DrTBarghouthi

Dear community,

This is a 29 year old gentleman who had a car accident at a young age and ended up with a wide scar in his donor area of the scalp. Luckily he has no obvious male pattern hair loss. We decided to transplant around 750 follicular units in it. I did use a higher concentration of TCN in the tumescent fluid to possibly enhance the raised scar better. 
 

I present the results 9 months later. 
 

Before

Immediately after

4 Months

9 months

Thank you for tagging me. I do believe that things are quite getting clear in your situation. This means that we can focus on front, mid scalp and part of the crown for a reasonable number (beard and scalp) and leave a good number behind for any future work that may be needed. I would consider you a NW 6 at this stage from a planning point of view. I would also recommend utilising the beard and scalp from the first session so as not preserve scalp donor too if needed. 

Thanks for the mention guys. I apologize for some delays in replying as I prefer to answer personally to all questions/mentions. 

@BlokeFromStokewould be great to see the donor, but It seems to me promising enough. Your pattern is not a 6 for sure. I agree it seems heading to a 5 and would therefore advise commencing finasteride (even if alternate days) and hopefully have no sides from it. What is your current age if I may ask. I think maintenance meds and adding density to the front, ms and crown is a possibility depending on age and donor area etc. 

21 minutes ago, SLA said:

Hi @DrTBarghouthi-Do you think his donor capacity would have been even greater if he had done FUT followed by FUE? If so, how many more grafts would you estimate?

 

Thanks!

Yes. I think he could reach the 8000  from scalp if he went for an FUT initially. The issue is that he used to shave his head with  the stage of hairloss he had so he could not imagine having a scar. 

3 hours ago, Curious25 said:

Nice so far, I like the hairline design you selected for this case. Any scope for further passes with remaining scalp donor or BHT?

What was his estimated donor capacity pre surgery? 

Yes there is still a possibility of further work through scalp and BHT. However, I would recommend delaying at much as possible since he is still 28. 
 

His donor capacity was around 7000-7500. So he might get another 1000 from scalp and the same from his beard most likely. 

Dear community,

This is a 28 year old gentleman who had a 2 staged FUE procedure . He is a NW 6/7 pattern with a family history of the same. His donor area is of good density and calibre despite dipping low in the mid zone. 

He underwent 2 procedures. The first one was in May 2020 to address the frontal and midscalp zones. The second procedure was then done in January 2021 to address the crown and any added density in the previously done areas. Photos were taken recently which means he is just over a year from his first procedure and around 8 months following his crown restoration. We do ofcourse expect more growth in the crown area as it usually taken well over 12 months to show full results.

Surgical details of 1st procedure: 

FUE 0.8 mm punch

Total grafts: 3226/ 425 refined singles in hairline. 

Average of 2.24 hairs/graft. 

Sites made using 0.8 mm and 1.4 mm Sapphire blades. 

Surgical details of 2nd  procedure: 

FUE 0.8 mm punch

Total grafts: 3201 mostly in the crown, Midscalp and some minor refinement to the hairline defined zone. 

Average of 2.34 hairs/graft. 

Sites made using 0.8 mm and 1.4 mm Sapphire blades.

Before: 

15 months after procedure 1 and 7.5 months after procedure 2:

Donor 1 months after procedure 2: 

Yes it is true that vasoconstriction is not of a long duration. That’s why we top up the effect using diluted injections with tumescent which is more frequently injected (in each zone we work with). Moreover, we really want the bleeding controlled while working so 30 mins is good enough while maximum visibility is important. After that your normal body clotting mechanism is sufficient to control. 

Thanks for the mention Doctor. Yes epinephrine tends to be used along with the local anesthesia to cause blood vessels to constrict and hence allow the local anesthesia to work locally in a more effective and safer way. This makes it possible to give a higher safe volume and allows it to last longer. I also tend to dilute more epinephrine in a very small volume along with the tumescent fluids. 
 

From an anesthesia point of view, you can exclude epinephrine but that means your maximum dose will be much lower, so maybe give anesthesia to small regions and spread out the time of administration and better off even the total amounts of grafts per day. So do less numbers per day and inject small areas, do the extractions and then inject a new area etc. This gives the body time to metabolize the drug since your safety dose is lower than if used with epinephrine. 
As for tumescent use, I would check with the cardiologist if a very diluted concentration is safe as it is quite helpful to reduce the bleeding from site creation and extraction. If this is not allowed as well, I would tend to attempt without epinephrine but I tell the patient that if bleeding tends to be more than what is normally expected, then we will have to stop the procedure.

I hope that is clear. 

Thanks for the mention. The pics aren’t clear enough but it seems promising enough. I think there should be some room for good improvement, given that you are on Finasteride now. 

Thanks for the mention @JohnAC71

May I ask what age are you currently?

I do agree that the donor is quite below average. I would tend to advise using finasteride for some time and assess gradual improvement. We do need to slow down your diffuse thinning on top my friend. 

12 minutes ago, cutiebunnie said:

thankyou doctor! i think ill get the forehead reduction and “if i lose more hair (but im pretty sure i wont lose a lot of hair because my dad n bigbrother 25y he doesn’t experience any hair loss that lead to balding”

 

but if i lose more hair and the scar shown in future, ill do HT..

what do you think doc?

It is hard to predict what pattern or extent of hair loss you can get. The safest thing is obviously to do nothing. However, If you elect to go for any forehead reduction surgery, then you should be aware of the possible need for a hair transplant etc. It is best to discuss the implications of this type of surgery with Drs who perform it as they probably see more longterm outcomes and consequences. 

This is normal at this stage. These are all shafts and not follicles. Happy journey!

I strongly advise you not to undergo any HT surgery at this stage. Probably consult regarding forehead reduction but I also believe that if you lose more hair then the scar might show. Better to check with someone that does these though. Best of luck 

Thank you all for your positive remarks. He is certainly happy. Ofcourse I anticipate more growth and maturity for another while. I often see a change in character and demeanour following HT which is always good to see. His hair is not too thin but generally fine and not too wavy.  

This is definitely a NW 5/6 pattern going on. I agree that maintenance is key at this stage. I think give maintenance sometime to work, make sure you are happy with committing  to it and then get the HT. Yes around 3500 grafts is probably enough at this point. 

No worries at all. It all looks fine and there was nothing in the line of events that is concerning. Happy journey. 

It depends on the size of the crown really. If it it too big, you might need to shave the entire head. However if it is small then you can get away probably with not shaving everything as the transplanted hairs will kind of not be too obvious after a week or two. 

1 hour ago, JohnAC71 said:

For higher Norwood levels I would say Eugenix, HDC, Bisanga, Vertex just for starters. All those are recommended by the forum. Anybody’s best is subjective though. Get as many consultations done as possible and look through the forum for results from each clinic/Dr. 
If your looking at starting out with FUT then Hattingen do some pretty amazing larger sessions. Really impressive ! Dr Zarev is another to research. Good luck 😉 

Thanks for the mention guys. The OP does certainly have an advancing level of hair loss and would require 4000 grafts or a just about that. It seems the donor is good, the lateral humps are quite high and the hair texture is favorable. Please feel free to reach out to us either through this thread or directly. I’m sure you are in the right place in terms of making your choices. 

1 hour ago, JohnAC71 said:

No probs ! HDC @Doron Haratiand Vertex @DrTBarghouthiAre good considerations and have very active Drs/Reps.

Are you taking Fin/Minox ? Just wondering if your doing anything to retain what you have. Thanks 🙏 

Thank you for the mention. I can see that you are experiencing some thinning in the frontal tuft and possibly some recessions that can be filled. I don't see you needing more than 2000-2500 grafts for now. You are definitely on the right track as you are being given excellent recommendations and advice here. 

7 hours ago, JohnAC71 said:

@Anonymusplease can you re add your photos for the Drs I have tagged to see ? Thanks ! 

Yes that would be great. 

47 minutes ago, JohnAC71 said:

Some more options for you… HDC @Doron Haratiand Vertex @DrTBarghouthiboth recommended by the forum. 

Thanks for the mention. It would be great if OP can share some photos too either here or in private. 

1 hour ago, JohnAC71 said:

Interesting, have you performed any combo cases we can see ? 🙏

Will share some yes. 

Just now, SLA said:

Could you please clarify what you mean by this? Did you mean that he needed an FUT/FUE combo to get him to more than 3000 grafts? I don't think you meant this as he had more than 3000 grafts through FUE alone.

Thanks!

Yes. I meant due to his limited scalp laxity, a typical strip for him would have yielded around 2000-2500 grafts. So he would most likely needed a 1000 more done through FUE around the strip (combination procedure). 

54 minutes ago, SLA said:

I love the results @DrTBarghouthi.

Hairline is perfect and age appropriate- he will continue to grow into it for sure. I like how you approached this in a conservative manner given the family hx.

Looking forward to seeing the crown.

Did you consider performing FUT on this individual?

We are planning to do the crown soon. Looking forward to that. We did consider FUT but patient was not too keen on a linear scar and scalp laxity was not great for a wide strip. He needed combination to get him over the 3000 grafts anyway. 

Dear community,

This is a 35 year old gentleman who had an FUE procedure done in July 2020 . He is a NW 6 pattern with a family history of the same. His donor area is moderately good with some midline dipping in the back.  We did around 3411 grafts for both the frontal and midscalp zones to add definition and density. A planned second stage for the crown was proposed a year after the initial surgery.

 Photos were taken  at around 11 months from surgery. Patient placed on finasteride 1 mg on alternate days. 

Surgical details:

FUE 0.8 mm punch

Hairline 407 refined single hairs

3004 multiple grafts

Average of 2.6 hairs/graft. 

Sites made using 0.8 mm and 1.4 mm Sapphire blades. 

Surgical photos: (11 months from surgery )

Before: 

Planning/ immediately after: 

10 days after

11 months

Comparison: