Hairy Godmother

The case presented shows the progression of a 29 year olds' transplant procedure to blunt his temporal recessions. Per usual, extensive pre op consultation was performed regarding the use of medical management and ensuring that he understood not only all aspects of the procedure, but the long term implications of transplanting the corners in someone who is young. A primary concerns is continued loss of hair in the frontal region/in behind the newly grafted hairline. If this occurs, he will have to do additional procedures to chase that loss. He is a good candidate as his hairline was reasonable stable and he showed no evidence of miniaturization or pull test positivity within the frontal tuft, midscalp or crown. If any of these areas had shown instability, I would have advised against transplantation at this time, encouraged medical management and reassess in 6-12 months. The series of photos depict his pre op, 1 month post op, 4 months post op, 13 months post op and immediate post op photos following a smaller second procedure to gain the additional density I felt he needed to overcome his high contrast (very dark hair versus very white skin). The pre op photos show his deep asymmetric temporal recessions and high contrast between hair/skin color. His 13 month post op photos show the nice results obtained from planting ~450 grafts in each temporal recession at a density of 46-50 grafts per square cm. Note, no mid frontal hairline work was performed. It is nice to be able to show the one and four month post op photos and they highlight a couple of things that don't show up when you only have pre op/final result photos shown. At one month post op he has a nearly invisible scar that is already hidden by the prior trimmed hair regrowth. In the grafted zone some hairs remain and he continues to have a little redness. Patients need to know that while the redness usually goes away sooner, those with very fair skin can have prolonged redness with dense packing (the denser you pack, the more trauma, then the longer the redness can last). Finally, the four month post op photos show the redness has abated and his grafted hairs are showing the typical early regrowth. Note how fine and soft the hairs appear at this time. Over the next several months they not only gain length, but also the shaft diameter thickens as seen in the 13 month final result photos. Brad Limmer, MD/jac

Hi Brandon: It's great that you have had such a wonderful experience and are willing to help others. Here are some more patients that had their HTs in Texas, but here @ Dr. Limmer's office...ENJOY Limmer Patients

Often men in their lates 70's or 80's will note the volume of their donor hair will diminish. But, the actual number of hair can remain relatively unchanged. Bascially, the hairs diminish in caliber...becoming finer as you grow old. Jessica

Well...I thought this would generate some great responses. I must say I am disappointed.

BigBill1234: Pending where you live, maybe you can visit one of the HTN recommended doctors and discuss your options. If possible, get more than one opinion if your case is extremely complicated.

Check out Baz! Baz is looking great! Thank you for posting the post op photos! Jessica

Here is the journal of Tracy, Dr. Brad Limmer's nurse.TRACY'S WEBLOG

I got the idea for this post from another post I was reading up on. Just thought it would be interesting to see how many HT docs have actually had the procedure done, when and why? From my end, Dr. Limmer had a few hundred grafts about 3 years ago to redesign his frontal hairline that had receded. Also, in the office, 3 of our technicians have had work done. Two of them to thicken the top and one to advance her hairline. And then there are a several spouses that have had some transplantation work done as well. I won't go into the various other family members. I am anxiously awaiting your reponses! Jessica

This case represents the difficult but common problem hair transplant surgeons are often faced with??¦what to do with a young man who is losing his hair? He initially presented 5 years ago at age twenty five, having just started Propecia and a family history of Norwood pattern 5-6 hair loss. An extensive consultation was done, going over the pros and cons of both the medical and the surgical treatment of hair loss. He had recently started Propecia and agreed to add Rogaine to his daily regiment. He understood that if he did not continue medical therapy he would without a doubt continue to lose hair and most likely progress to a Norwood 4-5, maybe even a 6. I also told him that if he was not committed to medical therapy I would highly discourage transplantation. With the need for medical therapy fully understood, I then consulted him about how to best approach his problem taking into account his young age and possible future loss. He understood his commitment to possible future hair transplants and was agreeable to a conservative restoration of his frontal region and no work to be done in the crown. Basically my approach to a case like this is to help improve his situation but minimize the risk and need for additional transplants. So in young men the safest approach is enhancement of the frontal tuft. By staying out of the corners/crown, even if he loses more hair he does not absolutely need to chase the loss because he would be progressing towards a natural isolated frontal tuft. Working in the temporal recessions or in the crown in someone so young or with an unstable pattern can commit someone to extensive future work, something I discuss extensively with my young patients. So with all this and more discussed we moved forward with ~1100 grafts to the frontal tuft only. We did not blunt the temporal recessions. We did not work in the crown. He presented earlier this month one day past his 30th birthday and almost 5 years post op. His post op photos show how well he has done not only from his transplant, but also with his medical therapy. He shows no sign of progression of his hair loss in the corners or crown. In addition, I feel many of the miniaturized hairs in his frontal region responded to medical therapy. This is important to note, if he had done more on his initial procedure some of these miniaturized hairs might have been lost permanently, not having the chance to regrow. With this knowledge and the passing of time I was now more comfortable widening out his frontal hairline, slightly blunting his temporal recessions and augmenting his anterior crown. We moved forward with an additional 1600 grafts earlier this month and he remains committed to medical therapy. Presented today are his original pre op photos from 01/2005 and his post op/pre op 2nd HT from 11/2009. Brad Limmer, MD/jac

Typically our donor areas are 1.3 - 1.4cm wide, depending upon patient's laxity. If a patient's scalp is very lax, width can be increased. We often taper the width over the mastoid; secondary to increased tension in that area. Jessica

Your HT dr. should have sent you home with some post op instructions, if not I would call their office to see what they advise. We allow our patients to use their hair styling products 7 days post op.

If sutures were used, it could be a suture reaction. Jessica

Over the years the number of women seeking hair transplantation has steadily grown and in our practice it now accounts for upward of nearly twenty percent of our surgeries. In the past a vast majority of women sought transplantation to cover scars/place lost hair following facial plastic surgery. Today, more and more it is done to address androgenetic alopecia. The case presented here represents both reasons why many women seek transplantation: deepening temporal recessions as a result of genetics and the loss of pre auricular hair (sideburns) as a result of a facelift. Her case was fairly straightforward with some miniaturized hair remaining in the temporal recessions and complete loss of side burns. Women hate these two problems because they do not feel they can wear their hair pulled back. So while not always obvious, it severely limits styling options. The temporal recessions required the denser packing of follicular unit grafts (40+/cm??), while the pre auricular areas should be planted at a lower density and only performed with 1 and 2 hair follicular grafts. Never should a 3 hair f.u. be used in this area in a woman. In women this area should have a soft look. Nearly 1300 grafts were used to accomplish her goals. She now is able to pull her hair back, expose these areas and not worry that her scars show or her hairline looks abnormal. Hope this post helps women realize they have options, as transplantation for so long has been viewed more as a procedure for men and much of the information available is primarily related to male pattern androgenetic alopecia. Brad Limmer, MD/jac

Over the years the number of women seeking hair transplantation has steadily grown and in our practice it now accounts for upward of nearly twenty percent of our surgeries. In the past a vast majority of women sought transplantation to cover scars/place lost hair following facial plastic surgery. Today, more and more it is done to address androgenetic alopecia. The case presented here represents both reasons why many women seek transplantation: deepening temporal recessions as a result of genetics and the loss of pre auricular hair (sideburns) as a result of a facelift. Her case was fairly straightforward with some miniaturized hair remaining in the temporal recessions and complete loss of side burns. Women hate these two problems because they do not feel they can wear their hair pulled back. So while not always obvious, it severely limits styling options. The temporal recessions required the denser packing of follicular unit grafts (40+/cm??), while the pre auricular areas should be planted at a lower density and only performed with 1 and 2 hair follicular grafts. Never should a 3 hair f.u. be used in this area in a woman. In women this area should have a soft look. Nearly 1300 grafts were used to accomplish her goals. She now is able to pull her hair back, expose these areas and not worry that her scars show or her hairline looks abnormal. Hope this post helps women realize they have options, as transplantation for so long has been viewed more as a procedure for men and much of the information available is primarily related to male pattern androgenetic alopecia. Brad Limmer, MD/jac

Hair to skin match always makes the hair seem a little thicker. Go with a shade that mimmicks/matches your skin/scalp color. Blonde highlights on someone with light skin gives the appearance of more hair and it helps camo the scalp because there is not a huge color contrast.