Dr. Patrick Mwamba

This young patient, 29 years old of age , Norwood 5 in hair loss scale , with a strong family history of baldness came to see us to get full coverage from front to back . Such surgery will require about 5000 to 6000 grafts .Because of the limitations of the usual donor area in FIT/FUE, we advised him to do it in two parts .During the first surgery, we will focus on the frontal zone and later on, in one year, we will address the back or vertex. Because of his hair loss stage and the family history, we recommended him to follow our medical therapy protocol; it is a tritherapy based on combination of anti DHT (androgen modulator) plus anagen stimulators. In this specific case, we only proposed anagen stimulators (the patient was concerned with the possible side effects of anti DHT): 1. LED therapy with the TRIWINGS 2. Help Hair vitamins and proteins 3. Rogaine foam once a day Medical therapy purposes are to slow down hair loss progression, to improve hair quality characteristics (caliber and pigmentation) and in some cases to regrow hairs. In this patient, we had a very good response and we postpone the next intervention in the vertex for later .Being on therapy allows him to avoid a second surgery now. With wet hairs, you can still notice hair thinning but the improvement is obvious In frontal zone, we did 3585 grafts by FIT shaven .At this stage; we should be at 60 % of the final result. We are expecting more hairs to come in the following months. We will illustrate the pictures of our surgical protocol from hair design to 6 months post op dry and wet hairs: RESULTS 6 MONTHS LATER NOW WE WILL SHOW WET PICTURES

The patient ,middle age , walk in our consult room looking for frontal hair line improvement .As a businessman , he could not afford any change in its appearance .Therefore we choosed to go for the FIT patchy shaven .We do not shave systematically the recipient area in our patients . I will present the 9 months results where you can get an idea of our surgical protocole ( pictures , designs , surgery , post op , Fup ) .

I used mostly manual FUE but I do have motorized FUE as well ( The FUE extractor from LEAD company with a combination of oscillated mouvements and non oscillated mouvements ). Manual punch allows you to get a feeling of the difference in tissue resistance , especially when you have curve grafts or splay grafts .resistance of the hair shaft is different from the surrounding connective tissue and with a manual punch you will feel it and stop your penetration .With the motorized punch you are loosing a lot of that feeling .But with time , I know you can have some kind of feeling too . Second thing is the heating of tissue from the punch .With motorized FUE , when the punch get dull , you don't feel it necessarely , but the machine will still use it forces to cut .With forces , you can heat or get some torsions of the tissue . One thing also we need to face is hands fatigue with the manual technique . When I use the motorized FUE , I usually start with the manual punch to get all the characteristics of the patient :skin fragility , grafts angle and splay .And if I feel comfortable and I found out it is an easy case , then I switch to the machine to preserve my hands .And most of the time , I asked the patient if he feels comfortable with it . My transection rate is equal with both techniques .In terms of speed , I am faster with the manual technique as I got much practice with it .I tend to be more cautious and not in rush when I use the motor to overcome the weakness of the latter technique . I am not fan of the speed gain with the motor that everybody seems to voice out .What matters is the quality of grafts you are producing and if you can get it faster , then fine .I do not think that multiple days of surgery will impair the graft yield .

Hi Mickey , We could still extract 6900 grafts as I mentioned above . The density and the number of follicles we calculated is the current one at that specific time ie after he already harvested the previous 3000 grafts .It could imply that at the beginning he came from 23000 grafts to get to the 20000 we measured . From those 20000 , we harvested another 3000 .Now he remains with 17000 grafts . To be safe , you need to harvest up to 40% of the final number ie 40% of 17000 which gives you around 6900 grafts . Thank you

Bill , The patient didn't send dry top pictures .I will ask him for the 9 months post op to not forget getting that shot .Usually they also come around 12 months for the in person consultation and we can get our usual set of pictures ( dry and wet ) . Thank you

Thank you for your comments . His current donor had an average of 94FU/cm2 ( measures took on 14 different zones across his donor .We also calculated the number of follicular unit present : 20391. We harvested some area up to 25 % and some area only 12% as I mentioned to even up the donor look . After this surgery , we should still have 17250 grafts .And in theory , you can take up to 40% without thinning to much his donor ie 6900 grafts .

The patient sent us his 3 months and 6 months results as illustrated below. We even up the donor look His hair line looks natural with a decent coverage for 6 months. We will now present a summary of before and after with dry and wet pictures. Dry pictures Wet pictures

This young patient had a previous surgery in another clinic (3000 grafts by the FUE technique).He walked in our consultation room with pluggy look hairs, low density coverage and unnatural hair angulation in frontal zone. We could also observe some thinning on top and vertex which announces future loss in those areas. The donor area looked someway thin with some patchy spots of lower density. His goal was to build his frontal zone. Our first concern was his donor area .A bad donor area would disqualify him for the surgery .Fortunately he had a density of 100 Fu/cm2 with medium fine, dark brown, slight wavy hairs. In the Norwood scale, he was at level 3Vertex moving toward a NW5 .He was on finasteride (for the last 9 months) and minoxidil (for the last 6 months). Our plan was to recreate a new hair line in front of the old one without going to low .We were pleased his existing hair line was at 8.5 cm from the eyebrow which gave us enough room to build a decent, conservative hair line at 7.5 cm. We grafted the hair line at 40 to 50 Fu/cm2 ( because a high density in the micro scarring area could yield a poor growth ).In the frontal area and central top , we kept a density of 30 Fu/cm2 and in the temples 35 Fu/cm2 .The entire procedure was carried out in 3 consecutive days as outlined below :the pattern we followed ( from back to front and from the center to the sides ) take into account the nerves anatomy to lower any discomfort in the following days . The patient sent us his 3 months and 6 months results as illustrated below.

repair case 4994 grafts ( FIT shaven + plug removal ) :myWHTC -Dr Patrick Mwamba - Forum By and for Hair Loss Patients I opened a new thread to show the present status of this patient .Please visit the link above .Thanks .

This 40 years old patient ,NW 3 vertex in hair loss scale came for a repair case : He had 3 previous hair transplants by strip technique(3000 grafts). Result : wrong hair angle direction , pluggy look ,pitting , a damaged receiving area with bumps (cobblestone), And big scars in the donor. His goal was: 1. To look natural, 2. To fill in his back scar, 3. To lower his frontal hair line and frame his face so that he will stop wearing a hat all the time. Surgery 1 plan : -Removing the plugs ( to minimize the scarring ,we usuallyclose the punch holes with a suture ,nylon 5/0 , for 3 to 4 days. In this case , we left it for only one day because we had to graft the area ) -Lower FHL with hairs above the nape area, build back the temples pointes in harmony with the new hair line ( otherwise the result may look unnatural ). -Increase density in frontal zone . This area was fibrotic and whitish because of previous work and had poor blood circulation. (poking test ,bled after 20 sec or plus) -Fill in scars in the back . Total graft number : 4025 grafts in 4 days . After 9 months : -yield was very good in the virgin area ( temples pointes ,FHL). You will notice a difference in hair strenght and pigmentation between his FHL and temples pointes. Indeed hairs for the FHL originated from lower donor area above the nape hairs . - The pluggy look was corrected. -Poor growth in the scarring area in frontal zone . -Good coverage of the scar in the back ( not illustrated in our pictures). Surgery # 2Plan (9 months after surgery 1) : -We decided with the patient to lower the density in the temples pointes by removing the grafts and relocating them in FHL and frontal zone . -We completed the FHL with grafts from regular donor area for a total of 969 grafts . Results : Natural look with a low solid hair line , in harmony with temples pointes density . No pluggy look . Good growth in frontal zone that was grafted at low density . Next step : Reinforce some patchy area in the frontal zone to complete the work. Repair case requires patience and sometimes more than one procedure in order to meet some kind of expectations if possible.

This 24 year old patient is a Norwood 3 vertex. He has kept his forelock intact and was bothered by the thinning in frontal zone. He is on minoxidil 5%. The patient wasn’t interested to graft the vertex and the receding temples; he wanted to fix the central part of his frontal zone. We decided to address the area and grafted it at 40 fu/cm2. To allow a good transition between his face and the top, we scattered a few hairs in the receding temples at 30 fu/cm2 to keep the impression of receding temples, status that the patient requested. In our design, you can appreciate the design for his future loss which needs to be kept in mind while treating a young patient in his twenties.

This hair transplant patient, classified as a Norwood 4, had straight,fine hairs. Those hair characteristics usually play against the patient in terms of coverage. Something interesting was his calculated density (ie number of hairs per graft) which was averaging 2.9 FU/cm2. This type of CD compensate the previous hairs charactristics and we could be able to get him decent coverage. We grafted at 55 fu/cm2 in 3 days. The patient sent his pictures at 6 months post -op.

Thank you for your comments . Transected hairs or damaged hairs is lowered when you have a better visual control.Therefore , Strip/FUT ,is still a better choice for black patients .You will have to cut the skin no deeper than 2 mm and then use a spreader ( haber spreader ,rose spreader or others ) to complete the process. The only issue you will have to deal with is the scar in the back. Black has tendency to hypertrophic scar and they do like today to have short hair cut . Maybe a fox test will be appropiate for such patients .

30yo – NW2 – 1093 FIT Shaven – 1 year and 3 months results Kinky hairs have the tendency to be curve underneath the epiderm or skin. The curvature can be up to 90 degrees. Strip surgery will be appropriate for such patients because of visual control under microscope (everyone knows it is not an easy job). The doctor has to modify the angle of the blade when harvesting the strip. But linear scar is a big issue especially in this type of patient who prefers short haircut. Fit/Fue should be the answer and it is more difficult to get healthy grafts. With a proper technique and by taking time, we could make it. As you will notice in the pictures below you have three portions in black hair shaft: first portion is the one we are seeing exiting the skin. 2mm inside the skin, it changes its direction in a perpendicular way. Then at the end of the hair shaft you have a splay. I will describe the technique we used to address this issue: With a sharp punch of 1mm you score the skin for about 2mm. Then you look at hair direction with proper magnification With a second punch, dull, set at 4mm for his depth, you adjust the pinch direction according to what you saw. To finish the process you will need to use a needle to go around the splayed graft to avoid damages. The entire process will double or triple your extraction time . One year later you will harvest satisfaction and patient happiness. Following pictures illustrate a case where the patients was concerned about his face shape especially when he goes to the barber who is unable to design a nice hair line with his shaver because of receding hair line He didn't want high density or very low hair line (realistic expectation). We proposed him a conservative approach with a grafting density of 40 fu/cm2. Here are his results one year and 3 months later. By mywhtc at 2012-07-13 By mywhtc at 2012-07-13 By mywhtc at 2012-07-13 By mywhtc at 2012-07-13 By mywhtc at 2012-07-13 By mywhtc at 2012-07-13 By mywhtc at 2012-07-13 By mywhtc at 2012-07-13 By mywhtc at 2012-07-13 By mywhtc at 2012-07-13 By mywhtc at 2012-07-13 By mywhtc at 2012-07-13 By mywhtc at 2012-07-13 By mywhtc at 2012-07-13

We were talking about this patient . High or lower density is not the main issue for patients .I do believe we should focus to produce natural and undetectable results . Now if the patient hair characteristics allow you to dense pack , go for it .The more hairs you put , the greater the volume you will get with an incredible coverage .But most of the times , we have to deal with reality and provide a good illusion of coverage . Here below is an example of one of our patient with high density ( 65fu/cm2) in Frontal hair line . By mywhtc at 2011-03-11