Gencheff

Patient requested restoring his hairline with a less receded look. Presently patient has a comb down look and will conceal the surgery very nicely until he is able to comb his hair back off his face, which is his desire.

Patient was placed on Propecia 6months prior to his surgery and a conservative hairline was restored working the frontal third of his scalp. Patient will be reviewed in one year, 2010.

600 - 1 hairs

1100 - 2 hairs

320 - 3 hairs

2,020 graphs

Patient had previous surgery several years ago at another facility. As far as he could recall he had about 1200 graphs, but could not recall the size of the graphs. Previous work was ok; patient's concern was lack of density and wider scar to the left donor region. The procedure that was performed was removal of old scar and placement of additional 2020 f.u.'s, 1's, 2's and 3's to increase density and get back to mid-vertex area. Patient understands he will have a bald spot to the posterior third.

Patient had frontal 1/3 reconstruction to Zone I into Zone II, fortifying existing forelock. Patient strip was 1.2cm x 22cm. yielding the following numbers:

2126 sites

973 1 hairs 20 gauge

1732 2 hairs19 gauge

700 3-4hairs 18 gauge

Yielding 3,435 hairs

Also included is his 2 week post-op visit to remove sutures. Patient had excellent recovery and should have a very nice yield to the front half.

Patient is in his late 40's with stable loss and is on preventative therapy. What is also important is that this patient expects to lose more to the back half and wants to get a jump on his reconstruction to the frontal scalp by adding to his thinning. He fully expects yet another restoration to the frontal half. Fortunately this patient is blessed with excellent donor and can easily have another 2+ procedures. All my patients have to expect more hair loss if they haven't lost all recipient hairs, but given this patients age, preventative hair loss therapies, desire, donor density and expectations he was an excellent candidate. Also, should the patient lose more hair a diffused thin look can still be very natural in appearance when done with follicular units.

Patient had procedure mid September 2009, to recreate hairline and augment existing hairs, working all of Zone I and into Zone II.

1,180 20 gauge single follicular unit

1,020 19 gauge two hair follicular units

Total 3,220 hairs

I have observed and worked with Dr. Vladimir Panine and have found his expertise and staffing to be excellent in providing consistent surgical results. His artistry and command in the operating room provide his patients with comfort and excellent care. I defiantly support his recommendation. Dr. Christopher Gencheff

Full restoration Class IV + on 60 year old, 6,443 hairs.

Hairline and Crown follicular unit transplantation on Norwood Class IV

Patient was a class IV. He had 2 surgical restoration sessions 13 months apart. Initially he was placed on Propecia for 6 months prior to the start of his first session.

Zone I was done to augment his isolated forelock and re-establish his hairline to Zone II. The second session a TET was done and FUT to Zones I & III (posterior vertex).

Patient was happy with first session and then decided he did want a second session to address his back area once he realized he stabilized with Propecia. About 20% was added to the first session to increase densities and the remaining were placed posterior to give patient a see-through look vs. the bald spot he had.

First Session: 2550 hairs

388 ??“ 1's

895 ??“ 2's

95 ??“ Multi-unit grafts

Second Session: 3343 hairs

327 ??“ 1's

998 ??“ 2's

255 ??“ Multi-unit grafts

Patient had one procedure to lower and augment high hairline. Patient has been stable x 3 years on Propecia?®. A follicular unit transplantation was performed with the following numbers; 760 ones, 910 twos and 302 threes using nineteen and eighteen gauge for the threes.

It would have been nice to see Aaron in person to review his concerns. There is no substitute to actually seeing the results face to face.

Having said that, I tell all my patients, especially those under 30 years old that density (hairs per cm2) is always an issue especially if your donor hair is thin in caliber, skin tone pale and scalp elasticity snug. Moving the 2100 F.U.T. to zone I into II or frontal third had to take into consideration continued thinning regardless of medical therapy. These grafts were feathered into the lateral humps and mid-vertex as well as reestablishing a hairline. Existing hairs that were there may continue to thin, especially if the ???intermediate hairs??? are prone to the shock/loss of the surgery and that may be the stubble Aaron continues to feel. Again, that was discussed and a second procedure is always discussed with all patients, especially if patients have more original recipient hair to lose.

I have seen patients that have been done by the various clinics that have responded to this case and many supplement their look with camouflage products, until more hair is moved into the thinning areas.

My concern with Aaron was his age, the quality of his donor hairs, vascularity he displayed during surgery and the fact that he shaved his head. Donor scarring had to be as minimal as possible given his skin elasticity. I feel the F.U.T. moved in that single session is more than justified and density was never going to be that of a 15 year old with out any hair loss. Donor scarring vs. hair density is always going to be a balancing act in a younger balding patient.

I caution all future patients especially those under 30 to realize that F.U.T. is a good procedure with limitations based on not just what the patient desires but what his genetics will display. Therefore, planning is always discussed personally by me at great length with my patients and the take home message is conserving donor hair for the future. Results always vary from patient to patient, after all this is a surgical procedure and not a hair system that can give you all the density you want as hair supply is unlimited with a hair system.

I also implore all post surgical patient to give their respective surgeon a face to face to assess their concerns.

I welcome any comments from other Hair Transplant Network surgeons.