Hairtechnician

This patient first came to Dr. Keene at the age of 24, and she prescribed Finasteride for him to help maintain his existing hair. After taking Finasteride for about 8 years, which he did feel stabilized his hair loss but didn't augment the density enough, he decided to proceed with hair restoration surgery in 2013. These photos are from before and 13 months post 3000 FUT (including some DFU) grafts. Dr. Keene concentrated a little over 2000 grafts on the frontal area, and provided just under 1000 grafts to the crown. Now in his early 30s, he is happy with his decision to undergo hair restoration surgery. Here is the graft breakdown: 1s) 440+ 2s) 1328 3s) 878 4s) 393 Total grafts 3000+ Hairs 7302+

This gentleman came to Dr. Keene in to restore a more youthful hairline and to fill in the front and mid frontal areas. These photos are from before, and 1 year after 2600 grafts to the frontal area. Here is the graft breakdown: 1s) 514 2s) 1112 3s) 739 4s) 256 Total 2630

This patient came to Dr Keene to recontour, strengthen, and add density to his hairline. She prescribed Finasteride to maintain his non transplanted area, and augmented the approximately 50 sq cm of the hair line and mid frontal area with 2100 grafts. The photos are from before his procedure, and 4 years after. Here are the graft numbers by hairs per graft: 1s) 287 2s) 776 3s) 780 4s) 310 Total 2153

This patient came to Dr. Keene in his early 30s wanting to restore his youthful hairline. He was started on Finasteride to maintain his hair, and Dr. Keene filled in the frontal hairline and temporal area with 1800 FUT grafts. Here is the graft breakdown: 1s) 366+ 2s) 739 3s) 574 4s) 121 Total 1800+ The photos are from before and 2 years post surgery.

This gentelman came to Dr. Keene at the age of 43 with a type IVa pattern of hair loss. He had about 90 sq cm of area in the hairline and frontal area of his hair to fill in, and she gave him an estimate based on his hair caliber, and the lack of contrast between his hair and scalp, as well as his plan to not wear it extremely short, of 1800 grafts as a minimum for thinning coverage to 2700 grafts for a more dense coverage. He opted for 2000 grafts based on Dr. Keene's recommendations and his budget. She also prescribed Finasteride to help keep his hair in the vertex and central areas, and he seems to be holding pretty steady in those areas on the medication. These photos are from before, and 2 years post surgery. He is very pleased with his results. Here is the graft breakdown: 1s) 297 2s) 598 3s) 876 4s) 318 Total 2000+

This 40 something patient first came to Dr. Keene for a consultation about his hair loss in 2010. She started him on Finasteride to maintain his hair, and a few years later, he decided he wanted to restore his hairline with surgery. Dr. Keene brought forward his hairline, including the temporal area, and restored his temporal points on the sides. These photos are from before, and 8 months post surgery. He is very pleased with his results! Here is the graft break down: 1s) 414 2s) 707 3s) 799 4s) 464 Total Grafts 2384 Total Hairs 6081

This patient came to Dr Keene at age 30 to restore a more youthful hairline, as well as to add density over the thinning midfront and crown area. After his first procedure in 2007, he was very pleased with the results. But even though he has been taking finasteride since prior to his first surgery in 2007, he did continue to thin in the non permanent areas, so chose to add more density in 2010 with FUT, and 800 FUE in July of 2013. He was aware from the beginning that the risk of additional hair loss could occur, and he was happy to not have to go through a period of virtual baldness, so that the gradual attrition and addition of hair was not as obvious as it might otherwise have been. These photos are from before his first procedure in 2007, and from 10 months post his FUE surgery. Here is the graft breakdown for the total of his procedures: 1s) 304+ 2s) 1361+ 3s) 1375 4s) 563 Total 3603+ FUT and FUE *We include in the count the number of grafts he paid for, and indicate where he received more with a plus sign

Mickey85, Yes, we have discussed your opinion about Dr. Keene's choice to perform surgery on a 19 year old elsewhere, but since you are posting defamatory remarks about Dr. Keene in this post also, I feel the need to repost her response to your prior inflammatory statements. First and foremost, Dr. Keene does not perform surgery on someone who she feels will not benefit from it, period! The patient seeking opinions in this case is 35 years old, so your opinion regarding Dr. Keene's choice to do surgery on a 19 year old does not seem relevant to me, but since you stated again that you feel Dr. Keene's choice to do surgery on a 19 year old means she is not ethical, when she is an extremely ethical and caring doctor, I feel the need to repost Dr. Keene's responses regarding your statements. "The difficult thing about patient blogs is that protecting the privacy and anonymity of those who post can obscure or obstruct the knowledge of clinical nuances that contribute importantly to medical decision making. Likewise, the anonymity of those who respond, can cloud or camouflage a clinical bias which may not be based on scientific knowledge or expertise. In hair restoration, as all disciplines, expertise and training in the medical specialty are important. A doctor/surgeon must insure that all aspects of the medical history and hair loss history are part of the decision making process. It does not serve a worried patients interest to criticize their surgeons decisions, without being aware of all information—and can in fact unnecessarily increase or even cause a patients anxiety. Bloggers who request information, in my opinion, are best served when other patients share their experience of how to deal or improve a particular problem. This online environment should be a supportive one, and help guide fellow patients through a temporary anxiousness or to ask their doctor the appropriate questions if they need to. I have had patients share that experience from this website, and appreciate it. In my over 20 years of performing follicular unit transplantation , I have operated on a handful of patients under the age of 21, and only a small fraction of my overall patient population are under the age of 25. A decision to proceed with surgery at a young age must include a thorough understanding of the progressive nature of hair loss from androgenetic alopecia (AGA or male pattern baldness)—but if in my clinical judgment, after weighing the pros and cons, I think it will benefit a patients life and livelihood I have on occasion, been willing to do so. It is more customary for me to prescribe medication to stabilize a patients pattern. However, when I know the medication is not likely to achieve a goal that I think is reasonable, then surgery may be the best approach. Without violating the privacy of the patient which prompted my response, I would like to share the stories of a couple other patients who did not blog but were very young when they had surgery—their experiences changed my perspective. In the first 5 years of my career in hair restoration, I adhered strictly to the “rule” that no patient under the age of 25 should have surgery, as they won’t be able to predict their future pattern. During that time finasteride was not yet available, but furthermore, even with the benefits of medication these drugs cannot typically restore hairline areas that have receded….and can be the source of significant anxiety to many young men. Several years into my career, I was approached by a mother about her 20 year old son, who refused to attend family functions, refused to be included in family photos, and refused to be seen without a baseball hat because he had lost a considerable amount of frontal hair and had no distinguishable hair line. He sat in my office with his mother as she shared their story, but when I asked him if he felt the hair loss was interfering with his life, he looked down at his hands and stated firmly that this was all his mothers idea, he was fine with his hair loss. I explained to his mother how I could not recommend surgery to anyone who did not wish to have it, and the patient indicated he would be fine to proceed if it would make her happy. I felt ambivalent, by her report his hair loss was causing extreme self consciousness—by his, he was not at all disturbed by it. I spent a great deal of time explaining the benefits of medication therapy to stop future hair loss and suggested if he was not bothered by his hair loss there was no real rush to proceed with surgery at his young age—that in fact he would benefit from knowing if the medication might strengthen some of the thinning areas. I did express concern that something was causing his unwillingness to attend social functions, but the patient was adamant it was not his hair. A few months later he came back in for a follow up appointment; I was surprised to see him on my schedule as I did not expect him back for a year. When we spoke he felt his hair loss had stabilized, he was no longer shedding, and reported to me that he still wasn’t bothered by it. I told him I thought it was fine to continue on medication and he could always consider surgery at a later date if he ever changed his mind. Peculiarly, I received a call from his mother about 20 minutes after he left the office—she was calling to schedule a date for his surgery. I shared with her that her son stated he was fine with how he looked—and she stated he was the one who called and asked her to schedule. I felt perplexed, but assumed that despite his revelations to the contrary, she knew it was affecting him and he was willing to let her help him—even if he did not wish to admit it to me. I do my best to make patients feel comfortable, but when a parent comes to my office with their child, I know they have their child’s best interests at heart and are looking for me to help. A year after his surgery, his mother shared how his life had changed. He had become very social, he no longer wore a hat, he attended family functions again, had a girlfriend, and had experienced great success in his work which involved sales. When I saw him in my office, he looked me in the eyes, not at his hands…and though by then he was only 21 years old… I knew we had made the right decision. Although it has been some years since I have seen him, I did see him for several years after his surgery and we did eventually do a second procedure to strengthen his density and fill in for a little bit of additional hair loss—though the medication seemed to be holding him quite well. Furthermore, the permanent hairs in the front, allowed him to cover areas behind it which were slightly thinner. A second case I will share is similar in nature, except that there was no parent involved. A 22 year old young man came to me to ask me to fill in his hair line. We discussed the risks of advancing hair loss, which might be stabilized with medication—but there was no certain way to know that until more time had passed. So he began medication therapy, and a year later when I saw him his pattern had stabilized. He asked if I would do surgery, and I said we needed to wait for another year to be sure he was stable—this happened the next year, too. At the “magic” age of 25 we operated and filled in his hair line—and when I saw him back several months later he looked younger than when we first met. He was thrilled, glad to be getting carded again…and while I was happy for him, I thought about the 3 years I had refused to operate on him…with the wisdom of hind sight, I knew he hadn’t benefitted from that lost time—his pattern was stable on medication and from experience, I could have predicted that after about 6 months. And even if it wasn’t completely stable, he was intelligent and educated on the subject of progressive hair loss. Knowing what the risks were—that he might some day need another surgery, he could have, and should have been allowed to make that decision—age was not the issue, since the risk of additional hair loss was still present when we operated at age 25. In fact, for men of all ages, the risk of needing to ‘chase a hair line” is present in virtually every patient we operate on who has a minimal pattern of hair loss! In order to avoid that, should we then require that all patients progress to a Class V-VI pattern before proceeding with surgery? I don’t think that is reasonable. I am pleased to say that I am aware of the happier lives of many young men, who have their confidence restored by what I do. Nevertheless, do I encourage all young men to proceed with surgery? I would never suggest it unless he had been seen and evaluated by an experienced follicular unit transplant surgeon. Because of experience and knowledge I do have the ability to know whether a patient is likely to have progressive hair loss, and whether they are likely to benefit substantially both emotionally and cosmetically. Even in cases of Body Dysmorphic Disorder, according to studies and personal directives from psychiatrists I have spoken to when faced with this issue, some patients will be cured or substantially benefitted—but not all, and a multi disciplinary approach may be necessary." In another statement she continues: "Self image isn’t less important at age 19, it may be more so—or at least equally so. There are reasons not to proceed with surgery at age 19, often we are dealing with the early stages of thinning, and surgery could accelerate hair loss. In these cases, which are the majority, I always recommend watchful waiting and medical therapy. Fortunately, most 19 year olds are not affected with AGA at such a young age, but when they are, every patient is entitled to be fully educated about his options, and proceed accordingly. In my experience, few young people can afford cosmetic surgery, and are usually assisted in their decision making by the wisdom of a parent. Presumably this overcomes the reported objection to allowing a young person to make his own decisions—though I will address this assertion momentarily. Nearly all young patients I have seen over the years where the option of surgery has been provided, have parents who are professionals (including medical doctors) and usually do not make this decision alone, simply as a matter of economics. My job is never to persuade a patient to proceed with surgery—at any age—but merely to explain the options they have, both medical and surgical, including the consequences of future hair loss if it occurs. Each circumstance and patient is different, and each has a right to their valid concerns and approach to every challenge, including hair loss. For better or worse, the psychological literature is full of data to support that society and individuals make judgments based on the way a person looks, and this can affect the way a person is treated, whether they are 19 or 90. So it is not just self image we are speaking about, it is the way others view and treat us, too. While counseling can help a self conscious patient accept their hair loss, preventing and treating hair loss is an alternate or adjunctive approach. The more or less ubiquitous acceptance that hair loss due to chemotherapy is emotionally traumatic independent of the associated illness-- raises the question as to why anyone would think young men in particular or any man or woman who loses their hair has no right to be similarly upset, regardless of the cause. Losing hair can impact how we look to ourselves, and to others. Nevertheless, I also accept that some people look great with no hair, and for them shaving the hair off is not only acceptable, but promotes their positive self image. But this approach is not for everyone, either! Returning to the subject of young men and the risk of allowing them to make decisions about treatment of hair loss can be put into perspective if we look at other decisions we allow of 19 year olds. As a society we accept that 19 year olds can make life and death decisions in defending our country through military service. We allow them to decide for themselves whether to be involved with sports, whether it be kick boxing, football or skiing—all of which can have damaging, long term effects on the body. We also allow them to decide for themselves whether they should consume cigarettes or alcohol….or get tattoos or piercings—again, all of these decisions can have long term consequences. Is it reasonable to suggest that making an informed decision about hair loss treatments is out of the question? There are a variety of medical and psychological issues that can make it more or less beneficial to proceed with hair restoration surgery—at any age...every patient is entitled to their own opinion, and I listen carefully to each of them when they are in my office. If I am confident they have been fully educated and understand the long term risks and benefits of their decisions, they have a right to make them."

This 30 something gentleman came to Dr. Keene to regain his youthful hairline and add density to the front and mid frontal areas. The photos are from before and 17 months post 2244 grafts to the hairline, front and mid frontal areas including the temporal areas. Although he also has thinning in his crown, he chose to focus on the frontal areas for now and is pleased with his results! Here is the graft breakdown: 1s) 356 2s) 830 3s) 704 4s) 354 Total grafts 2244 Total hairs 5544

The difficult thing about patient blogs is that protecting the privacy and anonymity of those who post can obscure or obstruct the knowledge of clinical nuances that contribute importantly to medical decision making. Likewise, the anonymity of those who respond, can cloud or camouflage a clinical bias which may not be based on scientific knowledge or expertise. In hair restoration, as all disciplines, expertise and training in the medical specialty are important. A doctor/surgeon must insure that all aspects of the medical history and hair loss history are part of the decision making process. It does not serve a worried patients interest to criticize their surgeons decisions, without being aware of all information—and can in fact unnecessarily increase or even cause a patients anxiety. Bloggers who request information, in my opinion, are best served when other patients share their experience of how to deal or improve a particular problem. This online environment should be a supportive one, and help guide fellow patients through a temporary anxiousness or to ask their doctor the appropriate questions if they need to. I have had patients share that experience from this website, and appreciate it. In my over 20 years of performing follicular unit transplantation , I have operated on a handful of patients under the age of 21, and only a small fraction of my overall patient population are under the age of 25. A decision to proceed with surgery at a young age must include a thorough understanding of the progressive nature of hair loss from androgenetic alopecia (AGA or male pattern baldness)—but if in my clinical judgment, after weighing the pros and cons, I think it will benefit a patients life and livelihood I have on occasion, been willing to do so. It is more customary for me to prescribe medication to stabilize a patients pattern. However, when I know the medication is not likely to achieve a goal that I think is reasonable, then surgery may be the best approach. Without violating the privacy of the patient which prompted my response, I would like to share the stories of a couple other patients who did not blog but were very young when they had surgery—their experiences changed my perspective. In the first 5 years of my career in hair restoration, I adhered strictly to the “rule” that no patient under the age of 25 should have surgery, as they won’t be able to predict their future pattern. During that time finasteride was not yet available, but furthermore, even with the benefits of medication these drugs cannot typically restore hairline areas that have receded….and can be the source of significant anxiety to many young men. Several years into my career, I was approached by a mother about her 20 year old son, who refused to attend family functions, refused to be included in family photos, and refused to be seen without a baseball hat because he had lost a considerable amount of frontal hair and had no distinguishable hair line. He sat in my office with his mother as she shared their story, but when I asked him if he felt the hair loss was interfering with his life, he looked down at his hands and stated firmly that this was all his mothers idea, he was fine with his hair loss. I explained to his mother how I could not recommend surgery to anyone who did not wish to have it, and the patient indicated he would be fine to proceed if it would make her happy. I felt ambivalent, by her report his hair loss was causing extreme self consciousness—by his, he was not at all disturbed by it. I spent a great deal of time explaining the benefits of medication therapy to stop future hair loss and suggested if he was not bothered by his hair loss there was no real rush to proceed with surgery at his young age—that in fact he would benefit from knowing if the medication might strengthen some of the thinning areas. I did express concern that something was causing his unwillingness to attend social functions, but the patient was adamant it was not his hair. A few months later he came back in for a follow up appointment; I was surprised to see him on my schedule as I did not expect him back for a year. When we spoke he felt his hair loss had stabilized, he was no longer shedding, and reported to me that he still wasn’t bothered by it. I told him I thought it was fine to continue on medication and he could always consider surgery at a later date if he ever changed his mind. Peculiarly, I received a call from his mother about 20 minutes after he left the office—she was calling to schedule a date for his surgery. I shared with her that her son stated he was fine with how he looked—and she stated he was the one who called and asked her to schedule. I felt perplexed, but assumed that despite his revelations to the contrary, she knew it was affecting him and he was willing to let her help him—even if he did not wish to admit it to me. I do my best to make patients feel comfortable, but when a parent comes to my office with their child, I know they have their child’s best interests at heart and are looking for me to help. A year after his surgery, his mother shared how his life had changed. He had become very social, he no longer wore a hat, he attended family functions again, had a girlfriend, and had experienced great success in his work which involved sales. When I saw him in my office, he looked me in the eyes, not at his hands…and though by then he was only 21 years old… I knew we had made the right decision. Although it has been some years since I have seen him, I did see him for several years after his surgery and we did eventually do a second procedure to strengthen his density and fill in for a little bit of additional hair loss—though the medication seemed to be holding him quite well. Furthermore, the permanent hairs in the front, allowed him to cover areas behind it which were slightly thinner. A second case I will share is similar in nature, except that there was no parent involved. A 22 year old young man came to me to ask me to fill in his hair line. We discussed the risks of advancing hair loss, which might be stabilized with medication—but there was no certain way to know that until more time had passed. So he began medication therapy, and a year later when I saw him his pattern had stabilized. He asked if I would do surgery, and I said we needed to wait for another year to be sure he was stable—this happened the next year, too. At the “magic” age of 25 we operated and filled in his hair line—and when I saw him back several months later he looked younger than when we first met. He was thrilled, glad to be getting carded again…and while I was happy for him, I thought about the 3 years I had refused to operate on him…with the wisdom of hind sight, I knew he hadn’t benefitted from that lost time—his pattern was stable on medication and from experience, I could have predicted that after about 6 months. And even if it wasn’t completely stable, he was intelligent and educated on the subject of progressive hair loss. Knowing what the risks were—that he might some day need another surgery, he could have, and should have been allowed to make that decision—age was not the issue, since the risk of additional hair loss was still present when we operated at age 25. In fact, for men of all ages, the risk of needing to ‘chase a hair line” is present in virtually every patient we operate on who has a minimal pattern of hair loss! In order to avoid that, should we then require that all patients progress to a Class V-VI pattern before proceeding with surgery? I don’t think that is reasonable. I am pleased to say that I am aware of the happier lives of many young men, who have their confidence restored by what I do. Nevertheless, do I encourage all young men to proceed with surgery? I would never suggest it unless he had been seen and evaluated by an experienced follicular unit transplant surgeon. Because of experience and knowledge I do have the ability to know whether a patient is likely to have progressive hair loss, and whether they are likely to benefit substantially both emotionally and cosmetically. Even in cases of Body Dysmorphic Disorder, according to studies and personal directives from psychiatrists I have spoken to when faced with this issue, some patients will be cured or substantially benefitted—but not all, and a multi disciplinary approach may be necessary. In the case of this blogger, I know this patient does not wish to discuss his personal issues online, and I respect that. I have attempted to contact him and will continue to do so. I am unhappy that he has concerns about his scar—and once it has fully healed and we have dealt with it, I am confident it will not be an issue for him. At this point he is only 8 months post surgery and I would advise against massaging the donor area until he has been evaluated again as that can result in stretching of scar tissue if it is not fully remodeled because skin heals at different rates. I was very pleased with his evolving cosmetic appearance when we met a few weeks ago, and he seemed to be also. When dealing with young patients I do have concerns about the use of donor harvesting with the technique of follicular unit extraction, which in the case of 1500 grafts would have required a distribution of extraction sites between 100-150 square centimeters of his donor area. If a young man goes on to progress with falling lateral fringes or posterior hair line upward recession, these sites will be exposed (as happened in the ‘bad old days’ of punch graft harvesting using larger grafts) and the grafts will be lost. The entire development of the strip harvesting procedure was to take advantage of the concentrated harvesting of donor hairs from the zone of hair most likely to be permanent, and most likely to stand the test of time when transplanted. I further find this to be an advantage when we are trying to use as little donor hair as possible in order to achieve our goals—and with all the current, reliable hair counts on graft survival for both robotic and hand held FUE machines showing a lower survival with FUE vs strip harvesting with microscopic dissection (~70% vs >95%) there is less wasted donor hair from a potentially dwindling resource. Using simple math, I would have had to harvest over 2000 FUE grafts for 1500 to survive. I don’t think offering FUE donor harvesting for young patients offers substantial advantages over strip harvesting—and worry that with time we will have a whole group of young men with exposed scars in the future from over zealous use of that technique. That said, I do offer both forms of donor harvesting, and caution patients to consider that the appearance of a transplant is based on the experience of what occurs where the hairs are grafted (transplanted)—as most patients are not adversely impacted cosmetically by either form of donor harvesting unless they plan to wear their hair very short. If an educated patient opts for FUE, I will perform that method of donor harvesting at their request. It is my position that all competent hair restoration surgeons should know how to perform both techniques and allow patients to make an informed choice.

This 28 year old gentleman came to Dr. Keene to restore his hair line and augment the temporal areas (including his temporal points on the sides). The measured area of hair loss was about 17 sq cm on the lateral temporal areas, and 51 sq cm to the frontal area. Dr. Keene recommended a conservative approach for the procedure as he did not choose to combat his genetic hair loss by taking Finasteride, so they agreed to 1700 grafts assuring he would have the ability to add many more grafts in the future. The patient was educated about the risk that he may continue to lose more of the non transplanted hair behind his transplanted hair line, but felt that he preferred to consider future procedures to taking medication. The photos are from before, and most of the after photos are from 2 years post surgery. He is happy with his choice now at age 30, and plans to return to augment his density as needed.

This 24 year old gentleman came to Dr. Keene in 2011 to restore his front hairline. She recommended he start on Finasteride first to stabilize his hair loss. After a year, he came to see her again, and felt that the medication had stabilized his hairloss, but he still wanted to fill in his hairline. He had just a little hair loss in the crown, but that was not the area that bothered him, so he didn't choose to fill in that area yet. The pre-surgery photos are from 13 months after he started on Finasteride, and the post surgery photos are from 1 year 10 months after his surgery of 2100 grafts, (4725 hairs). He was very happy with his results! Here is the graft break down. 1s) 377 2s) 1036 3s) 520 4s) 179 Total 2112 Total hairs 4725

This patient came to Dr. Keene first in 2003 when he was considering hair restoration surgery, but decided to wait. He returned again in 2012 and decided to proceed as his hair loss had progressed and he is now in his late 50s. He had taken Finasteride for 5 years, and didn't feel it worked for him, but now considers his hair loss stable. His goals were to strengthen his frontal hairline and add midfrontal coverage, as well as to achieve natural appearing crown coverage. The results of his procedure provided excellent cosmesis with a natural appearance. These photos are from before and 1 year post surgery. Here are the graft numbers: 1s) 486 2s) 1047 3s) 934 4s) 499 Total grafts: 2966 Total hairs: 7378

This patient in his early 60s came to Dr. Keene to restore his hairline and his mid-frontal area. He also wanted to fill in his lateral eyebrow areas. These photos are from before surgery, and 11 months after a surgery of 2700+ FUT grafts to his hairline/ midfrontal areas, and 175 grafts to his eyebrows. He looks much younger with his new look! Here is the graft breakdown for the grafts to his hairline and mid-frontal areas 1s) 362 2s) 994 3s) 901 4s) 479 Total 2736 Total hairs 6969

This 50 something gentleman came to Dr. Keene to add density to the thinning he had in the front, mid front and crown areas. These photos are from before and 10 months after 3900 grafts, done in a consecutive day procedure, resulting in excellent cosmesis. The grafts were distributed with 2400 to the front and mid frontal area, 200 to the central area, and 1200 to the crown. Here is the graft breakdown: 1s) 424+ 2s) 1509 3s) 1342 4s) 625 Total 3900+ Total hairs 9968

This gentleman in his early 40s came to Dr Keene to fill in his front hair line, and to add density on the top of his head (the mid frontal area). He is very happy with his results a year later! He has been using Finasteride intermittently prior to the procedure to help maintain his hair, and plans to continue using it. Here is the graft breakdown: 1 haired grafts 338 2 haired grafts 700 3 haired grafts 748 4 haired grafts 396 Total 2100+ Total hairs 5566

This 40 something patient came to Dr. Keene with the goal of looking younger, and he definitely achieved it. He is very pleased with the results. Dr. Keene filled in both his front and crown with a little over 2500 grafts. He started Finasteride a little over a year prior to his procedure, and continues to take that to maintain his native hair (hair not transplanted). Here is the graft breakdown: 1s) 278 2s) 617 3s) 981 4s) 714 Total 2,590 Total hairs 7,311

This 30 something young man had extensive hair loss on the top and a receding hairline. He came to Dr. Keene for her to recreate his hair line and augment density, focusing on the frontal area mainly. The photos are from before and 1 year post surgery. Here is the graft breakdown: 1s) 291 2s) 1044 3s) 911 4s) 428 Total hairs 6824

This 50 something pt came to Dr. Keene to have her fill in his hairline. These photos are from before and after 2085 grafts to the front and midfront. His goal was to augment the density, and fill it in, while maintaining a conservative hairline. Here is the graft breakdown: 1s) 274 2s) 1073 3s) 487 4s) 251 Total 2085 Total hairs 4885

This 50 something patient came to Dr. Keene to repair the work he had done in the late 80’s and add more coverage. He had had a scalp reduction that left him with unnatural looking scars, and some hairline plugs. His goals were to fill in and soften areas of his hairline/front to mask the older punch grafts, and to be able to someday comb his hair back without being able to tell he had work done. He also wanted to fill in the crown. The photos are from before, and the after include some from 1 and 2 years post-surgery. His hairline now appears natural, so he doesn’t need to fear a breeze, and the crown area scars are completely covered. He is very satisfied with the results. Here are the graft numbers: 1s) 425 2s) 1046 3s) 1032 4s) 657 Total 3160 FUG Total hairs 8241

This young man came to Dr. Keene to have her fill in his temporal area., including rebuilding the temporal points. The photos are from before and 1 year post surgery. He had just over 1000 grafts to the temporal area and the te, mporal point. Dr. Keene also prescribed Finasteride to help prevent further hairloss, which he took for a year before proceeding with the hair transplant. I will add the graft number breakdown shortly.

This young man was 29 when he came to Dr. Keene to fill in his receding frontal and mid frontal hairline. She recommended Finasteride, in addition to surgery, in order to help maintain his existing hair behind the frontal area, and transplants for the area of significant hairloss. Now, 18 months after, at just over 30 years old, he looks younger than he did in his 20s . The photos are from before, and 18 months post operatively, when he stopped by because he happened to be in AZ. He was very happy with his results! The graft breakdown is as follows: 1 haired grafts 310 2 haired grafts 567 3 haired grafts 567 4 haired grafts 213 Total grafts 1657 Total hairs 3997

Coloring can help if the color of the scalp and hair is high contrast. For example, if you have dark hair and light skin, then you need more density to not see through the hair to the scalp, whereas blonde hair on a light scalp minimizes a thinning appearance. But I think in this patient's case, it was just a styling preference, because dying his hair a darker color would have made the contrast higher for him. It was something he could do now that he has more hair in the frontal area. A lot of people like to experiment with different styles and colors after a hair transplant. Thanks hoydoy, future HT doc and ttplunge:)

This young man came to Dr. Keene to haver her fill in his temporal recession. His wavy hair helps to make his hair look more dense even where he has thinning, but it still bothered him. These photos are from before and 1 year after 2200+ FUT. The patient provide the after photos as he was from out of the area. Here is the graft breakdown: 1s) 200 + 2s) 909+ 2s) 810 4s) 396 Total 2200+

This 50 something gentleman made a decision to restore a more youthful appearance, so came to Dr. Keene to have his hairline and mid frontal area restored. These photos are from before and 1 year 7 months after 2571 grafts. He looks closer to "50 is the new 30" status with his new hairline! Here is the graft breakdown: 1 haired grafts 293 2 haired grafts 862 3 haired grafts 911 4 haired grafts 505 Total grafts 2571 Total hairs 6770