 245+

2s) 732+

3s) 715

4s) 387

Total 2079+

This 50 something gentleman came to Dr. Keene to recontour his hairline and improve vertex coverage on his crown. These photos are from before and 1+ year after 3200 grafts.

Here is the graft breakdown:

1s) 328

2s) 1105

3s) 1261

4s) 712

Total 3406

This young man came to Dr. Keene to restore his hair line, mid frontal area, and his crown. The photos are from before and 1 year post surgery. 1500 grafts were placed in the front and mid front, and approximately 700 grafts in the crown. Dr. Keene also prescribed finasteride to help retain his non-transplanted hair. He is very pleased with the results!

Here is the graft break down by number of hairs per grafts (we did get extra as indicated by the plus sign, but we only include the number the patient paid for because extra grafts will vary in number, and we don't want some patients to feel disappointed because they didn't get as many extra as another--however Dr. Keene does place the extra grafts):

1s) 200+

2s) 889

3s) 763

4s) 351

Total 2200+

This forty something gentleman came to Dr Keene a type IV and would have progressed to a type VA or higher if he hadn't decided to take action against his hair loss. He was started on Finasteride to stop further hair loss and opted to undergo hair restoration surgery (FUT) to restore areas that had already been lost. These photos are from 1 year after his second procedure.

Here is the graft breakdown:

1s) 946+

2s) 2292

3s) 1951

4s) 813

Total 6000+

This gentleman came to Dr. Keene to restore his hair line and crown area. Due to his hair length, he is able to take advantage of layering, so Dr Keene recommended a minimum coverage of 20 grafts per sq cm. However, in the crown in particular, we focused on providing as many 3 and 4 hair grafts as possible. These photos are from before, some angles are 1 week post surgery, and 9 months after surgery. He appears to have his full growth at this stage, though we often see some added density for up to a year. If we are able to provide some additional angles at a year we will add more photos later.

Here is the graft break down by number of hair per graft, with about 1800 to the front and midfront and about 600 to the crown:

1s) 200+

2s) 700

3s)883

4s) 625

Total 2400+

Total hair 6749+

This patient came to Dr. Keene to augment his crown, mid front, and front hair line. She filled it in with just over 1900 grafts, 1000+ to the crown and 800+ to the front. He had a prior procedure a few years prior (in 2006) and continued to experience more hair loss so Dr. Keene got him to start on Finasteride to help stop his continued hair loss. His second surgery was in 2009, and the photos are from before his second surgery, and 4 and 5 years post his 2nd surgery. Here is the graft breakdown:

1s) 150

2s) 1170

3s) 2565

4s) 1496

Total grafts 1964

Total hair 5381

This gentleman, a young 60 something, came to Dr. Keene to restore his youthful hairline. His new hairline fits his active lifestyle--while he and his wife are out mountain climbing and traveling the world he doesn't have to think about styling his hair cause it looks great wash and wear. The photos are from before and 1 year later.

Here is the graft break down:

1s) 515

2s) 494

3s) 1444

4s) 827

Total 3280

Total hairs 9143

In my opinion as a hair transplant technician, not meant as medical advice because I'm not a doctor, I believe that the varying recommendations you received have to do largely with your risk of future hair loss and the doctor's approach to that consideration. You may feel that your pattern has stabilized, i.e. you're not losing more hair, but that is not definite as hair loss can occur gradually, to the point of being unnoticed, until its over 50% gone. In addition there are many people who don't lose their hair until they are in there 40s and 50s (or older) so it can be stable now, and then not stable when genetics for hair loss are triggered, which is unpredictable. So the risk here is that if a doctor transplants an area where you have diffuse thinning, the native hair present in the area may experience shock loss due to the trauma of having incisions made near it, and shed. It would regrow with your grafts if it is permanent hair, but if it's not, your hair loss could be sped up, so that instead of losing the native hair, for example, 5 years from now, when the hair growth cycle ends, you could lose it now. Avoiding shock loss is the reason for avoiding transplants to areas of diffuse thinning as a conservative approach because you still have sufficient density for cosmetic benefit, and are not taking finasteride to combat your genetics. Another approach is to assume your hair will eventually shed in the areas of diffuse thinning and treat is as though it's not there, which is likely where the recommendations for 4000 grafts came from. The recommendation for 2000 grafts is likely based on assuming you're right and you are not shedding, you patter is stable, and possibly that that won't change, or if it does, you know the risk and can get more grafts later. So it does depend on the doctor's approach.

If you choose to go forward with a transplant in an area that is experiencing thinning rather than baldness, when male pattern hair loss is present, you may be increasing the risk of losing native hair sooner. Medication can help diminish that risk of permanent shock loss due to surgery, but if you don't want to use them you can make a more informed decision keeping that risk in mind.

This young man had temporal / hairline recession he wanted to fill in. These photos are from before and a little over 2 years post surgery, with a density of about 30 grafts per sq cm. The linear excision from the strip procedure is not visible with his hair style, which is still fairly short, as you can see in the last photo taken 2 plus years after surgery. He is very pleased with the results overall.

Here is the graft break down:

1s) 180

2s) 183+

3s) 406+

4s) 258

Total 1000+