Cam Simmons MD ABHRS

See http://www.hairrestorationnetwork.com/eve/158033-dr-cam-simmons-%96-norwood-3v-man-%96-part-1-2885-grafts-hairline-crown.html

A year later, he was happy after his first transplant. However, with his higher transplanted hairline and receding temporal hairlines, his forehead still looked higher and broader than he would like.

We transplanted 2295 FUG’s to slightly lower his hairline, add a widow’s peak, and to make it more irregular. We also reconstructed his temporal points to improve the frame for his face on all 3 sides.

His previous scar was included with the donor strip so he still has one narrow scar.

He normally air-dries his hair and when it is shorter, it gets quite curly. He got caught in the rain and came to his follow-up visit with soaking wet hair. We took photos with wet hair then he dried it and we took more photos. His hair goes straight when he uses a hair-dryer.

After 2 sessions, he is happy with his hairline, temporal points, and crown. He has chosen to use Minoxidil and not Finasteride and knows that he could some day be back to transplant another 2000 grafts or so if he loses the hair between the 2 transplanted areas. We will reserve his donor hair for that possibility.

This 38 year-old patient had a NW 3V thinning pattern with brown, curly, fine hair and a Z-S Whorl in his thinning crown. He was most concerned about his crown but wanted to address his receding hairline too.

We could have easily used all of the grafts in front but instead we started with a higher hairline with 1500 FUG’s and transplanted 1385 FUG’s in his midscalp/anterior crown. His curly hair helped make the transplanted hair look denser.

http://www.hairrestorationnetwork.com/eve/158034-dr-cam-simmons-%96-norwood-3v-man-%96-part-2-2295-grafts-better-frame.html follows.

Great results Dr. Simmons! One small request though, I love seeing how the procedure was tackled in regard to the number of hairs placed in each graft... Could you possibly enlighten us with how many single, double, triple, and quadruple hair grafts were used?

Thanks Robin

We count the total number of grafts but we don't keep separate counts for the whole case. We do keep separate counts for sample areas so we can know the approximate distribution of grafts. This man had about 22% 1s, 55% 2s, 21% 3s, and 2% 4s.

Tom60

First, I have to say that this is educated guessing because I haven't met eh123 and we don't often hear about patients bleeding from a recipient site 17 days after their hair transplant.

In fact, on reflection, the bleeding could more likely have been a pimple from an early ingrown hair that broke open during exercise. They are more common after a month but could happen earlier. The same thing can happen in the shower, when brushing or combing your hair, or even rubbing your head with your hands.

I tell my patients that they can do cardio at 5 days and regular exercise at 2 weeks. I do ask them to avoid forcefully stretching their donor area for 3 months so they should avoid situps with their hands behind their heads, pull-downs, or lifting weights where they have to put their whole head and neck into it to get that last rep. It is best to follow your own doctors instructions because they have a vested interest in your outcome second only to yours.

Dr. Simmons, what length do you find best for transplanted hair? To me, I consider "short" anything under 2". I wouldn't know why anyone would spend the money and time for a hair transplant just to buzz cut it.

You are right that you get more layering if the transplanted hair is kept 2 inches or longer. Some of my patients do wear their transplanted hair shorter and it still looks natural but doesn't look as dense. Some also use gel or pommade, which also make the transplanted hair look thinner than a "dry look." I can make suggestions but it is their hair so they can wear it however they like and feel comfortable.

eh123

My best guess, without seeing you in person, would be that you lost a single graft that didn't take. We don't expect 100% survival and the loss of 1 graft should not affect your final outcome.

At 18 days, the vast majority of your grafts should have taken and will be in the resting phase. It is more fun when you get to see growing hair at the 4 month stage and it gets better each month after that.

Happy growth

Spanker

It looks like you have a clockwise or S-whorl. I tried to blow up your images but the resolution wasn't great. When your hair is brushed in a mostly clockwise direction, it will look fuller. If you push it counter-clockwise, as in photo 2, it will look thinner. If there are miniaturized hairs in your crown, medications would be your best bet, IMHO.

Hi Tao

I don't think that crown transplants take longer to grow than frontal or midscalp transplants. However, there can be variability in the same patient from one transplant to the next and you are only 4 months in.

At the same transplanted density, crown transplants tend to look thinner than frontal transplants. The crown is on a more vertical part of the skull and the hair direction away from the whorl reduces the shingling effect. On top of that many hair transplant docs purposely don't transplant the crown as dense as the front to save donor hair and reduce commitment to future hair transplantation. Once the crown is transplanted you are committed to transplanting from the hairline to the crown and joining up the sides, if you have ongoing loss.

Shagster

Based on your description, it sound like your hair is thick in the midline but that you have deep frontotemporal recessions. You would probably be a very good candidate for hair transplantation. If you have a narrow centre part through your natural hair in the midline, you could keep wearing that style.

If you later thinned in the midline or needed to transplant it, you would likely choose to stop wearing a centre part because transplanted hair is not as thick as a teenager's, the top of our "dome" reflects overhead lights, and that combination would make a centre part look wider.

You still want a mature man's hairline. Just because you prefer longer hair does not mean that you should be looking for similarities to a woman's transplant. I had to find an action shot to see Tom Petty's clearly male hairline!

It doesn't happen often but I am going to disagree with RCWest. Reasonably dense transplanted hair usually looks thicker when kept longer because there is more layering of hair on hair. Really thin hair looks thicker when kept short.

eh123

That sounds like a Canadian name, eh?

You were worried enough to post about your experience so it might be worth driving 60 miles to get some reassurance. Nothing beats a face-to-face meeting with your doctor to diagnose and possibly correct any problem.

However, to answer your question , we would need more details. How much blood was there? Where did you notice it? On your skin or on a towel? Was it bright red or darker brown? Was it thick or watery? It happened at Day 17 but how long ago was that? Could you tell if the bleeding was from the donor site or the recipient sites? Did you ask a friend or family member to check the donor and recipient areas? Is everything else OK?

All of these questions can stear the diagnosis toward or away from a possible cause. The answers to these questions may also generate more questions before the possible cause can be figured out. The diagnostic process is much faster and more accurate in person than "by forum or blog"

I hope that this is just a tiny bump on the road to your recovery.

Dr. Simmons is this patient wearing brow pencil or powder in results? Also, are there any immediate post-op pics to see exactly were the grafts were transplanted in the hairline?

Sonia

Thanks for your questions.

She does use eyebrow pencil as the transplanted hairs cannot be placed as close together as natural hairs in one session. The pencil and transplanted hairs work well together. Without the transplanted hairs, her eyebrows looked "drawn."

We did not transplant hair in her hairline. As seen in the "plan" photo, we only transplanted the midfrontal forelock or central tuft. Apart from the centre, her natural hairline looked good.

Looks much better Dr. Cam. I didn't know that you would need to use almost 700 grafts for the eyebrows. I would have thought about 200-300 would have been enough. Very interesting. I wonder what the eyebrows would look like if she didn't trim them!

Thanks aaron1234

We planned for 275 single-haired grafts per side but after the initial incisions were done we could see space for more.

Natural eyebrow hairs are tapered and don't grow the way scalp hairs grow. Her scalp hairs are finer at the base than her natural eyebrow hairs but coarser at the tip. If the transplanted hairs weren't trimmed they would get quite long and would get wavy. Her eyebrows would look fuller but would look less natural so it is best that she trims them as often as she does.

Ben UK

Good question and nice avatar.

Scalp flexibility is an important factor for FUT and donor strip removal. Scalp flexibility is determined by how much the skin can stretch and how much the upper layers of the skin can glide over the bottom layers. Scalp exercises can increase the scalp flexibility but not always. A tight skin closure increases the risk of getting a wide donor scar so the safe width of the donor strip should be determined based on the flexibility of the scalp.

Doctors have different ways to assess flexibility. Some make a qualitative assessment. Others use Drs Mayer’s and Paul’s method or caliper. With that method vertical marks are made 5 cm away from the midline and the scalp is compressed horizontally and the movement of the marks is measured. Ratios are used to determine how wide a safe strip can be. Other doctors, like me, use Dr. Jerzy Kolasinski’s method of determining vertical scalp laxity or VSL. A horizontal mark is made and a ruler is held to the skin. The skin is pushed and the upward movement and downward movement are added together. I take multiple measurements and use the total in each area as the maximum safe width of the strip at that point. It is not exactly what Dr. Kolasinski intended but it works for me.

It would be very difficult to measure your own scalp flexibility. Even men with flexible scalps won’t be able to pinch much scalp, like we can on our bellies. However, you can push your hands against your scalp and move it up and down to get a feel for how much it moves. A friend or family member could get a rough VSL measurement. You would need help interpreting the results of the Mayer-Paul method.

Of course, your doctor can assess your scalp laxity at a consultation.

Romeo99

As 1966kph has said Finasteride and Minoxidil used together would be a good combination.

You don't necessarily need to wait a couple of years for hair transplantation. You do need to have a face-to-face consultation with a doctor you trust to discuss all of your options, realistic expectations, and to devise a good long-term plan.

Romeo09

Please be careful.

You may have started as a Norwood 3V pattern but I would describe you now as having closer to a Norwood 6 thinning pattern with a persistent frontal fringe (hairline.) As you are just 25 you could develop a full Norwood 6 pattern later and could even go on to develop a Norwood 7 pattern.

If you are not already using medical stabilization, you should consider it. Whether you choose FUT or FUE there is a limit on how much scalp hair you will be able to transplant. You may not have enough scalp donor hair to cover your whole eventual balding area well. For this reason, I believe that most doctors would not agree to transplant your crown now.

If you did transplant 2500 grafts over your whole thinning area it would look quite sparse. There can be a role for hair transplantation for you but you need to have a good long-term plan with clear expectations and should understand your commitment to more hair transplantation later.

Surfarosa

I should also mention that bringing old photos to a consultation can help. Instead of seeing a snapshot of your current condition we can get a "movie" of your hair loss progression.

Hairthere - how do I get to the pictures you are referring to ?

 

Thanks

If you are still on-line hairthere, I hope you don't mind me stepping in. Surfarosa, I found this link by clicking on hairthere's name then looking for recent posts.

http://www.hairrestorationnetwork.com/eve/157589-temple-point-update.html#post2243326

Good night all.

I actually just had my TPs restored via FUE (200 to each side). Go to patient results section to see pics.

Hairthere

Thanks for directing us to your photos. You seem to have good growth at 5 months. The hair directions and angles look good. Dr. Feller has transplanted a small number of grafts well so that your temporal points are still subtle but create a nice balance with your transplanted frontal hairline.

Dr. Simmons - at what age do you feel that you can start making the "call" on predicting the extent to which a patient will lose their hair? I know this is a question that can have many answers with the usual caveats but you intimate above that it becomes easier to make a prediction thus you must have something in mind.

 

I have been losing my hair since my late teens, been on meds for 10+ years and feel at 36 I should be able to have an idea of where I'm destined. In my early 20s my fear was that I would follow my father's advanced MPB route. However, as I have not (he was completely bald by my age) I often wonder where I might end up or when I might have a pretty darn good idea.

Surfarosa

Great question. I can't give you a simple answer.

Without medications, it is easier to predict the future for someone in their 40s than in their 20s. If there is mild to moderate loss at 36, someone could still progress to as far as a Norwood 6 but very likely wouldn't get to a Norwood 7 pattern. Norwood 6 patients are much easier to treat than Norwood 7 patients, of course.

Medications can be great at slowing hair loss and can therefore make prediction harder. I always design hair transplantation as if patients won't keep taking medications while encouraging them to continue taking them. We can never know exactly how you would look now if you hadn't used meds for 10+ years but it would make sense that you would probably have much less hair. Sometimes patients only learn how much the medications helped after they stop them.

The genetics of hair loss are very complicated so you can't look at one family member and expect to follow in their footsteps. The fact that you could notice hair loss in your late teens, which is earlier than a lot of men, is a warning sign that you could have developed advanced MPB and it is good that you and your doctor started meds to slow your loss when you did.

To get your best estimate at your future progression, you would need a close personal exam to look for miniaturized hair where the hair currently looks thick. You would then have to add a measure of caution because you have been using medications.

Sorry the answer is a bit wishy-washy but its the best I can do.

Why isn't more emphasis placed on the temporal peaks/triangle in HT's? my uniformed opinion is that temporal peak restoration helps balance out weak transplanted hairlines with minimal grafts necessary.

 

My temporal peaks/triangles have always been thinner than the hair surrounding it. Sure there is a chance it could recede back, but from what i've gathered, it takes about 200 grafts to fill in the peaks and 400 to resculpt them.

 

How come more docs don't emphasize it?

JacksonBrowne

It seems that you are talking about your "temporal points" and others have replied accordingly.

I have had some patients contacting me about temporal triangles or temporal peaks that are talking about "temporal points" and others that are talking about "frontotemporal (FT) recessions." Temporal Points are usually triangular and project forward from the hairline on the sides. FT recessions are the usually triangular corners projecting backward that are made between the frontal hairline and temporal (side) hairlines.

Temporal points help frame the face but it is even more important that the frontal and temporal hairlines balance each other. People with naturally low, full hairlines tend to have strong temporal points and people with natural higher hairlines tend to have weaker temporal points. A low, full hairline without temporal points can look like a wig that has slipped forward. Strong temporal points make a receded frontal hairline look more receded and can look unnatural if there is little hair on top.

Dr. Mel Mayer has classified temporal hair loss as N= Normal, T = Thinning, P = Parallel (to the sideburn), or R = Reversed (concave backward above the sideburn).

The first 2 questions, hair transplant doctors will ask you are "Can you send photos?" and "How old are you?" Your current status and your age are the two most important predictors for your future hair loss. The younger you are now the harder it is to predict how much more hair you could lose.

It may not take a lot of grafts to transplant a young man's temporal points now but it could commit him to transplanting a lot more grafts later to maintain a balanced look. Usually for very young men, whose future hair loss is harder to predict, we start with a higher, more receded frontal hairline and leave N,T, or P temporal hairlines alone. If someone is older and their future hair loss is easier to predict, transplanting their temporal points to balance their frontal hairline can be a very good idea.

Thanks David and Blake

did you notice a lower yield transplanting at those densities? is the transition between the transplanted hair and the native hair almost seemless?

 

tnx!

Thanks Blake, David, and Megatron

She had fine hair and tightly grouped follicular unit grafts. We did not cut skinny grafts but her chubby grafts could still fit into small incisions. She had very good growth with no signs of decreased survival. I would not transplant average or coarse hair or bigger follicular unit grafts this close together.

She has not experienced hair loss and so we could afford to "spend" a lot of grafts in a small area. This would not be a good density plan for a man with genetic hair loss and a limited donor supply.

Although her transplanted hair is not as dense as her native hair it blends well so it is not easy to see where the transplanted hair stops and the natural hair starts.

Dr. Haber

Especially on the close-up view, his hairline looks very natural. He has both irregularity in the hairline itself and irregular density in the hairline.

The way that you designed his plan without actually drawing a "hairline" is also quite interesting.

Thanks

WOW what 2000 grafts can do when placed correctly! Excellent density. This patient is probably so happy he can't sleep!!

Louise,

 

This is a very impressive result! The density and naturalness are superb. Great work by Dr. Simmons!

 

Thank you for sharing!

Thanks RC West and David

His natural forelock helps and counts for at least 500 grafts ... He is very happy but he was always relaxed and confident so I don't imagine much would interfere with his sleep!

This 48 year-old man wanted to restore his frontal hairline and temporal recessions. He had experienced very gradual recession over the last 14 years or so. He had a Norwood 3 thinning pattern, light brown, salt-and-pepper, wavy, and finer than average diameter hair.

He had strong central and lateral peaks in his natural hairline and so his transplanted hairline was designed to match.

We transplanted 2125 FUG’s in one session. His donor strip had 21% single - haired grafts, 51% two - haired grafts, 18% three - haired grafts and 10% four - haired grafts. I used a 2-layer trichophytic closure.

He is not interested in medical treatment but has had slow loss so far and has plenty of donor hair available if he continues to lose more hair.

He is happy with his hair and “Even (his) own barber can’t tell.”