Dr. James Vogel

This is an example of a recent transplant to the eyebrows. These results are 6 months following the procedure.

Dear Cant Decide

Sorry for the long delay in responding to you regarding the hair line lowering surgery. I was out of town and it took a long time to dig out when I returned! The hair line lowering procedure is an extensive mobilization and movement of the scalp from the front hairline all the way back to the occipital protuberance (i.e. the bony bump just above the nape of the neck). Generally 1.5 to 2 .0 cm of lowering can be achieved. While the procedure sounds major, it is remarkably well tolerated by the patient and often they are able to get back to work within 3-4 days post operatively once the swelling has subsided. The nice feature to this procedure is that it is an instant gratification for the patient and makes a huge difference in the size of the forehead with in the span of several hours. The resulting scar at the hair line is permanent however often no additional hair grafting is needed to camouflage the incision. On the other hand, a modest amount of hair transplants as a single session are all that is needed to provide additional cover for the scar as well as lower the hairline even further. The procedure is most applicable for women with male pattern hair loss and a familial tendency for a large forehead and high hairline. As a plastic surgeon and hair restoration specialist this type of surgery is very much part of my training background and surgical practice. Look for more examples to come!

This patient was offered two options for enhancing her hairline. The first option was a hair transplant and the other was a hairline lowering procedure. She choose the later. This is a procedure in which the front hairline is lowered through direct advancement. In general the hairline can be lowered by 2 cm during this 2 hour procedure. The incision is located at the front hairline and 50% of patients will benefit from an additional hair transplant procedure to improve the hairline appearance and even lower the hairline further. This patient did not have an additional hair transplant.

The results seen are 8 months following the hairline lowering.

Results 8 months following 2700 grafts. Coarse hair but natural result using the current ultra refined methods.

Results seen 8 months following 2500 grafts

Results seen 8 months following 2200 grafts

Results seen 8 months following 2200 grafts

Results seen 8 months following 2300 grafts

Results seen 8 months following 1500 grafts

This result is seen 8 months following 3200 grafts to anterior hairline and forelock.

Patient testimonial following correction of pluggy hair transplants.

8 months following 2500 graft session. Thin narrow hair with low follicular density yet fullness as a result is achieved but patients awareness of their pre-op hair characteristics and the anticipated outcome is important.

This man has relatively isolated crown vertex alopecia and underwent 1900 grafts to reconstruct this region. Notice the recreation of the whorl pattern. It is also important for patients with this type of alopecia to be using finasteride to prevent additional ongoing hair loss in the crown.

Results 8 months after 1800 grafts and plug reduction and recycling.

8 months following 2500 grafts to forelock

I am humbled by the kind words above from Maxxy and B-spot, thank you both

Regarding cost, I do keep the fees quite reduced in these cases as a way to

help these unfortunate folks bring closure to an unhappy path . The only variability is when several expanders are needed for the procedure.

Patient photos taken 8 months after 2nd transplant totaling 4200 grafts

Maxxy

No problem with the dissection of my reply

Tissue expansion is the end of the road, last ditch effort to repair a wide donor scar. And believe me I do it VERY infrequently. This is why you have not read about it in many or any posts over the years. My comments probably did not reflect this situation adaquately. Sorry for not making that clear.

In addition Scalp stretching is mechanical and not biological (like tissue expansion) Also, to be anatomically correct scalp stretching really stretches the underlying galea, which is the tight leather like covering for the skull and is adherent to the scalp. The galea is the limiting factor and perhaps you have heard of the technique in which galeotomies (scoring or incising) are sometimes performed to gain more mobility of the galea.

Finally, a scar revision might be a possibility for the patient who started the thread. The final determination would need to be made in person and yes, scalp exercises are always recommended !

thanks

JEV

You are entirely correct that scalp exercises help loosen tight scalps and I recommend this maneuver to many patients. However in the case of an individual who has already undergone one, and in this case probably 2 , or more harvests from the same site there is considerable tissue physically , already missing and scalp exercises in this situation are unlikely to produce enough added laxiety to make a real difference.

Tissue expansion literally induces biochemical and physiologic tissue duplication known as tissue "creep" and adds tissue to the area and this is why expansion is such a powerful tool for selected situations

Hope this answers your question

After reading my message I do want to be clear that for some selected patients, tissue expansion can be a tremendously rewarding procedure and the only solution to address their individual concerns.

JEV

I happened to be reading this thread and thought I would add my 2 cents. Tissue expansion is the only way to add available scalp to excise a tight or wide donor scar. The downtime, discomfort, strange appearance and potential risk that a patient takes to undergo this staged procedure is considerable however. Interestingly I am on a panel in Boston at the next ISHRS meeting to discuss this very topic. Another easier option for a wide donor scar is to place some HT's into the scar to provide as much cover as possible.

31 year old following 1200 grafts to the forelock

This patient is a 39yo male who underwent 2 sessions of plug reduction and recycling and a total of 2800 grafts.

Results after 2500 grafts in a single session. This case illustrates the effect that favorable hair characteristics has on coverage, the silver hair with moderate texture helps to maximize the density achievable.

58 year old male received 2800 ultra refined transplant to anterior hairline and frontal area