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I think it looks very good and should thicken up quite a bit more over the ensuing months. He packed it in good based on your immediate post-op shots. Very nice.

Great result.

Beautiful results. Excellent coverage.

Wow!

Top down shot is money. This ledge closure version of trichophytic closure seems very clever - excellent donor scar.

I would add 45 degree angle shots also so 6. True frankfurt horizontal also please. Thinnish somewhat to my untrained eyes - who knows.

Very nice work.

It's difficult to say with your hair that long but adding density should help.

Thanks Dr. Simmons and Dr. Lindsey. Still trying to figure out the difference between a simple locking suture vs. this double locking suture that you mentioned Dr. Lindsey that allows some swelling and expansion. This august heat definitely causes some swelling and expansion and I could see how the pressure from a simple locking suture could lead to some superficial skin necrosis.

Thanks for your informative reply Dr. Simmons! I did think that the undermining was done superficial to the galeal layer which you confirmed and indeed, that would release tension on the edges possibly making deep sutures redundant. Throwing a deep suture in the galea or pericranium does not seem standard of care for hair transplantation overall although they would really release a lot of tension - maybe increased risks of hematoma/infection/blood supply, etc. And a suture in the fat does nothing as you stated. So there is some small risk to the follicle in placing your buried suture in the dermis - how big who knows? There is no other place to put the deep suture. Thanks again for the reply.

Based on your immediate post-op results compared to now, I'd wager more than half of your grafts have not grown. Wait til 12 to 15 months for complete judgment.

That's very interesting regarding the minutiae of undermining. Articles have been written describing undermining one side the whole length of wound vs. undermining half the length on both sides - very academic but useful I suppose. That's brings up a few other questions in my mind. If you are underming, are you doing so subgaleal or above the galea above the occipital protuberance? Also I guess you are undermining above the galea b/c when you go laterally, the galea blends with the temporal fascia. So is there any time you would go subgaleal and score the galea and maybe be less tension on closure with the deep stitches placed into the galea - also possibly less chance of deep sutures catching the follicles? Does this make any sense? Also with suture closure of the skin, I have seen some using locking sutures - I don't remember who that was. Would it make more sense to use a horizontal mattress everting suture which may possibly be less asphyxiating to the follicles or does this not matter? Ideally if deep sutures approximated the wound like they should, you could put steri-strips for the skin - that's extreme of course. My only experience with this is doing bicoronal flaps for frontal sinus obliteration for chronic frontal sinusitis and also flap closure of large scalp defects after skin cancer removal which I haven't done in a long time. I remember scoring the galea to release some tension - not sure if it helped a little or a lot. Any observations appreciated Dr. Simmons.

Nine days is fine. Less chance of railroad tradcks.

Great documentation and nice work. Why only undermine one side though?

I would look into serial excisions of the scars.

c'mon tell us please.

Pain is mild to moderate not terrible. Take your pain pills and it is under control. Sleep elevated, take prednisone if doctor prescribes to minimize swelling. Worst sensation is feeling tightness on scalp at least to me - that went away at about 3 weeks.

Fraxel frankly to me is a lot of marketing and very expensive. Any fractionated technology can still wound deep and be an issue. For surface ablation, I would think a fractionated erbium/yag laser would work best since it is pretty superficial and less likely to damage hair follicles.

excellent, concise review

Very natural, smooth and age appropriate. He must be happy.

Your hairline looks too wide without enough of a widow's peak to me. Hope it works out well.

I thought you were further out from surgery.

25 procedures! That has got to be some sort of record.

You can always counteract the propecia with enzyte.

I think he does high quality work. I just had a procedure done. I think you'll do well to go with him. My case was repair work and still early but I'm very happy thus far.