HairCenter

This patient is in his early 40’s and wanted to restore his frontal hairline. He had been taking finasteride for some time and was encouraged to continue to do so. We performed FUSS 3,241 grafts. He is shown 14 months post op.

This patient is in his early 30s and wanted to correct his frontal hairline and temple recession. He did not have any crown thinning and did not have a family history of extensive balding. We prescribed finasteride and planned an FUE session, given that he wears his hair short on the back and sides. We transplanted 1,569 grafts. He is shown one year later.

Hi VicTNYC, DHT definitely nullified whatever finasteride was doing. The effect of DHT on transplanted donor hairs depends on genetic sensitivity. Some people have some low level DHT sensitivity in their donor zone which is why finasteride may help with long term maintenance of transplant results in some people. In those people, taking DHT may have some minor negative effect on their transplant. Thank you, everyone, for your kind comments.

This patient is in his early 50’s and has type IV hair loss. We started finasteride and minoxidil and performed FUT 3,694 grafts and PRP/ACell. He is shown one year later. He noted that the results actually looked better at 8 months. When I questioned him about what happened, he confessed to using anabolic steroids about that time, which contained dihydrotestosterone! I counselled him that taking exogenous DHT will damage the hair and finasteride won’t help because it lowers your own DHT but does not block the DHT receptors.

This patient is in his early 30’s and had an FUE procedure of 2000 grafts at another clinic one year prior. He was unhappy with the unnatural look of the transplant. There were several noticeable problems with the prior work: 1) The hairline was placed too low and straight. 2) There were two and three hair grafts at the very front line. 3) The grafted area was not blended into the existing hair, leaving a halo effect. 4) There was no blending into the temporal area, creating an unnatural fronto-temporal angle. Simply adding more grafts might have given improvement but would also have worsened the front heavy appearance. After discussing the options, we agreed on a combination of FUE grafting combined with bilateral ‘mini’ hairline excision to raise the lateral frontal hairline. This involves tiny FUT strips on either side of the hairline. Along with temporal grafting, this created a more natural fronto-temporal angle. Grafts were also concentrated behind the prior grafts to better blend into the existing hair. A total of 1,529 grafts were placed (1-361, 2-783, 3-385). PRP/ACell was also performed to provide some overall thickening. The patient is shown one year later. He was extremely pleased with the result. This case demonstrates one of the problems we are now seeing more commonly in the FUE era. Doctors are mistakenly believing that advances in FUE are giving them the freedom to make more aggressive hairlines. We are seeing more and more young patients with inappropriately low hairlines and significant donor depletion from FUE. This patient is young and has diffuse thinning throughout his scalp; the fact that he has been on finasteride for several years should not lead to a more aggressive approach. I generally place my hairlines at 7-8 cm from the eyebrows. If I were treating him for the first time, I would have recommended a conservative hairline with good density throughout the front half of the scalp. Unfortunately, once an aggressive approach has already been taken, our hands are tied and we have to do the best we can. The hairline excision helped place the lateral aspects of the frontal hairline in a more natural location, but it leaves thin white lines that are visible on close inspection. To repair prior work, we also can remove old grafts via FUE and do selective electrolysis. None of these repair techniques are perfect and each have their particular drawbacks. It is far better to do it right the first time!

This patient is in his early 20’s and first came to see me with his parents at the age of 18. We started finasteride and deferred any further treatment other than topical minoxidil. He returned several years later, expressing in interest in hair transplantation. We discussed all the possible drawbacks of undergoing a transplant when young, including the likely need for future procedures. He had absolutely decided against a ‘shaved head’ look and was committed to doing everything necessary to keep his hair looking natural in the future. After considering all the pros and cons of making this commitment, the patient opted for FUT. We performed 3,493 grafts combined with PRP/ACell. The hairline was placed at 7cm, to ensure it would continue to look natural as he ages. He returned 11 months later, ecstatic with the results, noting how restoring his hair had changed his life for the better. He understands the need for periodic PRP treatments and possible transplants in the future.

There are several parameters that dictate whether a result will have the illusion of density or actual density and the space covered is one of the biggest factors, of course. It also has to do with hair type as coarser hairs are more difficult to pack together tightly but at the same time there is a threshold where the number of grafts that occupy a given area doesn't have to be quite as high as with finer hair to achieve the referenced "illusion". Skin characteristics are a little discussed factor as well as one cannot simply assume that dense packing is possible. Everyone's skin reacts slightly differently to having 2000 incisions made very close to each other. Some patients will see the connective tissue literally fall apart so lower density is necessary so that a second pass can be made later. Thank you for your comments!

This patient is in his late 30’s and first came to see us in 2014. We first prescribed finasteride. He returned one year later showing his loss had stabilized and he underwent a conservative hairline restoration of 2,000 grafts using the FUT procedure with PRP/ACell. He was very pleased with the results. He returned in 2017, requesting a slight lowering of the hairline and temple angle closure. Given his excellent response and compliance with medical therapy, and his willingness to continue PRP in the future, we decided a more aggressive restoration would be an option for him. We performed 1,000 grafts FUT with another PRP treatment that included ACell. He is shown one year later in 2018. As with all of our videos, this result is presented in Ultra HD 4K resolution and we are the first clinic in the world to standardize on this format in order to show as much detail as possible.

Jean, There are two problems with your observation. 1. Your forelock was noticeably miniaturized throughout and placing within it was the right move. This patient's forelock is thin around the perimeter, not within the forelock itself, and while it is not native density, it is considerably more dense than your own and with more obviously terminal hairs, and there was no need to add anything to it. Why would Dr. Cooley want to make the thickest area of the patient's scalp thicker when the rest of his scalp was bald? That doesn't make sense. 2. You present a contradiction. How can a more natural result be achieved by focusing all of the grafts near the front? Is "density" your definition of natural? The density could of course go higher but then that would mean the coverage to the vertex would not have been achieved. All of the grafts would need to go up front to blend the density with the forelock and little coverage would have been achieved in the mid-scalp and none on the vertex. It comes down to simple math. I can appreciate if your taste would call for a different approach but what meets one's taste does not always meet with what is practical.

UKlad81 has a very good result that is still maturing, so I would expect to see the more seasoned members of this forum remember the basics of hair transplant timelines. He's at 8 months so there is more development to be expected. Some points about UKlad81's case should also be remembered. His hair is not only very dark with a high contrast to his fair scalp, his hair overall is quite fine. His existing forelock was also still very prominent so the procedure had to not only cover a nearly shiny bald NW5A area (we did not go far into his crown) but the density had to blend with the forelock which already had a high density. I'll also remind people that when you wish to compare result to keep the hair style in mind (as well as other factors) and in this case, where UKlad81's case was compared to another with similar loss, the hair coarseness difference, which is significant (and confirmed by the clinic consultant on their respective thread), was not included in the consideration, nor was the style. UKlad81's hair is brushed back while a comparison shared was brushed forward. This makes a very significant difference in perceived density and actual coverage and will vary widely from patient to patient. At this point, Dr. Cooley is pleased with UKlad81's progress and there is nothing to indicate that there is anything wrong with the result thus far.

Thank you all for your comments.

ACell is added to the PRP after the centrifuge portion is complete. There is a video on Youtube showing exactly how it is done. Search for the video with the title "What is PRP for Hairloss?". We believe that ACell makes a difference but we cannot say for sure how long the effects are extended because of its use. This is not a standard procedure and while we have shared our protocols with some colleagues most clinics will have a different protocol than the next clinic. Our approach calls for only one treatment a year, but that is subject to change based on the clinic. We have had some patients with only one treatment in three or four years with documented improvements. You can see them on our website.

This patient is in his early 40’s and had undergone a prior transplant at another clinic and was not pleased with the results. We performed FUSS of 3,105 grafts, focusing on the frontal hairline and temples. We also performed PRP/ACell to address thinning in the midscalp and crown. He is shown 12 months post-op.

This 28 year old young man had advancing Type V hair loss. We started him on finasteride and minoxidil and performed PRP/ACell with FUSS of 3,618 grafts (7,636 hairs). He is shown one year later. He obviously had an excellent response to the PRP and medical treatment, which blended nicely with the results of the transplant.

Your reference to the result being "horrible" was completely unwarranted, not to mention unusual, since you are the first and only person to make a negative comment about this result in the seven years since it was first shared online. This leads me to believe that you focused on the first result you could find that was less than perfect, according to your standards, and amplified the issues in order to drive home your points with the other member. Thank you, and enjoy your day.

HTSoon has the right points, especially with the makeup reference. Folliculitis can be the symptom of a larger issue, such as inflammation, so you may be experiencing issues with any of the products you're using or it could be dietary. What many do not realize is that you can also develop low grade allergic reactions to products over time, even if you haven't had any reactions to them in the past. You should consult with a qualified dermatologist to have them help you figure out the issue. FYI, any reputable hair restoration doctor will insist that your scalp be clean and clear of issues before undergoing a hair transplant.

Horrible? I'm really not sure what to say. Opinions are fine but to say that the result is horrible is a stretch, and quite frankly, I see no basis for your comment. Dr. Cooley, who is also highly regarded Coalition member for his designs and abilities, felt it was good enough to present and of course the patient was very happy with the result. Please explain your position.

Pimples occur due to ingrown hairs, more specifically the grafts are starting to grow. Sometimes they are due to transected hairs in the tissue that are eventually seen as foreign bodies and the skin tries to expel them.

This young man is in his late 20’s and has evolving type VI baldness. We started him on finasteride and performed FUSS 3,500 grafts with PRP/ACell. He represented an aesthetic challenge in that he had remaining miniaturized hairs all the way to his teenage hairline, 4cm above his eyebrows. This would have been much too low to build a new hairline around. We removed a 2-3 cm band of these thinning hairs using electrolysis. The hairline we built contained a larger zone of lower density single hairs, so as to avoid creating a ‘front heavy’ look. The majority of the density was in the mid-scalp. The crown was given a light ‘dusting’ of two hair grafts and the PRP treatment helped blend everything together. He is shown one year later.

This African American female presented with diffused hair loss throughout the top of her scalp and with very receded temples. Dr. Cooley and the team at Haircenter in Charlotte, North Carolina carried out an FUT procedure of 2249 grafts for the hairline reconstruction and placement throughout the central portion of the top of her scalp. The recipient zone and donor incision were treated with PRP with ACell to improve overall healing. PRP with ACell was also applied to the temple regions for an outstanding response as seen in the video.

This delightful woman is in her early 60’s and has significant androgenetic alopecia. She had extensive miniaturization throughout her scalp and her donor area was below average. We discussed the possibility that more than one transplant would be necessary and that even then, we would be unable to create a dense look. We started her on finasteride and minoxidil, and performed FUSS consisting of 2,249 FU’s (1-1320, 2-787, 3-139, 4-3). We also performed PRP/ACell throughout the entire area. She is shown one year later. The results were better than expected, due to an excellent response to the PRP and medications. The grafts were concentrated along the hairline and down the center, and can be seen as the darker hairs compared to the lighter colored native hairs.

This patient was in mid-40’s when he came to see us. He had been taking finasteride for twenty years and had noticed progressive thinning in the past few years. We switched him to dutasteride to inhibit further loss. We performed FUSS consisting of 2,215 grafts and PRP/ACell. He is shown 15 months later. The grafts went in the frontal third and the PRP/ACell thickened up the mid-scalp and crown.

This patient came to see Dr. Cooley regarding his hair loss and to learn about his options. He is in his mid-thirties and had already stabilized his hair loss with long term finasteride use. The patient wanted to move forward cautiously as he'd already performed lots of research and wanted to consider how PRP with ACell might improve the vertex/crown region before attempting surgical intervention. So he and Dr. Cooley agreed that a procedure for the front would be the way to move forward and allow PRP with ACell to have a chance at improving the back. 1500 grafts were removed via FUE by Dr. Cooley. After the grafts were examined and refined using stereoscopic dissecting microscopes Dr. Cooley and Brandi placed the grafts into the frontal third of the patient's scalp, making sure that only single hair grafts went into the very front of the hairline and all multi-hair grafts were placed immediately behind. The result shown is at one year post.

In order to assess your candidacy for either donor removal procedure we need to see your actual donor area;) Are you taking any preventative medication such as finasteride or minoxidil?

Hypopigmentation refers to a loss of pigment in the skin. Since you are dealing with scar tissue, which is different from skin and has no pigment by nature, there is no Hypopigmentation.