mattj

Important note: When doing repair at the hairline, the goal is to remove larger plugs but not incur more scarring.

Since the pluggy grafts often contain 3-5 hairs per graft and in order to get the whole graft out, you need to use a larger punch.

However, we want use the smallest punch possible, typically .75 or .8 mm punch, in order to minimize any scarring at the hairline. With this small punch you cannot always get the whole pluggy graft in the first go, and will occasionally need to go back to remove any pluggy grafts left behind.

I work for Dr Rahal so my opinion might be seen as biased, but I think this result looks as natural as any other.

Hopefully the patient will either make it back to the clinic or meet with Dr Rahal somewhere, so that better quality photos can be taken.

Is Dr. Rahal doing surgery in Toronto now? I had gone for a consult a couple of years ago, and it was consult only in Toronto, surgery in Ottawa.

That used to be the case, but surgery is now performed in Toronto as well as Ottawa.

I can remember you (and your hair) from first time around. Good to see you back!

You aren't alone in not having suitable follicles for FUE. It's rare but it happens. The important thing is that the problem was recognised fast and the procedure stopped. Must be frustrating though.

The extracted follicles should be examined under microscope and this is where the equipment used for FUT surgery comes in. Some clinics that sprang up only doing FUE don't have the microscopes. They'll still be using magnification during the procedure, but might not be sorting and counting the grafts under more powerful microscopes.

Note that when we post results, we have a graft breakdown - a tally of how many singles, doubles, triples and quadruples there were.

There might be some dormant hairs within a follicular unit, but the number will be low.

Yes, adding more density in a 'second pass' is a good strategy.

This repair patient result I posted recently involved the removal of grafts that had been poorly placed by another doctor.

http://www.hairrestorationnetwork.com/eve/189610-dr-rahal-1591-grafts-fue-repair.html

I can see that the area you circled looks a bit thinner, although it doesn't look too bad to me. It's possible that there is an increased risk of the hairs not growing after they have been extracted for a second time. I'm just speculating.

All patients are different and that goes double for repair patients, where additional factors are at play. What you describe is possible in theory, but you would need to consult with a surgeon to get the advice you need.

If you are a candidate then I don't see why you can't address your frontal area now, with it in mind to treat the rest later. This is a strategy that gives a natural result, even with loss behind the transplanted area. That is assuming you are in a position to undergo multiple procedures. I'm saying all this blind as you don't have photos.

Punch sizes are typically 0.8mm.

Question:

 

I'm a young individual debating my hair transplant down the road.

 

 

Do you have any photos of your hair before or around the day that you started finastiride in 1999? and then right before your first hair transplant so I can gauge where my hair loss might end up in 10-15 years?

 

So I can plan accordingly?

You aren't addressing me, but I want to say this: you cannot compare yourself directly to someone else. Nobody loses hair at exactly the same rate as the next person. Unless you have an identical twin, it is impossible to gauge how your loss will progress by comparing yourself to somebody else.

Here we have a very nice FUT case to share. The patient was aged 29 and he came to Dr Rahal to treat frontal recession, His goal was to restore his hairline and frontal zones, re-framing his face and gaining back styling options.

He re-connected with us 6 years later. He has lost hair at his crown (which will be treated in the near future) but his front is looking great. We appreciate that he was happy to show his face as well as his incredible hairline.

Surgery type: FUT

Recipient Area treated - 75 cm

Grafts Transplanted - 3744 grafts

Recipient Graft Density - 49.9 grafts/cm

Recipient Hair Density - 99.17 hairs/cm

Graft breakdown:

Single Hair - 751 grafts

Two Hair - 2292 grafts

Three Hair - 701 grafts

Four Hair - 0 grafts

TOTAL GRAFTS - 3744 grafts

TOTAL HAIRS - 7438 hairs

HAIRS PER GRAFT - 1.99 hairs/graft

Of course there will be a difference between 3500 and 2500, but that difference can be made up with a second procedure. This is assuming that your donor isn't well below average.

Barely 2.5 weeks since your last update and already the difference is clear. Nice.

I'm pretty sure that George Clooney's hairline is all natural, native hair. I've seen no evidence that he's had a transplant and heard plenty about him shaving it. In fact I've examined closely some of the hi-res, outdoor photos that exist of him at events and I've seen signs of clipped hairs at his hairline. His hairline isn't even amazingly dense if viewed up close.

Italianchange, why don't you post some photos for us to assess?

I'm guessing you rarely, if ever, see yourself from this angle and what you saw scared you. What I see doesn't show any obvious signs of balding. It's a matter of seeing if any changes occur over the coming years. Don't fret, your hair is in great shape.

You are 19 years old so in today's digital age I would probably estimate you have a few thousand selfie pics to choose from.

 

This made me chuckle.

I totally agree with the others. No hairloss visible. Monitor over time without letting it become an obsession.

I agree with Shera. More photos are needed. Your hairloss appears to be very minimal. I doubt whether you really requite anything but, at most, some hairline work. But photos will tell the story.

Another dazzling FUE case. This 39-year-old Norwood 2 patient came in to restore his hairline and receded temples.

Dr Rahal designed a hairline without dropping the front, but added density and adjusted the lateral temple angles. The resulting hairline allows for so many more styling options.

Only 2024 grafts were used and the patient has ample donor left for future needs.

Surgery Type: FUE

Recipient Area Treated - 41cm

Total Grafts - 2024

Total Hairs - 4258

Recipient Graft Density - 49.36 grafts/cm

Recipient Hair Density - 104 hairs/cm

Graft Breakdown:

Single Hairs - 400 grafts

Two Hairs - 1029 grafts

Three Hairs - 580 grafts

Four Hairs - 15 grafts

Average Hairs Per Graft - 2.09

This patient, aged 57, had an FUT procedure with Dr Rahal to restore his frontal zones.

Photos and details can be found here

The bald patch is almost certainly part of the normal shedding process. This is quite soon to be going to a wedding. I think you should follow Melvin's advice and try concealers. I think it's safer to use those than to buzz it down again at this stage.

As I always say, not all Norwood X's are the same. You are definitely not a typical NW6 and have a lot more hair left than I was imagining. A lot of NW6's should probably avoid surgery, but you look like you could see significant benefit. It is essential that any doctor see more angles so they can see your donor area. Assuming you have good donor supply, it should be possible to beef up your density.

Here we have a 56 year old patient who had thinning throughout his frontal zones. This included some miniaturised hairs. He chose the FUT method and Dr Rahal restored the area for a dramatic improvement.

Surgery Type: FUT

Recipient Area Treated - 63cm

Total Grafts - 3025

Total Hairs - 6329

Recipient Graft Density - 48 grafts/cm

Recipient Hair Density - 100.5 hairs/cm

Graft Breakdown:

Single Hairs - 557 grafts

Two Hairs - 1932 grafts

Three Hairs - 836 grafts

Four Hairs - 0 grafts

Average Hairs Per Graft - 2.09

Looks like undeniable improvement to me. And very good improvement at that. If you've seen such a big change at three months then I wouldn't be surprised if more change was to come. Keep us updated.

Infection is highly unlikely and the main swelling tends to begin a couple of days after the procedure. But really it's much better to stay close to the doctor's clinic for several days after the procedure, so they can check on you and keep your recipient area clean.

Are you having FUE or FUT?

I had FUE and flew home five days later. This was an 8 hour international flight, so yours is short by comparison. I was completely open with anybody I came into contact with at the airport and it was an easy experience.