Michael Vories, MD

Attached is an update on a previous 5125 graft FUE case we performed in September 2012. For increased density in the frontal forelock the patient returned last week for 2000 additional FUE grafts. Also included is a photo of the donor area to show scarring using a 0.80 mm punch. All grafts extracted and placed by the physician using Hans Lion Implanter Pens. We will continue to post monthly updates as the second procedure matures.

60 year old male with stable hair loss over the past 10 years. Due to budgeting concerns, we grafted 2000 follicular units into his frontal forelock, and built a conservative hairline. His hair was fine (average caliber of 50 microns), but the result achieved his modest goal of not seeing himself in the mirror as "bald." All grafts were harvested and placed by the physician. Photos are before surgery and 2 years post-op.

2 Day 4000 graft FUE Session performed in our Charleston clinic. Stable hair loss over past 4 years, maintained with finasteride. Per patient concern 2900 grafts placed in midscalp-vertex, and remaining 1100 grafts placed in frontal forelock. After photos taken 15 months post-op. All grafts harvested and placed by the physician.

Thanks for the comments. For most or our patients I recommend combining finasteride with minoxidil before switching to dutasteride. As you probably know, the problem with minoxidil is compliance, and staying with applying it everyday can be difficult. Usually we suggest to apply it only at bedtime (if you normally shower in the morning), because water is a barrier to minoxidil. This allows 8 hours of dry scalp so the minoxidil can be absorbed by the skin.

This maybe better.

52 year old male with stable hair loss in vertex, mid scalp, and frontal forelock. A two day 3000 graft FUE session was performed 9 months ago with results shown below. 0.8 mm motorized punch was used with grafts manually extracted. Grafts were placed with Hans Lion Implanters. All grafts were extracted and placed by the physician.

We continue to struggle with African American hair. Some recent postings have illustrated this, and I wanted to take the opportunity to respond. As many Forum readers know, African American hair can sometimes have a high percentage of follicular units with a severe curl beneath the skin. For those of us who practice FUE, this can present a real problem: a straight punch cannot capture a severe curl, no matter how experienced or talented. Fortunately, most African American patients have graph morphology where tissue comes out cleanly, with minimal transection. I show these patients in my before and afters, and this works most of the time. But what about those patients who have the severest of curl? Some would simply answer to increase the punch size. I believe this is a poor answer due to any punch that exceeds 1.0 mm has the probability of causing visible scarring in the donor area. This presents the exact problem FUE is trying to solve. Much better to perform FUT if this the case, where at least with the scar you are receiving intact grafts. While at the recent ISHRS conference in Malaysia, myself and other physicians who practice FUE were in discussion over best practice for these patients. My approach for new African American patients is to inform them that if this is one of those rare cases the tissue comes out transected, there will be the need for repeat procedures, and keep the punch size small to avoid scarring. The other option is to perform test grafts, and if there is a large amount of transection, then to opt for FUT, or reconsider hair transplantation entirely. However, I believe that even in the most severe African American cases good growth maybe obtained, it just will likely take more than one procedure to get there.

Modest grafting for a 28 year old male, stabilized on finasteride. 2000 graft FUE procedure performed in a one day session to his frontal forelock using 0.8 mm manual punch and Hans Lion Implanter for placement. All grafts were harvested and placed by the physician. Included are before photos, immediate after photo, 2 week follow up photo, and one year post-op photos.

Thank you for the comments. Our reasoning concerning our transition from motorized suction assisted extraction (using the NeoGraft machine) to manual incisions and hand extractions was simple. The reason to begin using motorized suction assistance is to improve speed. After several years of building up our ability to extract manually approximately as fast as motorized, we lost the reasons to use the motor and suction assistance. After all suction can only harm the grafts, and with a motorized punch, you lose the touch sensation to minimize transection. For us, it was time to lose the training wheels.

Patient with frontal hair loss- underwent FUE 2000g, (one day procedure)- last July and came in for follow-up earlier this week. Due to desiccation issues, we have recently changed our procedure so that grafts are not removed with suction assistance, but manually removed. All grafts are still extracted and placed by the physician using Hans Implanters. This patient is the first we have presented using this procedure. Before surgery, immediate post-op, 2 week follow up, and one year follow up photos shown. 2 sets of one year post-op shown with different lighting.

Jay- 6 months is far from a finished product, although I am concerned about the next few months. There should be substantial growth between months 6 and 9 if this is a case of delayed growth. Part of the procedure is to have both a 6 month and 12 month follow-up with me. Please arrange to keep these appointments, and keep in mind we do have a 85% graft survival rate guarantee at the one year mark. This is there so you will have some measure of comfort for the final result. Thanks!

Thanks for the comments. What I like about this case is the effect it has had on the patient. Just in our brief follow-up visits you can tell he has become much more outgoing and positive. I love those cases!

Here are the same photos brightened, as well as a separate set of after photos where his hair is not quite as long. Also included is the before set of photos. Thanks!

No doubt the lighting is darker in the second set of photos- but I believe the general idea of hair architecture is present.

Update on patient who underwent a 2 consecutive day session of 4225 grafts over his vertex, mid scalp, and frontal forelock. Final hair count of 6120 follicles. Patient is now 24 months post-op and is allowing a longer hair length. He is also being maintained on finasteride.

Before and After Photos of a 29 year male with advanced hair loss. 3000 grafts were used with the following distribution: 821 one's 2045 two's 134 three's Immediate after photos also given, with final after photos taken at his one year post-op visit.

Correct. All the grafts were used in the frontal forelock and hairline.

Before and After photos of a 1700 graft FUE case. Also included is a 2 month follow-up photo that shows minimal growth. Patient is stable on finasteride as well.

42 year old patient with loss of frontal forelock and hairline. Conservative plan of 2000 grafts FUE over a one day session. Before video, immediate after video, 12 day post-op video, and after photos are presented. Good hair caliber makes 2000 grafts look better than in most cases we see.

40 year old with stable hair loss- desiring modest improvement in frontal forelock and vertex. 2000 FUE grafts used- 1500 grafts in the frontal forelock and 500 grafts in the vertex. Pre-Op hair dye was needed due to gray hair, and results are posted 9 months post-op. 0.8 mm punch was used for extractions, and Hans Implanters were used for implantation. Pre-Op, Donor/Recipient design, Immediate Post-Op and 9 Month post-op photos are shown.

There is absolutely no reason to deny you. All clinics should be using universal precautions, regardless of the status of the patient. This is medical ignorance.

I believe any type of bottled water should be fine. I would follow the recommendations of the hotels you will be staying.

By 7 weeks post-op all tissue will have granulated and healed. Only general hygiene instructions should be used. If you cannot drink the water, I would hesitate to wash with the water, with or without a hair transplant. Hope this helps!

3000 grafts is our maximum in one day. Exceeding this number exhausts both the patient and myself, and it is best to split a 4000 graft case into two days. Thanks for the comments!

Before and After Photos and Video of 28 year old patient with prominent hair loss in frontal forelock and vertex. Patient responded well to finasteride, and conservative grafting was used in the vertex. Patient hair length certainly contributed to the overall result. Counts: 1128 singles 1360 doubles 522 triples Total hair count: 5414 follicles