HairCenter

This patient is in his early 30’s and wanted his hairline restored. Initially, he wanted it very low but Dr. Cooley was able to talk him out taking such an approach. Instead, Dr. Cooley proposed a more conservative hairline but after some discussion and negotiation, this is what he and the patient agreed upon. 2,651 grafts 1-714 2-1440 3-455 4-52 The results are shown two years post op. Dr. Cooley had recommended medication at the time of his procedure but the patient decided against it. At the followup, Dr. Cooley again suggested medical therapy with Propecia and the patient accepted.

"Clearly" is subjective as some would say it is the demarcation itself that is visible rather than the scar and most would barely notice that if it were not pointed out by Dr. Cooley in the video. However, the patient feels that strip was clearly the better choice. What you refer to as a "very small" area that is thinned out is, in reality, no less than 40% of the entirety of the occipital region. I'm not talking about the safe donor zone, I'm talking about the entire back of the scalp which includes the lower portion of the unsafe crown region. What you are referring to is called homogenization. Yes, of course there are more grafts to be taken with FUE but after the thinning that occurred we believe it is obvious why one would not want to purposely thin out the donor zone further.

The extraction pattern with FUE plays a big role in determining how the patient can shave (or not shave) after everything has healed. Case in point is our most recent patient that had only 1500 grafts via FUE with an FUE specialist at a different clinic. The extraction was poorly planned and obviously thinned the donor region.

Here is another 4K Ultra HD video result by Hair Center and Jerry Cooley MD. This is our patient that came to see us after his FUE procedure with another clinic. We highlight not only the result but the damage that was done to the donor zone due to the extraction pattern that was apparently too tight and compare it to the donor scar from Dr. Cooley's FUSS procedure. He received 1535 grafts along with PRP/ACell which is responsible for the majority of the thickening behind the hairline region.

Thank you everyone for your comments. I wish to make it clear that the result has nothing to do with finasteride as the patient was on finasteride for a full year before he ever set foot in our clinic. As you can see in the placement photos the majority of the grafts were placed in the first few centimeters of the hairline and temples with the mid-scalp receiving moderate surgical attention. The majority of the thickening of the mid-scalp is due to the PRP/ACell treatment. Here is a video we finalized to show the result in 4K Ultra HD and the patient even mentions his finasteride usage and how he feels that his FUE procedure made little aesthetic improvement.

FUE has certainly made a huge impact on the hair restoration industry and has really found it's stride over the past few years. Dr. Cooley has been performing FUE on a regular basis since 2010 and it is an invaluable option for our patients. Sometimes patients want to have FUE but may be better candidates for strip instead but this all depends on a multitude of factors. Being very proficient in both methods allows Dr. Cooley to provide either option, or both in some cases, to patients depending on their needs and wishes. The case below is one case where FUE was requested but FUSS was indicated as being the better option. The patient is in his late thirties and had already undergone one FUE procedure of 1500 grafts with another local clinic one year prior to his visit to us at Hair Center. The grafts from his FUE surgery were not placed into the hairline but were sprinkled throughout the top of his scalp. He felt that while there was an improvement he could not distinguish if his improvement was from the surgery or from his recent use of finasteride. When the patient came to us he wanted to have another FUE to thicken the frontal zone and to add density to his hairline. He liked the shape of his hairline and Dr. Cooley agreed that it should not be drastically altered so the plan was to move another 1500 grafts (1535 to be exact) to reinforce the frontal zone including the hairline. The result shown is ten months post-op. Why would FUE not be indicated for such a small procedure? Because the already small FUE procedure he had undergone the previous year drastically thinned his donor zone. We could have moved another 1500 grafts from the rest of his donor area by creating a wide extraction pattern. This would have given us a more homogenous appearance however the potential problems of dealing with another clinic's previous work made FUSS the better choice as the patient was not happy with the idea of thinning his donor zone further.

Hi Ontop, The distribution is not exact but it was roughly half and half. 1800 or so in the front and the same for the crown and vertex with some of the grafts in the crown blended into the surrounding hair to avoid an obvious demarcation. The only real difference is that the singles were almost all used in the hairline and the multi-hair grafts were all used in the crown/vertex region.

Thinningout123, Thank you for continuing to update the community with your excellent documentation and commentary. The best thing is that your result will continue to improve incrementally for the next few months so you're not finished yet:)

I believe one problem with your approach is that you are not taking into account the future loss in the area where you will have surgery. If you are acknowledging that your will lose more hair (and it appears you will lose a lot) then you have to address the issue of the hair you have in the front, not just what you have in the back. If you have a surgery to get a strong hairline today, it won't be very strong in the future (assuming no medications) because the hair you have now will be gone as well and these hairs will represent the appearance of a thinning hairline and you will potentially be right where you are now, again. This might put you in a position of having to choose to thicken the front again or to have a thinner hairline and address the back for an end result that may not add up to give you the appearance you have now. This is the problem with young patients that still have hair but are destined for advanced loss. They routinely know to plan for the future but this is usually conveyed as planning for loss in the crown or the vertex but rarely includes planning for loss in the frontal zone after the first surgery. Keeping the native hair healthy through medications enhances the final result because you are adding to the existing hair with transplanted terminal hairs and you are keeping the native hair through medical intervention so that they work together. Once you lose the native hair then the gaps they leave will have your final result looking much weaker in the end.

Here is another 4K Ultra HD video shot of a patient of Jerry Cooley MD and Hair Center in Charlotte, North Carolina. This patient is in his late 30’s and was very bothered by hair loss in the crown and at the hairline. He had been taking finasteride with stabilization of his hair loss. Dr. Cooley discussed the pros and cons of FUSS vs FUE. Because he was unable to shave his scalp due to work requirements, he opted for unshaven FUSS. We performed 3,648 grafts, placing the 1 and 2 hair grafts at the hairline, and the 3-5 hair grafts in the crown. We also performed PRP/ACell. He is shown at 12 months. Optimal detail is best observed on a 4K smart tv or 4K monitor. www.youtube.com/watch?v=J4wrAlLE-ks&feature

This patient is in his early 30’s and wanted to address his hairline. It had always been high but was now receding as well which only made things worse for him. He had been taking finasteride with stabilization of his hair loss and with a favorable family history it was decided that a moderately aggressive approach was warranted. We performed strip FUSS of 2,292 grafts. He is shown 18 months post op. The donor scar was about average and would not show unless the hair was very short.

Here is another 4K Ultra HD video for your review. This patient came to see Dr. Cooley to inquire about filling in his donor scar from his previous strip surgery. The back had stretched but the worst areas of stretch back were the back "corners" sometimes referred to as the mastoid processes. These two regions always have a higher degree of tension than other areas of the donor zone and when clinics decide to get aggressive these are the areas that tend to have the highest chance of stretching to the point of dissatisfaction. The patient also expressed a desire to finish the attempt at coverage that was not quite fully realized from the last surgery so Dr. Cooley suggested 800 FUE with 50 grafts extracted from the beard. This allowed for 400 grafts to be placed into the scar and the other 400 grafts were used to fill the small area of the crown that was still bare and without hair. The result is one year after his procedure. If you have a 4K monitor or television be sure to crank the resolution of to 4K to see the details.

JrSmith28, We look forward to having you with us. We'll take great care of you, I promise! Chewy, Thank you for the kind words. We look forward to watching your progress unfold:)

Hello Carlc1979, As already mentioned by some of the members, Dr. Cooley does not require shaving the recipient area for his procedures, as has always been the case. You should contact the office and we can provide you with not only additional photographic documentation but contact information for a few former clients as well.

This patient was concerned about his temple recession so he came to see Dr. Cooley to learn about his surgical options. Both FUE and FUSS were discussed and the patient decided he wanted to have FUE so he could continue to have his shorter haircuts. The patient is very active physically so he also wanted to avoid the longer downtime from FUSS as it would interfere with his routine too much. The result presented is nine months after his FUE procedure. Because it was recorded in Ultra HD 4K it is best viewed on a large 4K smart TV with the Youtube app or on a 4K computer monitor, although 1080p will still be very clear. www.youtube.com/watch?v=yQkuIgP43nA

Hello Mickey85, Thank you for your question. The total number of grafts is the cumulative number over three procedures. Indeed, it does seem like a lot but it is necessary to get close to matching the density along the peripheral of the scar tissue. If you zoom on any of the after images you'll see the density achieved is pretty high. The only reason why the scar is still visible is because of the lack of pigment. This makes it stand out but the patient is currently working with another clinic in the area to laser the scar in an attempt to further reduce the contrast in pigmentation.

Medical therapy should always be reviewed before surgical intervention. This is especially so when considering surgical hair restoration. This is not a spa treatment and should be taken quite seriously as the procedure will quite literally dictate how you not only appear to others in the future, but it will also dictate how you feel about yourself, you self esteem, confidence (or lack thereof), etc. It could mean the difference between happiness and absolute misery for many years to come. You may in fact have such a positive response to medication that you wind up seeing surgery as being unnecessary. At the very least, however, if you do have surgery you will continue to lose more hair so why would you not stop the loss before you replace what has been lost already? If you do decide to try medication seek the opinion of a hair restoration specialist that is reputable and have them direct you to the best source for medication.

Some of this depends on your personal comfort level. It can be argued that for the survival of the grafts the extraction process is the most crucial. Others would argue that the placement is more crucial but the placement is irrelevant if the grafts are dead before they are placed. This is where you have to decide if you are more comfortable with the doctor performing the extractions or the technicians. Ultimately the doctor is directly responsible for the success or failure of a procedure regardless of who performs the extractions but many people simply feel that a doctor should be doing the extractions. It is surgery so why should you allow a technician, with no formal medical training, perform surgery? Regarding Dr. Bernstein's protocol, it is a logical modification. However, when grafts are stored in a hypothermosol/ATP mixture the grafts can be out of the body for not only hours, but literally for days, and they will grow after they are placed. Dr. Cooley proved this with his initial trials using various holding solutions when he first introduced this holding solution to the industry.

Dr. Jerry Cooley and the team at Carolina Dermatology in Charlotte, North Carolina have had a stellar, if not somewhat low key, reputation for many years. The popularity of Dr. Cooley has been primarily through word of mouth online and in person and by using among the highest quality photos found anywhere online. Clarity of detail, consistency with lighting and backgrounds have been a staple of all of Dr. Cooley's presentations. However, you have never seen us present a single before/after video because we really haven't needed to use them and with how busy we have always been we really haven't have the time. Now it's time to change. We've never used video to document our results but now we will and we will do so in a manner that no one has before. I'd like to introduce the world's first 4K Ultra HD hair transplant result video. This video is best viewed on a 4K television or a 4K monitor. If you do not have either it is still visible at lower resolutions so set the resolution preference in the bottom right corner of the video frame. About the patient; he first came to see us in 2006 to lower his hairline and to achieve moderate temple angle closure. He was 35 at the time. He had already been on Avodart for three years by the time he had his first surgery. Since then he had two much smaller procedures to add density and refinement. The result was recorded two weeks ago and this represents in great detail how he looks today.

Being at one year post-op the donor area tissue has remodelled as much as it's going to. The scar is formed and the vessels are created as well as nerve tissue has reconnected. The previous poster is correct in that one year does not see a finale of the result but all of the hair that is going to grow has grown by one year and any subsequent changes are on a hair by hair basis. In other words, the hairs can change in diameter and the quality of the hair can improve where some people see their hair being somewhat kinky and wirey between 8 and 12 months will see it being smooth and silky by 16 to 18 months. What I see in the photos is that the overall pattern has not expanded but there was a tiny bit of hair in the central crown that appears to have thinned or disappeared. The pattern on top is beyond a NW6 as the parietal humps are non-existent but the crown is not so bad as a NW6. I think that if you were to lose a quantifiable amount of hair it would be in the crown but with the stark demarcation of miniaturized hair to non-miniaturized hair in the perimeter of the crown this likelihood of this is low. Continue your medication, consult with the doctors you are considering and move forward with diligence and caution. You have already seen the majority of improvement that you are likely to ever see because where you were once bald, you are now not bald. Everything else from here on out is icing on the cake:)

Thank you everyone for your comments. We try to create the most realistic presentation possible and we've been lucky to have the foresight a few years ago to set up a proper photo area. We have photography flood lights and of course the consistent background. We decided to go with a moderate grey color for the background as it doesn't distract from the result with a high level of contrast. We have something fairly big coming up in the next few days so stay tuned.

Yes, it is best to seek out the advice of a professional that has experience dealing with hair loss. There are a lot of factors to consider but most likely it is androgenic alopecia.

This patient is in his mid-40’s and had been on finasteride for many years with stabilization of his hair loss. He wanted to address his hairline as well as thicken the frontal third. He was very nervous about undergoing a hair transplant and wanted the smallest possible surgery to provide some improvement to the hairline. We performed FUT 1,446 grafts +PRP/ACell. He is shown one year post op. He was extremely happy with the results but understands the possible need for more work in the future.

Hello thisguy1, We appreciate your comments about Dr. Cooley's results. Regarding his posting frequency, there have been several results posted by the clinic since October. I have gathered the URLs for each of these subsequent posts to share here for your review. 2241 grafts... http://www.hairrestorationnetwork.com/eve/181881-dr-cooley-2241-grafts-one-year.html#post2455852 3049 grafts... http://www.hairrestorationnetwork.com/eve/181780-dr-cooley-3049fu-prp-acell.html#post2454793 1213 grafts... http://www.hairrestorationnetwork.com/eve/181626-fue-dr-cooley-1213-grafts-%40-10-months.html#post2453390 4289 grafts... http://www.hairrestorationnetwork.com/eve/181923-dr-cooley-unshaven-fuss-4289-nw5.html 4693 grafts... http://www.hairrestorationnetwork.com/eve/182461-dr-cooley-4693-grafts-16-months.html 1819 grafts... http://www.hairrestorationnetwork.com/eve/180293-dr-cooley-1-819-grafts-hairline-1-4-year-followup.html 1756 grafts... http://www.hairrestorationnetwork.com/eve/182371-dr-cooley-hairline-result-1756-grafts-via-fuss.html 1888 grafts... http://www.hairrestorationnetwork.com/eve/182180-female-1888-grafts-w-acell-scar-revision.html

PRP with ACell is the preferred treatment but not all PRP treatments are the same. There are a number of different centrifuges that are on the market and they all have their own advantages and disadvantages. Dr. Cooley has used several centrifuges and has settled on one that he feels helps to get the best results. With the use of ACell we're seeing good results on a good percentage of patients. You need to understand however that PRP is only an adjunct treatment for most patients in that it can help with the quality of results from surgery and it can be combined with other traditional treatments such as finasteride and minoxidil. In cases of advanced hair loss the benefits are only seen when combined with surgery as PRP is not effective enough to expect measurable improvements for those with advanced loss alone. In other words, if you have areas of loss that are fairly devoid of hair and you have shiny scalp visible then PRP on it's own probably won't do anything worthwhile for you. PRP is especially effective in patients with diffused loss. This is because sufferers with diffused loss tend to have a lot of miniaturized hair and these hairs respond best to PRP/ACell treatments. This is why PRP/ACell is recommended for many women with visible improvements expected as female hair loss almost always involves diffused hair loss. As I mentioned, PRP is not a standardized procedure. There is no established industry wide standard for how PRP is derived or delivered as a treatment. Simply spinning viles of blood in a centrifuge and injecting the platelets back into the patient's tissue is not PRP on it's own. Dr. Cooley has been experimenting with PRP for years and is recognized has having one of the most effective treatments in the industry. He is recognized as not only being a world class hair transplant surgeon, he is also recognized as being a world class researcher in the field of hair loss and PRP, combined with Acell, is one of the innovations that he leads in.