Hairtechnician

This 53 year old gentleman came to Dr. Keene to restore his hairline, midfront and crown area. Dr Keene transplanted 3450 grafts, totaling 9009 hairs, that included both fu and dfu in a consecutive day surgery session. We think he looks much younger, and he is very happy with his results! The photos are before and 1 year after surgery.

Here is the breakdown of the graft numbers:

1s) 411 (hairs 411)

2s) 1180 (hairs 2360)

3s) 1234 (hairs 3702)

4s) 360 (hairs 2536)

total grafts 3459 (hairs 9009

This patient came to Dr. Keene to have his temporal recession filled in and to bring his hairline down. We did over 2700 grafts with the following distribution.

1s) 718

2s) 797

3s) 768

4s) 445

Total 2728

Hairs 6396

Just to verify, yes, Dr. Keene would take the donor strip from the same area as she did before, so there would not be an additional incisional scar. Unfortunately, there is no scarless procedure, though it is minimized with the double layer and trichophytic closure that Dr. Keene uses.

When grafts are removed through FUE, the small .75 - 1 mm holes that are left in the area where they are removed are left open to fill in, usually with scar tissue. So while the scars are usually very small, just as they are with the strip technique, there is still no scarless procedure. FUE tends to leave more of a moth eaten appearance when it scars, where as with the strip procedure, it is a fine linear line, and hair can actually grow out through the incision with the trichophytic closure. There are other disadvantages to FUE, such as not getting as many grafts from the area due to damage to the follicles.

We have patients with the strip technique and trichophytic closure where we can't find any evidence that the donor was removed. The same people who scar from the strip technique are more likely to scar from the FUE technique, but refining the FUE scars would be more difficult than refining a strip excision scar.

Remember that in order for you to make a comparison of how your hair looked before to how it looks now, it is important not to cut it as short as possible--the shorter the cut, the more likely it is to look thin. Even men with no hair loss can appear to have thin hair when it is buzzed.

Also, if you thin as you get older, and we do the same density as your youthful hair was, it will limit the donor supply for the future. I know Dr. Keene also put you on Finasteride to maintain the hair you have, but there is still a risk. So you need to weigh your options carefully. Your current result looks very natural and completely undectable as a hair transplant. Right now you have plenty of donor for the future. And your normal hair style is not a buzz cut. It would be nice to see what it looks like grown out to the length you normally wear your hair.

I think your results look great Ryan, but if you have concerns, please call us to schedule a follow up with Dr. Keene.

I just wanted to post this result, even though it is from when Dr. Keene first started doing hair restoration surgery, because I was reading the posts on how some patients feel it is not ethical that doctors ever did the really unnatural plugs, and how the technology has not changed, just it's use. We completely agree that the technology was there to do natural transplants long before it was adopted by many clinics! These photos are before and 15 months after of a patient Dr. Keene restored in 1994, with around 700 grafts. His result is completely natural, at a time when plugs were still common.

The doctors who pioneered micro grafting techniques, now called follicular unit grafting, years before many others, worked very hard to bring the technique to the forefront. They helped to train other doctors in the technique, and have refined the technique even more over the years, so today's patients can find doctors who offer a procedure with a completely natural result. Some patients were even able to do that in the early 90's, as you can see from this result.

This gentleman in his 40s wanted to strengthen his mustache and eybrows. We augmented them with 1115 follicular units. Here are his before, immediately after, and 10 months results. The patient is very pleased.

TC17,

I liked his hair style in the more current photos. Unfortunately, when you see photos in the small size you see on a camera review they look great, but then you blow them up and sometimes they are a bit fuzzy even though they looked in focus when taken. Anyway, I added some and deleted some so they are better focus now.

jon breese,

FUE is not a scarless procedure and it decreases the amount of donor that can be harvested from the donor hair, which is why Dr. Keene doesn't recommend it over the strip technique. But I have to agree that the new frame to the patient's face does improve his appearance aesthetically. The patient is very happy with his results!

This young man in his early 30s came to Dr. Keene to restore his youthful hairline. He received over 1700 grafts to the front and sides of his hairline, for a total of 4599 hairs in one session, and his results did indeed return his youthful appearance.

Here is the graft distribution:

1s) 246

2s) 494

3s) 707

4s) 311

Total 1758

Total hairs 4599

This patient had 2100 grafts, 1800 frontal and about 300 to the crown.

His distribution was

1s) 241

2s) 688 (1376 hairs)

3s) 754 (2262 hairs)

4s) 431 (1724 hairs)

Total 2114 grafts, 5603 hairs

This patient wanted to fill in his frontal hairline and crown. He took a couple of years to decide to do it once he had a consult, but he is now very happy he did! These photos are from 1 year after his surgery (1 session).

Here is the graft break down:

1s) 308

2s) 265

3s) 865

4s) 441

Total 1879

Total hairs: 5197

Thanks for the comments on her results!

Goldilocks,

These photos were more than a year after surgery. The placement of the hairline is determined during the consultation through patient preferences and goals, combined with Dr. Keene's recommendations based on experience. Personal tastes vary, and Dr. Keene will give her input, but in the end it is the patient's preferences that make the decision.

M1A1,

Whether her hairline was raised due to genetics or plastic surgery I don't feel comfortable discussing--she gave us permission to use her photos but not more.

This patient wanted to fill in her hairline. She had over 2000 grafts distributed in the frontal area. The graft distribution was as follows:

1s) 416

2s) 1045

3s) 477

4s) 109

Total 2047

This gentleman is in his mid sixties and had started losing hair when he was 40. He was a hairloss pattern type VI. Dr. Keene filled in the frontal and midfrontal area with 3900 grafts an a consecutive day surgery (CDS) session.

His graft distribution was:

1s) 651

2s) 1716

3s) 1153

4s) 388

Total 3908

Total hairs 9094

This 50 something patient started noticing his thinning in his 40s and rapidly progressed. Dr. Keene put him on Finasteride to stabilize his hair loss, then restored his hairline and frontal area with 3300 grafts, and 850 grafts in the crown. The hairline was only single follicular units, then 1-4 haired grafts behind that, with a focus on 3 - 4 haired grafts in the crown.

Here is the breakdown on his graft count

1 haired grafts 454

2 haired grafts 1458

3 haired grafts 1693

4 haired grafts 657

Total grafts 4,262

Total hairs 11,077

Please keep in mind that it the number of hairs moved rather than the number of grafts that gives you the outcome. So when you make your decision on where to have hair restoration surgery, remember to compare the results rather than solely the number of grafts.

That being said, sometimes spreading out the grafts into and dissecting mainly 1-2 hairs per graft can cover more area when you have limited donor, but if that is the goal, obviously it will not be dense packing. So that is another factor to consider--numbers of hairs vs. numbers of grafts.

Atomic,

Dr. Keene already let Dustin know that she has learned through many years of experience as a surgeon specializing in hair restoration surgery, through observation of thousands of men, that the donor area in the back of the head can not be defined solely by the location of the occipital hump. Some patients carry their donor hair above, some below, and some at that area. Your individual experience is indicative of your hair loss pattern. But it varies from patient to patient, and Dr. Keene assesses each patient individually.

Sir Fivehead,

If you have concerns please call Dr. Keene's office. It is unlikely that you have "permanent donor shock loss," rather, you may have an area where the incision stretched. There are many factors that can contribute to donor scar stretching, or suture reaction. This is not in fact permanent donor shock loss, but rather issues of incisional healing, and can typically be repaired. So please call us to schedule a follow up appointment with Dr. Keene.

Thanks--just added a few more from the sides showing the temporal augmentation as well.

This patient opted to have 2 surgeries close together, the fist concentrating on the back, and the second on the frontal area.

He had a total of 5029 grafts, including

530 1 haired grafts

759 2 haired grafts

1094 3 haired grafts

481 4 haired grafts

For a total of 13,224 hairs

Hi Mrkneed,

We usually tell patients that they can expect most of the hairs to have emerged by around 8-9 months, but that the hair gets thicker in caliber for up to a year. However, Dr. Keene and other doctors have noted that at times it can take slightly longer than a year for the hair to reach full growth/maturity in the crown. We have seen further growth in the crown even after the 1 year mark.

We know that waiting after the surgery for the full growth is the toughest part of the surgery. How long did it take after your first surgery with a different doctor? That may give you some guidance.

Of course, it helps to hear about other people's experiences as well, but I also just wanted to reassure you that it is typical for growth to occur for up to a year, and sometimes longer in the crown.

Originally posted by mrkneed:

Dr. Carman and Dr. Beehner Thanks for your response. Actually it was another poster who said they had a similar experience to the point where thier rate went to 230 - All I know is that I was not monitored for the heart rate and my heart raced after the shots for roughly 10-15 mins then went to normal. Once the doctor started the donor removal was when I started to feel sick, extremely light headed, sweating and could feel my heart rate slowing down which scared me. However once the doctor flipped me on to my stomach tilted downward I felt ok.

I realize this is a post from some time ago, but I just want to clarify that Mrkneed's first surgery was not with Dr. Keene. Dr. Keene's office does constantly monitor heart rate. I believe Mrkneed did much better during the anesthetizing process at Dr. Keene's office.

FYI, Dr. Keene does a lot of the graft placement, but she does indeed also have assistants help--she has never claimed otherwise. However, she participates throughout in placing the grafts, along with her most experienced placers, who have been placing grafts longer than some hair transplant doctors. She doesn't just leave it in the hands of her assistants, as is sometimes the case.

Yes, hair transplantation is a team effort, but Dr. Keene prefers to participate throughout. This topic comes up a lot and I have posted about it before, but again, this is Dr. Keene's preference and she has no criticism of other doctors who don't have this preference.

Combining 2 follicular unit grafts to add density without affecting naturalness can be an advantage to the patient.

Double follicular unit grafts (DFU's), can consist of two 1-haired grafts with a little space in between, or a 2-haired graft combined with a 1-haired graft, etc. So they don't have to be 5 haired grafts, they can be anything more than 1 hair, but just not grouped as a bundle.

Dissecting hairs grouped as a DFU can be an advantage to avoid making an extra incision and extra dissection. If hairs are spaced less than a mm apart, there is no need to separate them in order to create a natural appearance, while still creating very minute, tiny incisions. Take a look at a ruler to see just how miniscule a mm, or 1.5 mm are--a magnified photo doesn't really get that across.

A follicular unit is usually referred to as exiting the head in a bundle, so hairs with a .8 mm space in between might be considered 2 seperate follicular units--yet they look natural when grouped. That is why Dr. Keene does use DFU's of up to 4 hairs--they look completely natural, but decrease the numbers of incisions needed while increasing density. There are patients where the space in between hair is too great to give them many 3 to 4 haired grafts, but we do try to give patient's who we can as many as possible, depending on the area being transplanted.

DFUs would not be appropriate in the front hairline, of course. But neither would 2, 3, or 4 haired follicular unit grafts. Only 1 haired grafts are used in the very frontal hairline.

Although a follicular unit is defined as bundles of hairs that exit the scalp as a group of from 1 - 4 hairs, with very few 4 haired groupings, it is interesting to note that depending on the natural angle of the hair shafts, the hairs might exit the scalp at the same place but splay out at the roots with spaces in between. Or vice versa, the hair might exit the head spaced a mm apart, and the roots are very close together.

We have photos on Dr. Keene's website of magnified grafts dissected as single and double follicular units, which you can view here DFU photos

I totally agree with Sir Fivehead. The numbers of hairs placed is more important in creating density than the number of incisions per sq cm, which connotes with the number of grafts per sq cm. For example, 25 3-haired grafts is equal to 75 1-haired grafts, so saying that 50 grafts per sq cm is more dense then 25 grafts per sq cm would not be accurate in that example. It really makes sense to look at the numbers of hairs transplanted rather than the numbers of grafts transplanted in a procedure.

Hi Heretoday,

I just wanted to let you know that it is not at all atypical to have no growth at 2 months post operatively. We tell patients verbally and in the written post op instructions that you should expect to start seeing the new growth at about 3 months after surgery, but that will only be the very beginning of the growth. Of course, growth rates vary from person to person. Typically you will see significant growth by 6 months, but it will continue to mature and add density for up to a year, and in some cases even after 1 year. I hope this gives you the reassurance you were seeking.

Also, it is okay to use Toppik--it should have no impact on your graft growth.

Minoxidil (Rogaine or any generic) can speed the rate of graft growth by putting your newly transplanted hair into the growth phase, as well as any surrounding hair experiencing shock loss. Hair goes from anagen, or active growth, to telogen, or resting. Minoxidil can put it into anagen. This is a different use of minoxidil because the grafts are permanent whether you use the minoxidil or not. You just might see growth faster by using it. But gradually taper off when you stop using it to prevent hair from entering the telogen phase which could stimulate shedding. You may want to review your post operative instructions to remind you of these recommendations. Please don't hesitate to call Dr. Keene's office with any of your concerns!

Probably your best bet is to take a look at the doctors in your vicinity that are listed on this forum and give them a call to find out if they will fill in a small scar. My guess is most would. Either the strip technique or the FUE should leave minimal scarring in the donor area since it will be a small amount of donor. Niether is a scarless procedure. There are pros and cons for each.

Dr. Keene in Tucson does not have a minimum. You would need to be assessed to determine if you are a candidate for surgery and what it would take to achieve your goals.

Have a good evenining!