Dr. Carlos Wesley

Thank you for your comments. Yes. The patient was very pleased! I neglected to include an image of his resultant donor scar. This is slightly smaller than his previous donor scar (1mm wide currently versus the previous 3-4mm scar) and represents an area harvested over a total of three times.

This very pleasant 50-year-old man had undergone two previous sessions to his frontal third (including his hairline) with another physician and - for some reason - did not have significant growth. He presented for an improvement in density throughout his hairline. Only FIVE MONTHS after a 1457 FU session (smaller than average size due to excision of 3-4mm scar left from his prior sessions), he returned with a large smile on his face stemming from the early growth that he hadn't previously experienced.

This 39-year-old man had a session of 1916 FU within his anterior scalp to address his progressing recessions. Returning only 7 months later, he felt that the improvement was noticeable enough to prompt his return for early follow up pictures.

Thank you, Capelli11. I used a standard, non-trichophytic closure on this patient. Often times, a trichophytic closure can make graft dissection during subsequent strip harvesting sessions more challenging due to the "criss-crossing" of the follicles adjacent to the scar. Therefore, in patients who are committed to returning for an additional session to address a different part of the scalp, it may be beneficial in terms of future FU yield to use a standard closure. This patient is returning for a midscalp session. As that will likely be his final session, I do plan to use a trichophytic closure at that time.

Thank you. And, this video demonstrates his donor scar 9 months after the session...

Hi, community. As those with whom I've been able to chat in person since my initial post know, I really do enjoy explaining everything in detail and fully answering any questions people may have regarding the study. Sorry about appearing so "cloak-and-dagger" about this study. It is certainly not my intention. I am truly just trying to be responsible for how I present proprietary information as well as being thorough in describing the steps involved (since 2008) that led up to the trial. Finally, patients needn't commit to being involved in the investigation to learn more about its merit. While I can best demonstrate features of the concept in person, I am also willing to share details with interested folks outside of NYC via Skype at a mutually-convenient time. A sincere thanks to all for their interest! Carlos K. Wesley, M.D.

This patient has just returned 9 months after a 2179FU session to his frontal third. He was most thrilled during these summer months to feel comfortable in situations during which he had to get his hair wet (e.g. poolside, beach, etc.). So, while the "wet" look in the right-and-left-side preoperative photos do magnify the thinning prior to the session, they most effectively demonstrate what no longer bothers this particular patient.

Thank you to those who have privately expressed interest in participating. The anticipated dates of the study are September-December 2011. You can learn more about the investigated method at: Hair Transplantation by Carlos K. Wesley, MD

Dear HTN community, I am writing to invite you to participate in a very exciting investigation that I truly believe will improve the overall field of hair restoration surgery. Our clinical trial has received approval from the Investigational Review Board and may lead to both increased graft survival as well as elimination of any donor area scarring (i.e. less than FUE). For your participation, you will receive a limited number of “grafts” (transplanted hair follicles) at no charge. Patients interested in taking part in this endeavor must be able to travel to the office of Dr. Carlos K. Wesley located at 710 Park Avenue, New York, NY, USA. Both the 30-minute informative consultation and the 1-to-2-hour investigative procedure will be carried out in our surgical facility. For more information about how to participate, please contact me directly via email: carloskw@aya.yale.edu. Warm regards, ckw -- Carlos K. Wesley, MD 710 Park Avenue New York, NY 10021

Thanks for your comment, Blake. She wasn't looking for a "thick" hairline, just - as you'd mentioned - something that more appropriately framed her face.

This 53-year-old female desired to lower her hairline. Post-operative photographs were taken approximately 20 months after the 1802 FU session. Her stated objective was to "lessen her forehead." This required not only a lowering of her hairline, but also a subtle advancement of her temples so as to provide support for and blending of her newly-transplanted hairline. The profile images (illustrating the contour of her forehead) best demonstrate the positive impact of this advancement.

This video depicts a repair session performed on a 58-year-old man who had undergone 8 (eight) previous hair transplant sessions by a different surgeon. He requested a softening of a "pluggy" appearing hairline. Using a total of only 647 FU, coupled with strategic removal of coarse grafts within the hairline, this objective was met. Images of a separate patient taken 10 months post-operatively are also included. They depict a 45-year-old man who underwent a repair session with Dr. Walter Unger using 1973 FU.

Thanks, logo, for your post. Peri-operative use of minoxidil (Rogaine) is something that can actually minimize (rather than magnifying) shock-loss from an HT session. One of the primary benefits of minoxidil is that it shifts a larger percentage of hair follicles into the growth (anagen) phase of the hair cycle. Hair follicles that are susceptible to falling out are in the telogen phase. So, the percentage of telogen-phase hairs is reduced with minoxidil use. While a mild degree of thinning may certainly occur within a few months of using any product that promotes hair growth due to the influx of fine, new vellus hairs replacing their more coarse telogen counterparts, the benefit of using minoxidil for a few weeks around a session encourages us to recommend this to patients in our practice. Regards, Carlos K. Wesley, M.D.

An interesting repair case that took place in our practice recently: a 26-year-old Asian patient who had previously undergone FUE with a different surgeon at an out-of-state practice presented for scar revision. He was originally under the impression that FUE is a "scarless" procedure, but due to a number of factors, developed noticeable punctate scars in his donor area that bothered him considerably. Those factors include a slightly-lower-than-average donor density coupled with his coarse caliber hair follicles (common amongst the Asian patient population). The previous surgeon's diligence in staying within the "safe donor zone" constrained him to extract FU more closely packed in order to achieve a 1000+ FUE session using a 1.0mm FUE punch. After being thoroughly advised during the initial consultation in our practice about the advantage of wearing his hair at a different length and the possibility of tattoos into the hyperpigmented scars to conceal them, the patient remained adamant about undergoing a repair session. Therefore, using a smaller, 0.8mm, FUE punch a total of 388 FU were extracted in a sparsely-distributed fashion from within the fringe of the "safe donor zone" (3rd image) before being transplanted in a similarly sparse fashion into the punctate scars within the donor area (images 4 and 5). While this repair approach will obviously not completely "erase" the punctate scars with which he presented, smaller scars in a more spread out distribution will likely soften the marked noticeability left from his initial surgery.

I certainly appreciate your comments and have recently posted a few more patient examples. Hopefully, this will provide a bit more evidence to support my candidacy. Thanks, ckw

This 36-year-old male had 2746 FU transplanted in a pattern addressing thinning in his frontal third. The after images were taken approximately 2 years later. One reveals the look of the transplanted grafts up close and another a close-up of the scar after a trichophytic closure. Additional images show the "combed back" hairline after the session.

This 46-year-old male had 2391 FU placed in a pattern designed to restructure his hairline and temporal recessions. The after images were taken approximately 10 months later.

Thank you for your comments. Your points are well taken. It’s important to realize, however, that the most important value is not FU/cm2, but rather the number of HAIRS/cm2. Transplanting 2-to-3-haired FU at 35/cm2 results in equal or significantly more hairs/cm2 (70-105) than densely packing single-hair FU at 70 FU/cm2 (70). Furthermore, by dividing out the micrografts as they naturally occur (rather than creating single-haired FU from a natural two-or-three-haired FU, you’re retaining the protective subcutaneous tissue surrounding the follicle’s base. By minimizing negative forces such as dessication and mechanical trauma from handling, you’re improving survival. Combined, these factors provide an extremely desirable density for patients with a single session. Furthermore, to clarify a statement in the quote above, patients return for a subsequent session to cover a portion of their scalp not addressed during the initial session (e.g. a midscalp or vertex treatment following a treatment of the frontal third). It is during the subsequent session that they may use a percentage of FU to also add to an area that they’d like even thicker. A single session provides ample density and does not require a follow up to the area treated. The “breather” that patients get after one session should last a lifetime.

24-year-old male on finasteride 1mg for over one year with minimal to no response and reporting possible associated side effect of "decreased energy" presents for a session to the midscalp. Initially, his desire was to address the crown. However, concentrating all 2265 FU within the vertex would not have been prudent with respect to addressing areas of future loss at his young age. Instead, his midscalp and areas of future loss laterally were covered as well as a posterior "bump" that extended into the crown (as seen in the black markings of the pattern design). The freckle in the center of his balding crown serves as a reliable landmark demarcating the positive impact the session had as seen 11 months after the transplant.

A 38-year-old male with 2369 FU placed throughout his frontal half. Only 9 months after this initial session, the fullness of his recipient area is marked despite his decision to color his hair. In general, minimal contrast between hair and scalp helps improve the appearance of coverage. In his case, darkening his hair would theoretically lessen the appearance of thickness.

Although there has yet to be a thorough controlled, double-blinded study to prove this theory, many physicians feel that excessive use of epinephrine may contribute to post-operative telogen effluvium. In general, factors that may cause an "insult" to the local blood supply (epi is a known vasoconstrictor) in a hair-bearing area have this potential.

Thanks, RCWest, for your comment. Fortunately, this patient did not experience any noticeable post-operative effluvium. While this is certainly more of a concern in our female patient population (approximately 50% of women may experience some temporary hair loss), a combination of minimizing epinephrine usage and simply going very slowly and carefully when designing the recipient sites through hair-bearing areas (I generally take over 2 hours to complete a pattern) helps significantly reduce the percentage of male patients who experience telogen effluvium in our practice.

Approaching the Donor Area: The majority of our patients undergo a trichophytic donor wound closure. The first image illustrates how Dr. Wesley de-epithelializes a small (<1mm) portion of the inferior edge with a bent razor blade prior to suturing the donor area. The donor wound is closed with a single, running, sterile nylon nonabsorbable suture. In this patient, a non-trichophytic closure was performed for two reasons: a) the lack of color contrast between the patient's scalp and hair and, b) the fact that the patient plans to return for a follow-up session in 9-12 moths. Generally, a trichophytic closure may complicate subsequent tissue dissection with a greater portion of criss-crossed hairs along the prior donor scar. Recipient Pattern Design: This session of 2167 FU focused on the frontal third. This patient, a 35-year-old male, desired a reinforcement of his thinning hairline and temporal recessions. An average density of approximately 30 FU/cm2 was achieved Graft Creation: The graft creation process in our office requires at least six nurses and technicians. One nurse, the designated "slicer" of the donor strip, uses simple loops to create the initial slivers which are one FU wide. The remaining five staff members divide those slivers further into naturally-occuring FUs. The grafts are then separated not only by the number of hairs they possess, but also the caliber of the hair. Graft Placement: The planting process is performed by three nurses and technicians either along with or under the guidance of the physician. Grafts removed from their storage wells in Ringers Lactate solution are held in small ring-like storage vessels filled with sterile saline prior to placement with fine planting jewelers. The final two images of the placed grafts illustrate the importance of not only the angle and direction of the grafts, but also their depth. Vellus hairs along the hairline serve as guides for the angle and direction of recipient site creation. Once placed, the epidermal depth of each graft is ideally flush with or slightly above the native epidermis.

This 54-year-old male desired filling of his temporal recessions and a subtle advancement of his hairline. With a total of 2172 FU, we were able to not only accomplish these goals as we reinforced the frontal third of his scalp, but also transplant into areas of future loss and temples. During the pre-operative consult, the patient emphasized a natural, "not too dense" appearance along the hairline. He returned 9 months postoperatively very pleased with the age-appropriate results.

This 23-year-old male had a family history of Norwood Type VI pattern hair loss. Using 1854 FU, hairline was designed to not only reinforce his currently-receding hairline and temple, but also address areas of future loss in the lateral humps. He returned less than six months later very pleased with the natural-appearing thickness of his hairline.