Dr. Jean Devroye

12 months post-op / Photographic and video update

Thank you all for your kind comments, I really appreciate.

On 8/28/2018 at 6:13 AM, wazaam said:

Dr. D excellent result. The patient must be thrilled. 

What size punch was used ?

How many remaining FUE grafts do you think this patient has left? 

Your work continues to impress. 

Thank you wazaam and TrixGlendevon for your comment and questions.

The punch used was an external 0.9. We can notice how small the holes are and how fast the healing process has been.

There should probably remain between 1000 and 2000 grafts according to if I extract in the most lateral areas or not. And if I use beard, this number can increase from 500 to 1000 additional grafts.

17 hours ago, TrixGlendevon said:

Good work @Dr. Jean Devroye. Both the crown and the hairline look great. It does look a little less dense on the hairline than behind it though. How many grafts were used in the front and how many in the crown in the initial procedure? Thanks.

As far as the distribution of the 4600 grafts is concerned, the vertex must, in total, have been transplanted about 2000 grafts and the rest was added in the front and on the midscalp for the second procedure.

On 8/7/2018 at 11:15 PM, Sean said:

Impressive.  Looks quite natural.  Looks like a normal head of hair which is the ultimate goal of any hair restoration patient.  Patient must be really happy.  

Thank you Sean for your comment. Really appreciate!

I don't have any experience with a SMP treatment on an inflamed area and I wouldn't like to risk a try, but this has probably been tested by others. However, the use of Toppik or any other keratin-containing product is not an issue given the neutral character of the product (which moreover remains external).

On 8/18/2018 at 9:37 PM, Melvin-Moderator said:

Dr. Devroye, thank you for your continued participation and long-term support of our community. This is an excellent case presentation. How many grafts were used in the lateral humps near the crown, as you can see there was significant thinning in the midscalp and crown area. I would like to know how many grafts were approximately used to thicken up the lateral portion of the crown?

Melvin, thanks for your kind words. It is not easy to answer precisely to your question. As you can see, the vertex area was implanted with a slightly less strong density than the midscalp. The two lateral areas you have mentioned probably represent 300-350 grafts per side.

On 8/7/2018 at 11:16 PM, Sean said:

Impressive!

On 8/8/2018 at 2:13 AM, TrixGlendevon said:

Hi- great result. Can I ask, why does the FUT scar appear longer on the patient's left side than his right side? Was this a laxity issue? I don't suppose there is a pic of his scar now to see how it has healed? Not his donor but the scar itself?

Thanks for your appreciation.

To be honest, I do not see an important difference between the two sides of the scar. In any case, that was not intentional and the patient didn't present any laxity issue. 

Concerning the scar pictures : unfortunately we didn't receive any until now, but my secretariat has contacted the patient and we will provide you with some pictures as soon as they'll be available.

On 8/8/2018 at 1:01 AM, jj51702 said:

Thank you doctor.

Do you feel it is safe for a patient to use a potent corticosteroid such as clobetasol for two months leading up to the surgery?

I've never prescribed this specific medicament to my patients so I would tend to not give a definitive answer about it. 

However, I consider that in general it is always preferable to perform surgery on a less inflamed area - even if the patient is on medical treatment.

On 7/26/2018 at 6:05 PM, Melvin-Moderator said:

Wow great work Dr. Devroye, I see the extraction pattern on the last surgery went fairly high up in to the donor zone. What is your opinion on using these donor hairs that are generally not considered “safe” I feel that my best hair is located in that section. 

This is a very interesting question and I congratulate for your keen sense of observation.

That boundary zone can be treated in accordance with two philosophies : the first is the "prudent", the most orthodox, taught everywhere and which consists in leaving one or two centimetres not exploited between the donor and recipient areas. There are two main reasons to act in this way : to not use hair potentially unstable and, furthermore, to not create scars in a zone potentially balding.

This modus operandi presents however a big inconvenient, mostly when performing a second (or further) FUE : in fact, it creates a no man's land between the donor and recipient areas having an original density - which is often ungraceful, especially when the patient wears his hair very short - that resembles a halo all around the skull, often called fringe.

The second philosophy, which I tend to apply when the patient wears his hair very short and/or it is about a second (or further) surgery, consists in ending the extraction in a progressive way, approaching the recipient area as much as possible. Obviously, it is difficult to be certain about the boundaries between the donor and recipient areas. However, at worst, we will have transferred a limited amount of unstable grafts. In this specific case, we were practically obliged because of the patient's safe donor limitations (more than 5000 FUE grafts already extracted).

I never had the need to treat a scarring issue in that area but, if it happened, it would be simple to solve by transplanting some hairs taken from the lower area.

On 8/1/2018 at 8:56 AM, Sean said:

Dr. Devroye, Impressive result based on the patient’s skin conditions too.  Really made a big difference.  This is what I am calling/coining a “distinct” change.  Considering the number of grafts used too.  Excellent work!  

           Thank you for your comments, much appreciated. 

On 8/2/2018 at 9:09 AM, jj51702 said:

Which corticosteroid was used by this patient?

          Medrol was prescribed to this patient.

PATIENT'S DETAILS

✓ 27 years old at the time of the first surgery (Test 2015)

✓ In 2012, he had a previous procedure done in another clinic, 2300 FUE grafts.

✓ Treatments : to be confirmed.

✓ Medium caliber hair.

✓ Fragile follicular units.

✓ Normal % of hair in telogen phase.

RECOMMENDED TREATMENT

This patient presented for the first time to my office in October 2013, one year and a half after undergoing a 2300 FUE grafts procedure in another clinic. This previous procedure ended up with poor results and, worse still, two weeks after the surgery the patient started to develop a severe shedding due to psoriasis and dermatitis. This condition (never experienced before) affected him to a great extent both physically and emotionally, so much so that he didn't dare to go out without wearing a cap anymore. During this first consultation, I suggested him to start a treatment based on Nizoral and corticosteroids in order to mitigate the shedding.

In March 2014, the patient showed important improvements in regards to the skin diseases. However, I suggested him to wait further before performing a hair transplant procedure, since the dermatitis was still present at that time.

In February 2015, the patient informed that the symptoms were reduced, nevertheless still evident. Despite that, we agreed upon performing a small test (+/- 100 FUE grafts) in order to check the regrowth rate and if the psoriasis/dermatitis would develop again after the transplant (hence to verify the viability of a more important procedure).

In July 2015, the test was performed - 78 FUE grafts implanted in the vertex area. The test proved to be successful. Nevertheless, I suggested him to wait again for a complete healing before performing an important procedure: analysing his evolution, the symptoms were likely to develop quite rapidly and unforeseeably.

In December 2015, the patient announced that his skin lesions had completely disappeared. So, in February 2016, we were finally able to perform a first procedure to restore his hairline, frontal area and a part of the midscalp - using 2903 FUE grafts. I also suggested him to continue to wear his hair very short after the procedure, since I found that UV rays had a positive impact on the skin disease.

The patient was extremely pleased with the results obtained and decided then to perform a second surgery in order to restore the vertex area. In August 2017, we managed to transplant 1437 FUE grafts (because of his limited donor resources). The last pictures sent by the patient show the current situation, nine months after the second surgery. The regrowth appears satisfying, the density acceptable : if he wish to further strengthen it, we could consider a BHT complement in the future. 

SURGERIES DETAILS

1st Surgery (TEST) -  July 2015

✓ 78 grafts

✓ Technique: FUE

✓ Incisions: N/A
✓ Grafts Breakdown: N/A
✓ Total number of Hair: N/A
✓ Average Hair/Graft: N/A

2nd Surgery (FUE I) - February 2016

✓ 2903 grafts

✓ Technique: FUE

✓ FUE scoring and extractions executed with my WAW system, now widely used in the sphere of FUE. It consists of a very precise pedal that enables to control the movement of the punch, that I also designed myself. The main advantage is to reduce substantially the number of damaged and transected hair, thus to raise the quality of the procedure. The system is now used worldwide and several dozens of surgeons or centres are already using it.

✓ Incisions: 40-45/cm2

✓ Grafts Breakdown:
☞ 1042 Single FUE grafts
☞ 1698 Double FUE grafts
☞ 159 Triple FUE grafts
☞ 4 Quadruple FUE grafts

✓ Total number of Hair: 4931

✓ Average Hair/Graft: 1.70

3rd Surgery (FUE II) - August 2017

✓ 1437 grafts

✓ Technique: FUE

✓ FUE scoring and extractions executed with my WAW system.

✓ Incisions: 25-30/cm2

✓ Grafts Breakdown:
☞ 147 Single FUE grafts
☞ 936 Double FUE grafts
☞ 339 Triple FUE grafts
☞ 15 Quadruple FUE grafts

✓ Total number of Hair: 3096

✓ Average Hair/Graft: 2.15

Dr. Jean Devroye

PATIENT'S DETAILS

✓ 31 years old, NW IVa, losing hair since the age of 24. Hair loss stabilized since two years. No available data about his family hair loss history. 

✓ Started taking Finasteride 1mg after the surgery. Treatment currently suspended.

✓ Medium caliber hair.

✓ Normal follicular units.

✓ High % of hair in telogen phase.

RECOMMENDED TREATMENT

This 31-year-old patient presented with a NW IVa hair loss degree: an almost completely bald anterior area, a thinning mid-scalp and obvious signals of loss in the vertex area.

We agreed upon performing an FUT procedure of approximately 3500 grafts in order to rebuild his hairline and cover his frontal and midscalp areas - leaving the vertex untouched for a potential, second procedure. The proposed hairline, slightly conservative and drawn following the patient's original one, will guarantee a suitable look also in the long-term.

In January 2018, the patient eventually received 3757 FUT grafts. The 3rd and 5th post-op month pictures show an early regrowth and already remarkable improvements. During the next 7 moths we expect the results to further improve, especially regarding the hair density and texture.

As usual, we'll not hesitate to update this case as soon as new photographic material will be available.

SURGERY DETAILS

✓ 3757 grafts

✓ Technique: FUT

✓ Incisions: 40-45/cm2

✓ Grafts Breakdown:
☞ 519 Single FUT grafts
☞ 2573 Double FUT grafts
☞ 644 Triple FUT grafts
☞ 21 Quadruple FUT grafts

✓ Total number of Hair: 7681

✓ Average Hair/Graft: 2.04

Dr. Jean Devroye
 

On 7/6/2018 at 5:03 PM, TrixGlendevon said:

I have 2 more questions though (sorry). 1) Are there any pictures of the donor and the scar both immediately post-surgery and at the points in time you have shown the front 3rd (1 month, 4 months, 6 months, 2 years etc)? and 2) Why is the hairline that you have drawn in the last 0- picture not symmetrical? Looking at the second 0+ photo as well as the 1 month ones, this is clearly noticeable. Was this intentional? Thanks!

Concerning the scar: unfortunately we do not have any pictures taken at the clinic other than the immediate after surgery. Since the patient lives abroad, I didn't have the opportunity to see him in a post-operative consultation so far. However, I can share with you the pictures the patient posted in a French hair loss forum while sharing his experience. Please find them below.

Pre-Op / Immediate Post-Op:

+37 days:

+69 days:

+103 days (haircut 9mm):

 

The asymmetrical hairline design was indeed intentional and agreed with the patient. I translate below his comments on the subject (original comment located on the first page, first post of the following thread: http://www.international-hairlossforum.com/tomish-4575-fut-devroye-2015-t3776.html) :

"As you can see in the pictures, Dr. Devroye has drawn my original hairline, asymmetrical and slightly conservative. I told him that it's perfect, because I always had this asymmetry, it's part of me and I didn't want to change it."

PATIENT'S DETAILS

✓ 36 years old.

✓ No medications.

✓ Medium caliber hair.

✓ Normal follicular units.

✓ Low % of hair in telogen phase.

RECOMMENDED TREATMENT

This patient started to lose his eyebrows hair since his childhood as a result of unfortunate family circumstances that provoked very severe stress periods. The loss continued until stabilizing during his adolescence.

Unfortunately, by time, the eyebrow hair hasn’t grown back. The patient has therefore found himself in the unpleasant situation visible in the pictures below until 36 years of age, when he gathered the courage to contact me to explain and attempt to correct his difficult situation.

We therefore decided to perform an FUE procedure of approximately 500 grafts (taking his scalp hair as donor area) with the aim of rebuilding the eyebrows original shape with a good density. The final grafts count states 510, exclusively single (+/- 250 for each eyebrow). The regrowth of transplanted grafts has been relatively fast and the patient is fully satisfied with the results obtained.

In general, the eyebrow transplant uses the same technique as for a classic hair transplant : we graft hair or, when it’s possible, body hair (coming from armpits or the pubis for example). It is mandatory to use exclusively single grafts (containing just one hair) in order to guarantee natural results. The incisions must be made in a very tangential way and the natural hair orientation must be necessarily respected.

SURGERY DETAILS

✓ 510 grafts

✓ Technique: FUE

✓ FUE scoring and extractions executed with my WAW system, now widely used in the sphere of FUE. It consists of a very precise pedal that enables to control the movement of the punch, that I also designed myself. The main advantage is to reduce substantially the number of damaged and transected hair, thus to raise the quality of the procedure. The system is now used worldwide and several dozens of surgeons or centres are already using it.

✓ Grafts Breakdown:

☞ 510 Single FUE grafts

✓ Total number of Hair: 510

✓ Average Hair/Graft: N/A

Dr. Jean Devroye

22 hours ago, hairlossPA said:

this is a great result

Thank you for your appreciation hairlossPA.

18 hours ago, TrixGlendevon said:

Thanks for this thorough answer. I have booked into see you for a consultation at the start of September when you re-open the clinic at the end of August. 

It will be my pleasure TrixGlendevon.

On 02/07/2018 at 10:54 PM, TrixGlendevon said:

Great result Dr Devroye. I am sure he will be very pleased with it. May I ask, is the patient on medication? Why did you do the crown work when he is so young? Surely this area will continue to deteriorate and you cannot know the pattern it will take at such a young age.

TrixGlendevon, thanks for your comment.

Yes, I confirm that the patient is on medication, taking Finasteride since the surgery. He was also applying Minoxidil 5%, nevertheless he has stopped the treatment some months after the procedure because he was bothered by the greasy and oily hair texture caused by the lotion.

As agreed with the patient, we have performed a FUT ASMAP (As Much As Possible) procedure with the first objective of covering the frontal and midscalp areas with a maximal density so that, even if he will lose his hair in the future, these areas will be permanently stable. Depending on the final numbers of grafts included in the strip, we reserved the possibility to reinforce also the vertex area, which was starting to thin as well (as noticeable in the pre-operative pictures). We finally managed to extract 4575 grafts, therefore we had the opportunity to add coverage to the vertex as well.

The patient has been informed prior to the surgery and is perfectly aware that he may need a further procedure in the vertex area in the future, if his hair loss will continue. His family hair loss history shows however very limited cases of baldness. Specifically : his father has lost his temples corners and is slightly thinning on the vertex area; his grandfather (paternal side) lost his vertex; no hair loss problem detected on his maternal side. In general, I consider these as positive indications in regards of the patient's future hair loss. Nevertheless, the patient donor area can still supply several thousand of grafts if a further procedure will be needed - via one or even two additional FUT procedures, plus a FUE complement if necessary.

In details + 2 years post-op update

Melvin, JohnCasper,

Thank you for the kind comments.

Indeed, it is always very challenging to cover the crown with a maximal density. This, for two main reasons: on the one hand, hairs in this zone follow a spiral pattern (unlike in the frontal area, where hairs go towards the same direction) and this consequently reduces the apparent density (that is the effect given by a certain quantity of hair). On the other hand, the surface to be covered is higher than that of the anterior area.

As you say, the angle of the incisions and the grafts placement orientation as well play a key role in getting good cosmetic results. On the contrary, I would not mention a poor blood supply as a general reason why results are often subpar when treating this area. It could be true in some cases but, if a patient presents a poor blood supply, this should theoretically affect the whole of his scalp and not merely the vertex area.

PATIENT'S DETAILS

✓ 32 years old.

✓ No medications.

RECOMMENDED TREATMENT

One of the most frequent questions I get asked from people interested in a beard transplant is : "How my beard donor will look after the procedure? How long will it take to recover?"

I recently had the opportunity to closely follow-up one of my patients after his beard transplant. I'm glad to share below his photographic documentation as it can be instructive and clarifying in regards to what one can expect both in terms of donor management and actual results.

Since always, the patient was bothered from the lack of beard hair, noticeable especially on his cheeks. We therefore decided to perform a FUE procedure, using his same beard as donor area (particularly the area under the chin and the neck). The patient received 1011 single FUE grafts.

As can be seen in the photos below, the beard donor healing process was already advanced just 3 days post-op, while 2 weeks after the surgery the signs of the extractions were no longer visible. Concerning the results, the patient is extremely satisfied since we reached his goals just 5 months after the procedure.

Generally, the beard transplant presents a main peculiarity : the beard follicle is always constituted by a single thick hair (rarely two). On the contrary, hair follicles can grow naturally in groups of 2, 3, 4 or even more hair. This is one of the main reasons why I always prefer to use beard hair when performing a beard transplant procedure (when possible) : same hair structure, no need for grafts dissection.

In fact, the follicles resulting from a strip (FUT) or a FUE (from the scalp donor) must be subdivided in order to obtain one-hair grafts, because only single hair should be used in order to ensure natural results (with the exception of some double grafts that can be used to increase the density throughout the central areas). The beard present also an advantage compared to the hair: the beard hair density is less strong than the density of the scalp. So, it relatively easy to reach an original density in a single session.

SURGERY DETAILS

✓ 1011 grafts

✓ Technique: FUE

✓ FUE scoring and extractions executed with my WAW system, now widely used in the sphere of FUE. It consists of a very precise pedal that enables to control the movement of the punch, that I also designed myself. The main advantage is to reduce substantially the number of damaged and transected hair, thus to raise the quality of the procedure. The system is now used worldwide and several dozens of surgeons or centres are already using it.

✓ Grafts Breakdown:

☞ 1011 Single FUE grafts

✓ Total number of Hair: 1011

✓ Average Hair/Graft: N/A

Dr. Jean Devroye

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

You are really doing fantastic work these days Dr. Devroye. Keep it up!

Many thanks for your kind words delancey !

Melvin, Spanker,

I appreciate your comments, thank you.

Melvin, Pelo Dinero, Dhananjay,

Thank you kindly for your comments.

That’s very interesting Dr. Devroye, so the use of nizoral everyday has helped his hair loss in your opinion? What a stellar result, it’s amazing the patient probably doesn’t recognize himself in old pictures.

The daily usage of Nizoral has indeed helped to improve the dandruff condition the patient was suffering from, but it doesn't have any effect on hair loss.

Really nice result. It's time to put Dr. Devroye in the same sentence with the likes of H&W and Rahal when it comes to FUT.

 

Dr. Devroye, why does his hair appear to have flakes and scabs 9 months post-FUT 2? Seems pretty far removed to still have that.

The flakes and scabs visible on the 9 months PO FUT II pictures are actually the consequence of the severe dandruff I was mentioning on the post. The patient started using Nizoral after that and, as you can see in the 2 years PO FUT II pictures, the usage of the shampoo has almost completely solved the issue.

The patient already had a tendency to develop big dandruff flakes, as can be seen in the first pre-op pictures. That's the reason why I have recommended the usage of this specific shampoo. Unfortunately, we are talking about a recurring illness.

In October 2015 the patient underwent a second FUT surgery with a view to covering the vertex area.

He received 2720 grafts which, added to the first 3708, make a total of 6428 grafts transplanted in two sessions.

Please note that the patient started a Minoxidil 5% treatment since the first surgery.

Just before undergoing the second surgery, he had also started taking Finasteride - nevertheless he had to stop the treatment after less than one year because of side effects (symptoms of depression).

The patient also experienced a quite severe dandruff which obliged him to wash his hair everyday : the usage of Nizoral shampoo has considerably helped to improve the situation.

SURGERIES DETAILS: 6428 FUT (3708 + 2720)

1st Surgery - July 2014

✓ 3708 grafts

✓ Technique: FUT

✓ Incisions: 40-45/cm2

✓ Grafts Breakdown:

☞ 724 Single FUT grafts

☞ 2200 Double FUT grafts

☞ 667 Triple FUT grafts

☞ 117 Quadruple FUT grafts

✓ Total number of Hair: 7593

✓ Average Hair/Graft: 2.05

2nd Surgery - October 2015

✓ 2720 grafts

✓ Technique: FUT

✓ Incisions: 35-40/cm2

✓ Grafts Breakdown:

☞ 573 Single FUT grafts

☞ 1712 Double FUT grafts

☞ 435 Triple FUT grafts

✓ Total number of Hair: 5302

✓ Average Hair/Graft: 1.95

Dr. Jean Devroye

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Thanks for your comment Melvin, greatly appreciated.

PATIENT'S DETAILS

✓ 37 years old, NW IV, losing hair since the age of 20, with a hair loss history in his family (father and brother, same condition).

✓ Taking Finasteride 1mg/day since the surgery.

✓ Thin/Medium caliber hair.

✓ Normal follicular units.

✓ High % of hair in telogen phase.

RECOMMENDED TREATMENT

This 37-year-old gentleman came to visit me in order to find a solution for his hair loss, that was affecting him since the age of 20.

He wished to restore a large part of the thinning areas and wanted to be able to wear his donor hair short after the procedure : for these reasons, we agreed to perform a 3600-3800 FUE surgery in 2 consecutive days.

In July '17, the patient eventually received 3723 grafts in order to rebuild his hairline, cover the frontal area and fill the midscalp. Just after the surgery, he has also started a Finasteride treatment in order to maintain his native hair and increase its quality.

We present below some pictures showing his results 6 and 10 months after the procedure. The patient is currently considering a second surgerywith the aim of adding density to the vertex area. We'll keep you updated as usual in case he will proceed with it.

SURGERY DETAILS

✓ 3723 grafts

✓ Technique: FUE

✓ FUE scoring and extractions executed with my WAW system, now widely used in the sphere of FUE. It consists of a very precise pedal that enables to control the movement of the punch, that I also designed myself. The main advantage is to reduce substantially the number of damaged and transected hair, thus to raise the quality of the procedure. The system is now used worldwide and several dozens of surgeons or centres are already using it.

✓ Incisions: 40-45/cm2

✓ Grafts Breakdown:

☞ 1055 Single FUE grafts

☞ 1273 Double FUE grafts

☞ 1385 Triple FUE grafts

☞ 10 Quadruple FUE grafts

✓ Total number of Hair: 7796

✓ Average Hair/Graft: 2.09

Dr. Jean Devroye