Dr. Damkerng Pathomvanich

A 34-years old Asian male has extensive hair loss from the front toward the crown with dense miniaturized hair at forelock and mid scalp. The balding area measured 212 cm2. He has good donor hair and scalp laxity. The hairs are wavy, coarse, and black. He underwent 2 sessions (strip). The first session had 3969 transplanted grafts (7951 hairs) from front to mid scalp. The second session had 2736 grafts (5808 hairs) transplanted at crown. A total of 6705 grafts (13759 hairs) were transplanted. Below are before and after photos one- year after the procedure. He was placed on oral finasteride and minoxidil post op and was happy with the result.

A 29-year-old white male who has receding hair line, deep temporal angles, markedly thinning hair at the front and some thinning at crown. He has a coarse, black and wavy hair with good donor density and average laxity. He underwent hair transplantation on February 8th, 2012 with a total of 2756 grafts (5759 hairs) 1-hair=548 grafts,2-hairs=1637 grafts, 3-hairs=347 grafts, 4-hair= 224 grafts were transplanted in 61 cm2. Below are pre and post operative pictures that were taken 10 months after surgery. He is very happy with the result, the donor scar is minimal.

58 years old white male, known history of toxic goiter and on Synthroid for the last decade and symptom free. He has receding fronto- temporal hair line and baldness at the crown and wanted to have his hair line restore first and crown later. His hairs are weavy, dark brown, coarse hair with good density. He underwent hair transplantation since Dec 25th,06 and just returned for follow up on Nov 20th,12 six years later and complaint of some progressive hair loss. He didn’t take Finasteride or Minoxidil due to site effect. His balding area measured 79 cm2 included the temple. A total of 2724 grafts ( 5958 hairs) were transplanted to the front and temple. Below are pre and post op pictures were taken six years later. He is planning to have further session at crown and add some density at front next year due to his budget constrain.

Hi Jana, You're right it took much longer than straight hair.It was 9 hours.The cutter and inserter were unhappy while cutting and implanted the grafts with extreme curly hair and slippery.I have to give big bonus for all my assistants. Thanks Janna for your comment.

Busybee, Thank you. I believe we submited at least 3 african hair patients in the forum for the past few years.You can search in my album,if not I can post it again .

Here is a 42 years old white male who has receding fronto-temporal hair line and has good donor hair. He wanted to lower the hair line and reconstruct both temples. He underwent hair transplantation on Dec 10th,2010.The balding area measured roughly 50 cm2, 2,784 grafts were transplanted (1 hair graft=626,2 hairs grafts=1786,3 hairs graft=462, total number of hairs=5584).His post op pictures were taken at one year 7 months as seen below included the donor scar.

A 45-year old Caucasian male who had receding hairline, deep temples, and slightly thinning at the top area of the scalp consulted at the clinic for hair transplantation. He had a family history of Norwood Class III from both his father and paternal grandfather. He has no systemic diseases apart from a 10-year history of Guttate Psoriasis, which he has been treating with topical steroids and tar shampoo. On physical examination, he had a few psoriatic lesions on the top of his scalp. He underwent hair transplant in August 2011 with a total of 2777 grafts (1 hairs=351, 2-hairs=1741, 3-hairs=685) corresponding to 5888 hairs. On the 5th day follow-up after surgery, the grafts settled well and there were no new psoriatic lesions noted on the donor or recipient areas. 1 year post-op photos show excellent results with good density at the hairline and at the top. The patient reported no eruption or aggravation of his psoriasis after surgery.

Dear Akuma, We have not heard from you. Kindly contact us for a follow-up to add on the density to your area of concern. We can further discuss during your visit to the clinic. We look forward to hearing from you. Best regards, Dr. Pathomvanich

30-year old male from Middle East has extensive hair loss from front toward the crown with dense miniaturized hair at the bridge and good donor hairs at back. His hair is coarse, black, wavy. He wanted to transplant only the front part due to limited budget. He had hair transplant on July 21st, 2011 and had a total of 1971 grafts or 5133 hairs (1-hair= 200, 2-hairs=947, 3-hairs=446, 4-5 hairs=378 grafts). The insertion was difficult due to increased bleeding, popping, and slippery grafts. He returned after 12 months post-op with good growth and was happy with the results as shown.

Dear Akuma, As you were informed several months ago that I'm responsible for my work and will add more density at the front without charge. Please make your arrangement and when you're ready please let me know. Regards, D.Pathomvanich MD

A 28 year-old male from Ethiopia had receding of both temples as in Norwood III. He had extreme curly hair with density 76 grafts/cm2 and underwent hair transplantation on Sept 22, 2011. A total of 1763 grafts (1 hair graft= 276 grafts, 2-hairs graft=1257 grafts, 3 hairs graft = 230 grafts) or 3480 hairs were transplanted. He was seen 6 months post op and was very pleased with the result with minimal donor scar.

A 39 year-old Caucasian male had receding hair line and baldness at crown with thinning at the top.The recipient area measured 103 cm2. He had good donor hairs. He underwent hair transplantation on January 29th 2010 and a total of 3883 grafts (8270 hairs ) were transplanted. The front 2182 grafts : 1 hair grafts = 547, 2 hairs grafts= 1235, 3 hairs grafts =400 The crown 1701 grafts : 2 hairs graft= 1050, 3 hairs graft= 651 The results are shown below.

K.J. , 47-years old, African descent, male, had extensive hair loss from front to the crown (Class Va). He has coarse, extreme curly hair. He underwent FUT strip technique with a total of 3371 grafts with a breakdown of 1-hairs 864, 2-hairs 2162, 3-hairs 285. Total number of hairs were 6043. H e returned 1 year and 4 months after surgery , very pleased with the result and wanted to have more session on the crown and add some density at the front. Before and After pictures are shown below.

A 36-year-old Asian male, Norwood V with hair loss from the front to mid scalp and thinning at crown. He took Propecia 10 years ago, for 1 year and stopped since he did not see any results and started again 5 months prior to surgery. He was advised to use Minoxidil solution pre and post-op. The total bald area measured 71 cm2 at the front. The ultra refined follicular unit hair transplantation was done with strip technique and trichophytic closure. The detail of the hair transplantation is as follows: Frontal and top area: 1 hair: 374 FU grafts, 2 hair: 1769 FU grafts, 3 hair: 739 FU grafts and 4 hairs: 120 FU grafts. A total of 3,002 follicular unit grafts consisting of 6,609 hairs were transplanted. The patient was followed at 6 months post operative with good growth and significant cosmetic improvement. His donor area has minimal scar as shown in the photograph. We will submit an update of the patient at 1 year post-surgery when he returns to the clinic in the next 6 months.

A 43-year-old Caucasian male, Norwood VI with hair loss from the front to the crown. He didn’t want to take neither finasteride nor minoxidil solution pre and post-op. The total bald area measured 80 cm2 at front + top and 57 cm2 at crown. The ultra refined follicular unit graft was done with strip technique and trichophytic closure. The detail of the hair transplantation is as follows: Frontal and top area: 1 hair: 668 FU grafts, 2 hair: 2371 FU grafts, 3 hair: 545 FU grafts and 4 hairs: 200 FU grafts. A total of 3,784 follicular unit grafts consisting of 7,604 hairs. The patient was followed at 9 months post operative with good growth and significant cosmetic improvement. His donor area has minimal scar as shown in the photographs.

My record indicated that he had receding mid-frontal and temporal hairline with thinning eyebrow. His hair is coarse, with density at 80%. He underwent strip FUT on March 9, 2011. 830 grafts were transplanted at the mid-front of the scalp, 460 grafts at both temples, 224 grafts at both eyebrows, 56 grafts at the beard. I haven't seen his post-op photos since surgery and would like to compare from his pre-op photos before further discussion. He was informed that it would take 12-18 months to see the final results of the hair transplant. The frontal scalp hairs usually fall off first 3-6 weeks after surgery and grow back in about 3-4 months. For unknown reasons, the majority of eyebrow and temple hair transplants continue to grow without shedding. We transplanted the temples in a flat angle so the density appears greater as a shingle effect since the hairs lay down flat covering the scalp even with less number of grafts. However, the angle of the transplanted hairs at the frontal part of the scalp were made at 45 degrees so that the hairs when combed up, make the scalp visible. He should send me the post-op photos taken the same way as the pre-op photos so that I can compare and discuss his concerns.

A 44-year-old Asian male, Norwood VI with extensive baldness from front to crown. He wanted to do megasession hair transplantation. He decided to take proscar (5mg) 1/4 tablet once daily and minoxidil tablet (5mg) 1 tablet once a day after surgery according to physician recommendation. The total bald area measured 272 cm2. The ultra refined follicular unit grafting was done with strip technique and trichophytic closure. The detail of the hair transplantation is as follows: Recipient area: 1 hair: 497 FU grafts,1? hairs: 473 grafts, 2 hairs: 2,435FU grafts and 3 hairs: 911 FU grafts A total of 4,316 follicular unit grafts consisting of 8,810 hairs were transplanted. The patient was followed at 6 months post operative with good growth and significant cosmetic improvement. His donor area has minimal scar as shown in the photographs.

There's no doubt that one scar is the best for multiple HT sessions. However, subsequent sessions makes the single scar wider depending on the width of the strip that is excised. A 1 cm width strip will leave a minimal or an invisible scar on average, whereas a wider strip will leave a bigger scar. The outcome of a single scar after 2 strip techniques usually results in a scar that is wider than the original since the total width is doubled, more or less. Excising the scar from the first HT session is not easy since the hair follicles within the scar are not aligned in the same direction as do normal hair follicles since they are embedded in scar tissue. Even with trichophytic closure, the hair follicles within the scar are in danger of transection. Careful dissection is very important to avoid damage to these follicles even though I use my open technique with the aid of skin hooks. I still have a hard time in some cases to try to dissect the follicles that are within the scar to avoid transection, since the hair direction of the follicle is distorted due to fibrosis. If we excise the strip and the scar is included at the center it would be much easier, in the same manner as if we avoided dissecting inside the scar. However, slivering a strip inside the scar is more difficult. When you encounter the scar, there is the potential for follicular transection. In my opinion, if the scar is invisible, why bother to incise the same scar causing more potential for follicular transection. If we make a second scar, we do not encounter the old scar and there will be less potential for transection. If the patient needs further sessions, the two scars can be incorporated into one. If the scar from the first HT session is a little bit wider, I will use a single scar by excising the first scar and incorporating the scar inside the strip to prevent an even wider scar when it heals. I always discuss with my patients prior to surgery whether he would want a single scar or 2 scars. Whether to do one or two-scar strip is still a debate. However, majority of the hair surgeons as well as patients will select a single scar, if possible. Majority of my patients still have a single scar after subsequent sessions. I did not say that I recommend 2 scars for every patient. Dr. Damkerng Pathomvanich

He has my vote. I have no doubt in my mind that he is an expertise in the field of hair restoration surgery in the world. Welcome Mike. D.Pathomvanich MD

A 48-year-old Caucasian male, Norwood III vertex with receding frontotemporal hairline with mild thinning at the crown. He wanted feminine hairline. He didn’t want to take any hair loss medications. The total balding area measured 48 cm2 at frontotemporal area. The ultra refined follicular unit grafting was done with strip technique and trichophytic closure. The detail of the hair transplantation is as follows: Recipient area: 1 hair: 700 FU grafts, 2 hair: 1639 FU grafts and 3 hair: 223 FU grafts A total of 2,562 follicular unit grafts consisting of 4,647 hairs were transplanted. The patient comes for follow up at 2 year 2 months post-operative, the transplanted hairs grow well and significant cosmetic improvement. His donor area has minimal scar as shown in the photographs.

A 58-year-old Thai male, Norwood III with receding frontotemporal hairline. He wanted to transplant at frontal hairline. He didn’t want to take any hair loss medication pre and post-op. The total bald area measured 55 cm2 at front. The ultra refined follicular unit grafting was done with strip technique and trichophytic closure. The detail of the hair transplantation is as follows: Frontal area: 1 hair: 459 FU grafts, 2 hair: 2281 FU grafts, 3 hair: 281 FU grafts. A total of 3,021 follicular unit grafts consisting of 5,864 hairs. The patient was followed at 2 year 6 mo post operative with good growth and significant cosmetic improvement. His donor area has minimal scar as shown in the photographs.

Here is my response to the above concern.He has consultation on May 2010 and on examination shown extensive baldness from front to the crown as in Norwood VI-VII. The balding surface area measured 264 cm2, the length of good donor site was 29 cm2 , the donor density average 80 grafts per cm2 and scalp laxity 30%. The first session was concentrated at the front , 1914 grafts/ 3770 hairs were transplanted. He returned for the 2nd session on 20 May 2011 (one year) with good result from the first session (as attached before and after photos).He wanted to fill the grafts at top and back,since the balding area was very large, he was informed that it might not be dense ,total of 3569 grafts/ 6492 hairs were transplanted spread it over at crown as he wanted.This is only short of 7 months and he was informed that it will be premature to judge the final result since the hair grafts just start to grow.He said he has lost more hair and the balding crown is larger, medication didn't seem to stop the hair loss and thought he lost more hair with medication.I'm kind of concern regarding his current hair loss and told him that the cause of hair loss need to be investigated,not jumping to add more grafts. In summary, it's impossible to transplant 264 cm2 of his balding scalp with his existing hair since it will need 10,560 to 13,200 grafts to achieve good cosmetic result.Body hair transplant result is unpredictable reported by many experience surgeons and the growth rate is quite low compare with scalp hair.He need to be patient another 5-10 months to see the final result and work up for his hair loss.

A 38-year-old Caucasian male, Norwood VI with receding frontotemporal hairline , thinning hair from front to the crown and dense miniaturized hairs at the top. He wanted to transplant at front and crown at the same time. He didn’t want to take neither finasteride nor minoxidil solution pre and post-op. The total balding area measured 130 cm2 at front and top ,56 cm2 at crown. The ultra refined follicular unit grafting was done with strip technique and trichophytic closure. The detail of the hair transplantation is as follows: Recipient area: 1 hair: 192 FU grafts, 2 hair: 2775 FU grafts and 3 hair: 955 FU grafts A total of 3,922 follicular unit grafts consisting of 8,107 hairs were transplanted. The patient was followed at 1year 3 months post operative with good growth and significant cosmetic improvement. His donor area has minimal scar as shown in the photographs. He plans to add more density at the crown in the future.

Bill, I am confirmed that DHT clinic is still flood free. The flood is about 2 kms away from my clinic as up Today (Nov 14th). I have 2 of my patients answered the flooding situation in BKK because Andy wanted to know the recent patients who just have hair transplant done at DHT clinic. Andy also was informed by me regarding this situation. They had accessed to my account to answer the flooding situation since both are not the member of hair loss network. If you watch CNN news about flooding in BKK, you will scare to dead. There are many area that the flood are bad, but inside BKK is still dry and I hope it will remain dry as long as no one remove the sandbag that block the water to flood inside BKK. Damkerng Pathomvanich

------- Post by one of Dr. Path's patients ------- Hi to all concerned, I am currently in Bangkok and have just had surgery at the DHT clinic. There are no signs of flooding in the CBD of Bangkok or anywhere close to the clinic. Traffic is flowing normally and every day commuters are having no trouble at all travelling to and from work. I am staying in Sukhumvit and have had no trouble what soever getting to and from the clinic. Lastley I am very satisfied with all the work that has ben done from Dr Pathomvanich. (Name removed)