Dr John Frank, MD

This 29 year old new patient was only interested in FUE and not FUT. Following an extensive discussion about the progressive nature of hair loss, we offered him a conservative and affordable Follicular Unit Extraction. The photos demonstrate both the before and 11 months after FUE procedure-as well as images taken several days into the healing period. He obviously benefited from a frugal procedure (700 grafts) and the grafts were extracted using both hand held punches and the motorized Safe Scribe. We are attempting to emphasize the improvement despite the smaller number of grafts.

We are presenting a 53 year old man who had an earlier procedure several years ago at another facility. He was content with the hair line position and simply wanted more coverage. Our objective was to moderately increase the frontal density but also to allocate coverage posteriorly while working within a determined graft count (and budget). The results shown are from 9 months following an FUT of 2200 grafts.

I appreciate your comments!

This 28 year old Norwood Class 4 found no effective remedies for his hair loss. At first, he was overeager to have an unnaturally low hairline and after several discussions I was able to convince him to be more conservative. We finally designed an appropriate hair line and gently harvested 2500 follicular unit grafts. He had nice early results and these images were taken at 5 months. His hair now grows naturally forward and we're attempting to lift the hair and reveal the actual density. We are happy to have such robust early growth without the use of any preservative other than cold saline and gentle handling.

Experience My first exposure to hair transplant occurred during residency in 1996. Dr Raymond Konior was the facial plastic surgery attending and I learned all aspects of hair transplant and scalp surgery. In 2000, I opened a hair transplant practice in the city of San Francisco and also had the good fortune to work at times with Dr Sheldon Kabaker in Oakland, California. But after a 3 year west coast presence, I moved to New York City and began a short relationship with a hair transplant group (Medical Hair Restoration). I became instantly busy, operating on over 500 cases per year. I had the benefit of seeing a huge volume of cases from around the world and managed a sizable staff of nearly 25 technicians. I also trained 3 fellows who are active ISHRS members and full time hair transplant surgeons. But I was more interested the greater hands-on approach of a smaller practice and left the group. In 2006 I opened my own Manhattan based, private hair transplant practice. And for the past 7 plus years I have been refining the experiences learned since residency on, while building a practice based upon refined, natural results and satisfied patients-quite a transformation from the days of operating on 4 people a day. So, while I still maintain ENT privileges at several hospitals, 90 percent of my work is in hair. I am an American Board of Medical Specialties certified and skull base trained Otolaryngologist, as well as a fellow of the American Board of Hair Restoration Surgery. I have also been a fellow of the American College of Surgeons. As an Assistant Professor of Clinical Otolaryngology at The Columbia University College of Physicians and Surgeons, I frequently interact and assist with residents in hair transplant and hair loss research. I am a long time member-and have presented original research to the International Society of Hair Restoration. Finally, my former career as a Super Bowl winning tight end with the San Francisco Forty Niners has absolutely nothing to do with the technical aspects of hair transplant. On the other hand, it is a novel and engaging opportunity to address hair loss patients. Sometimes young men will ask if wearing a hat or football helmet can cause hair loss! Current Technique We like both the standard follicular cases and follicular unit extraction. Currently, our average case size is 2300 grafts for FUT and 1400 for FUE. The members of my team have all been working in the hair transplant field for over 7 years. For the smaller cases, I’ll utilize 3 technicians, but for cases close to 3000 grafts and above, I like to have at least 4-5 people cutting and placing. We are not currently training any technicians. Most of the them rotate between cutting and placing and they are all aware (and frequently reminded) of the delicate nature of the grafts and the inherent risks of crushing, desiccation and drying. They all use binocular microscopy when preparing the grafts. We prefer a long and narrow donor harvest as it creates the least tension across the wound and benefits the patient by leaving the thinnest possible donor line. This is our standard approach-along with trichophytic closure when called for. Anesthesia is local with oral sedation, the level depending upon patient preference. We are not averse to larger cases between 3000-4000 grafts, however I do like saving valuable donor for future years as progressive hair loss becomes more well defined. I usually make 0.7mm-0.9mm coronal oriented slits and even smaller sights and grafts for eyebrow cases. We’ll use slightly larger openings to accommodate multi graft units, curly hair or special circumstances. For patients with questionable mid-scalp circulation I prefer parallel slits. For density, we’ll place upwards of 45-50 grafts per square centimeter. We’re skilled at FUE and effectively use the Harris Powered Safe Scribe, but have access to a variety of hand punches depending upon the tissue properties. I always use 4.5X loupes for placing grafts and for all FUE cases and our objective is to keep a low transection rate. Philosophy Patient satisfaction comes first. The objective is to achieve maximum density while maintaining undetectability. Transparency is important as it only raises the bar for everyone and I yearn to never sacrifice quality at any cost. We only treat one person per day and from the initial consult onward, I’m involved in every step. Surgically, I’m present and active for everything from the harvest, slivering, anesthesia, sight development and placing. I think most patients appreciate this and it’s a nice bonding opportunity. I also strive to remove as many patients’ sutures as I possible. We usually charge a set fee per each graft transplanted. If someone can’t afford a larger case, we try to maximize the available grafts without forcing people to require additional procedures. Modern hair transplant is a very technical, tedious process and I yearn to offer every patient my sharply focused and intense attention from start to finish. At the same time, our philosophy is to maintain a very friendly, light atmosphere in the office as this benefits each patient and the field of hair loss in general.

We are presenting a 46 year-old male with a 20 year history of progressive hair loss. Harvesting 2600 follicular units, we carefully slivered, dissected and cut to size his tightly curled grafts. We delicately placed the finest FU's into the frontal hairline reserving the slightly larger grafts for more posterior. The results are shown for 20 months post op.

I appreciate your comments.

This 37 year old gentleman presented with Norwood Class 5 Male Pattern Baldness in May of 2012, requesting surgical hair restoration. We discussed several options but because of his complexion, hair color and coarseness, we carefully chose a conservative design consisting of #1000 densely packed single hair grafts to the hairline and #1917 follicular units more posterior. The results shown are at 10 months. The final, tightly cropped photo (as well as the intra operative and marked photos) illustrate a recreated, natural, blended hairline-the result of both preserving his native frontal forelock as well as carefully supplementing it with ultra fine grafts.

This gentleman with Norwood stage 3 male pattern hair loss was not successful with any oral or topical remedies. He was aware that his condition could worsen and together we mapped out a conservative hairline. We spent a fair amount of time discussing everything he may expect with a hair transplant, and performed a follicular unit transplant, harvesting 2606 grafts from an elliptical donor strip. We reserved the thicker 2 and 3 hair grafts for density, posterior to the finest grafts in the hairline. We're trying to demonstrate the natural hairline as well as the thickness from dense packing more posteriorly. The photos were taken 5 months post procedure.

I appreciate that Dr Arocha and I look forward to seeing more of your excellent results as well. John Frank, MD

That's helpful, thank you. John Frank, MD

This 27 year-old male with Norwood Type 2/3 hair loss was principally concerned about the bilateral temporal recession and we had extensive preoperative discussions about the progressive nature of hair loss. We harvested 1840 microscopic follicular units from a 34.5 cm x 1.2 cm donor ellipse. Because his frontal forelock was strong, we mainly transplanted the temporal hairline. Additionally, he wanted to improve the thin temporal tufts and we added grafts there as well as shown by the intraoperative photos. The typical before and after results were taken at 8 months and we're also demonstrating the improvement of the temporal tufts-with the gross photos of the left tuft and the cropped one on the right.