Dr.Thomas Rosanelli

This patient had a total of 1,830 grafts done over one session with a

Follicular Unit Strip method.

Grafts were placed in the following areas:

Hairline, 700 grafts

Front, 830 grafts

Right Temple, 150 grafts

Left Temple, 150 grafts

Photos shown below are pre op, and 1 year post op.

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This patient had a total of 2,485 grafts done over two sessions in the crown area with a

Follicular Unit Strip method.

Photos shown below are pre op, and 1 year post op after his second procedure.

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 This patient had a total of 4,240grafts done over two sessions with a Follicular Unit Strip method.

The grafts were planted in the following areas:

Hairline: 1200 grafts

Frontal Scalp, 700 grafts

Mid Scalp, 600 grafts

Left Temple: 275 grafts

Right Temple: 275 grafts

Left Parietal: 100 grafts

Right Parietal: 100 grafts

Partial Crown, 990 grafts

Photos shown below are pre op, and 6 months of the 1 year after his second procedure.

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This patient had a total of 1,205 grafts done over one session with a Follicular Unit Strip method.

The grafts were planted in the following areas:

Frontal Scalp, 400 grafts

Mid Scalp, 400 grafts

Upper Crown, 405 grafts

Photos shown below are pre op, and 1 year post op.

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This patient had a total of 1,745 grafts done over one session with a Follicular Unit Strip method.

The grafts were planted in the following areas:

Hairline, 600 grafts

Frontal Scalp, 650 grafts

Mid Scalp, 220 grafts

Right Temple, 150 grafts

Left Temple, 125 grafts

Photos shown below are pre op, and 9 months post op.

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Preoperatively, the patient was extremely devastated by his hairloss and especially his lack of symmetry, which obviously led to uncomfortable stares and questions. Patient is a national radio talk show host and also does small amount of TV. He would always wear a hat to cover his hairloss. We started his restoration in November 2013, and completed his surgery in 2015. I spoke with the patient just last week and got permission to use his story. He is extremely happy and satisfied and may return for additional follow up photos.

Patient came in October 2013 for an evaluation of hairloss that he suffered after craniotomy and radiation therapy for brain tumor. He had been evaluated previously by 2 other Bay Area physicians and told that he was not a candidate for hair restoration. His recollection was that he was told the hair would not grow due to the condition of the scalp following radiation. After exam and planning, I proceeded with a multiple session procedure so as to maximize graft survival, naturalness of results, and as much coverage as possible. In the first two procedures, we transplanted 4505 grafts (session 1 was 2400 grafts; session 2 was 2105 grafts).  The first two sessions were 6 months apart. Initially, I told the patient that we would not have enough donor for the crown, however, when the patient returned approximately 10 months after session 2, he said he was mostly satisfied with his hairline, frontal scalp, and mid scalp density, but he was really bothered by his bald crown. We did 1645 grafts in session 3 with the majority (approximately 1145 grafts) to the crown and left posterior mid scalp and left parietal areas.

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BACKGROUND:

Sorry for delayed response but I was not back in the office until January 3^rd, and I wanted to review this patient’s chart prior to responding. I appreciate your comments and would like to sincerely address them based on my practice which has been dedicated to hair replacement for over 30 years.  That said, I regret not posting background and details to put results in context

First, I would like to mention some of the factors which I take into consideration and which I will attempt to address with future postings for this readership. 

·         What are the patient’s desires?

·         What density is he looking for?

·         Age and family history and probably future loss?

·         Does the patient understand the pros and cons of each technique actually prefer a FUE or FUT based on personal preference?

·         Does the patient want to do several sessions for gradual replacement or a one and done? (This varies greatly from patient to patient-and there are many patients who look for a very slow increase in order to keep others from knowing they are having surgery)

·         Is he willing to commit to other non-surgical treatments such as minoxidil, finasteride, PRP, Exosomes, LLLT?

This is just part of the discussion I personally have with every patient in consultation before surgery (I do not use consultants to meet with the patients so they have all their concerns addressed by me well before they even decide to go forward with surgery).

THIS PATIENT:

Based on the health and family history of this young patient, there is a significant risk of future hair loss.  He had reasonable expectations and was not trying to get back the hairline he had at 15.  He wanted a gradual change, minimal grafts to increase his density, which would allow him to decide in the future if he wanted more density in front versus additional grafts mid-scalp or for potential future areas of loss. 

His choice was to have at least one additional surgery in 1 to 2 years for hairline advancement and refinement rather than have a more extensive surgery at this time.  I supported his choice as it is my policy to not over harvest the donor which is unfortunately very common in FUE procedures-not withstanding hand device, U graft, Alpha graft, ARTAS, Neo graft, etc.

In this patient a second session of 1,000-1400 grafts (based on his finances and desired result) will be placed with the “current hairline” buried .8-1.2 cm behind the single hair “new” future hairline. The use of some multi hair follicular units along a “Current HL” will add some needed visual density to the “newer” hairline that IS IN FRONT of this current hair line.

In addition, the use of the second session grafts can be distributed in appropriate numbers to create a more anterior natural hairline. Then the extra grafts can be used to add density to front or mid-scalp.

THE TRUTH ABOUT FUE:

 FUE is an adamant preference for some patients.  They should be totally educated on the pros and cons of the procedure-its benefits and limitations.  Whether a physician uses ARTAS, Cole punches, SafeSystem, U System, neograft, etc. does not reflect on the doctor’s ability or result. Many physicians use one or more of these systems effectively and efficiently.

One of the big negatives of FUE is the tendency of the physician to “Cherry Pick” the better-quality grafts. This in and of itself leads to a depleted donor. I have seen many patients and many different techniques used for FUE. No matter which system/ method may have been used, depleted donor due to overharvesting can and does occur. Doing sessions of 3,000-4,000 grafts FUE for hairline and frontal areas in patients that are younger may lead to depleted donor long term. The advantage of large sessions in achieving a higher density and fuller hairline can lead to less grafts available for treatment of mid scalp and upper crown. Unfortunately, some doctors regardless of experience, actually purposefully harvest into the donor fringe to achieve a short term 10-15 year “better result” at the expense of a 60+ year old with visible scars and thinning of the original HT surgery. The advantage of the multiple future session donor harvest allows for faster healing, less scarring, and also re-evaluation of the donor and the grafted area for best use of a limited resource.

MY BELIEF:

I have 30+ years of experience and have seen many of my own and other physicians HT patients who have 20-30 years post treatment hair loss. Any truly knowledgeable HT surgeon that believes they can overharvest and over treat balding patients between ages 25-40 with no long-term consequences is just delusional. A cautious approach with less grafts and more thought-out long-term plan can always get more detailed results that are tailored by patient’s desires and need, rather than get in, get done, and get their money. I do all my own consults and all my patients are informed of my techniques, methods, and long-term plan. Some of these consults decide they want a much larger session (One and Done) and then take themselves elsewhere, and that is fine. I have seen some of these patients that still come back to us for their non-surgical hair needs and some may have fine results. I have also seen many that come back 2-5 years later with depleted donor and terrible results and say they wish they had been more conservative and less aggressive.

CAVEAT:

Many of the comments as to FUE devices and HT surgery being marketed to non –hair restoration physicians are appropriate.  These physicians are not knowledgeable in hair (even if otherwise great plastic surgeons) and have “hired guns” come in and sometimes do the surgery with disastrous results. 

This patient had a total of 1,837 grafts done over one session with Follicular Unit Excision (FUE) method using the ARTAS robotics.

The grafts were planted in the following areas:

Hairline, 750 grafts

Frontal Scalp, 837 grafts

Right Temple, 125 grafts

Left Temple, 125 grafts

Photos shown below are pre op, and 9 months post op.

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This patient had a total of 2,041 grafts done over one session with Follicular Unit Excision (FUE) method using the ARTAS robotics.

The grafts were planted in the following areas:

Hairline, 400 grafts

Frontal Scalp, 400 grafts

Crown, 1241 grafts

Photos shown below are pre op, and 8 months post op.

This patient had a total of 2,113 grafts done over one session with Follicular Unit Strip method.

The grafts were planted in the following areas:

Hairline, 600 grafts

Frontal Scalp, 600 grafts

Mid Scalp, 413 grafts

Right Temple, 200 grafts

Left Temple, 200 grafts

Right and Left Parietal, 50 grafts each

Photos shown below are pre op, and 11 months post op.

This patient had a total of 1,815 grafts done over one session with Follicular Unit Strip method.

The grafts were planted in the following areas:

Hairline, 600 grafts

Frontal Scalp, 765 grafts

Right Temples, 225 grafts

Left Temple, 225 grafts

Photos shown below are pre op, and 9 months post op.

This patient had a session of 751 grafts with Follicular Unit Excision (FUE) using ARTAS robotics.

The grafts were placed in the following areas:

Hairline - 485 grafts

Right Temple - 125 grafts

Left Temple - 141 grafts

Photos shown below are pre op and 1 year post op.

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 This patient had a total of 1,750 grafts done over one session with Follicular Unit Excision (FUE) method using the ARTAS robotics.

The grafts were planted in the following areas:

Hairline, 600 grafts

Frontal Scalp, 300 grafts

Mid Scalp, 400 grafts

Right Temples, 175 grafts

Left Temples, 175 grafts

Right Occipital, 100 grafts

The patient had Alopecia in the right occipital due to traumatic injury as a child.

Photos shown below are pre op, and 10 months post op.

This woman had a total of 1,275 grafts done over one session with Follicular Unit Strip method.

The grafts were planted in the following areas:

Right Temple, 700 grafts

Left Temple, 575 grafts

Photos shown below are pre op, and 17 months post op.

This patient had a total of 2,050 grafts done in one session with Follicular Unit Strip method.

The grafts were planted in the following areas:

Hairline, 800 grafts

Frontal Scalp, 750 grafts

Right Temple, 250 grafts

Left Temple, 250 grafts

Photos shown below are pre op, immediate post op and 10 months post op.

This patient had Alopecia Areata in this area. Prior to surgery, he had a biopsy to confirm the diagnosis that the area was “burned out”.

The grafts were planted in the following area:

Right inferior temples, 310 grafts

Photos shown below are pre op, and 8 months post op.

This patient was satisfied with his first session of 2,700 grafts.

The grafts were planted in the following areas:

Hairline, 850 grafts

Frontal Scalp, 500 grafts

Mid Scalp, 500 grafts

Right Temple, 175 grafts

Left Temple, 175 grafts

Upper Crown, 500 grafts

Photos shown below are pre op, and 1 year post op.

This patient was satisfied with his first session of 2,477 grafts.

The grafts were planted in the following areas:

Hairline, 600 grafts

Frontal Scalp, 777 grafts

Mid Scalp, 600 grafts

Right Temple, 150 grafts

Left Temple, 150 grafts

Right Parietal, 100 grafts

Left Parietal, 100 grafts

Photos shown below are pre op, 1 year post op, and a well healed donor area.

This patient was satisfied with his first session of 1,890 grafts.

The grafts were planted in the following areas:

Frontal Scalp, 400 grafts

Crown, 1490 grafts

Photos shown below are pre op, and 9 months post op.

This patient was satisfied with his first session of 2,445 grafts.

The grafts were planted in the following areas:

Hairline, 650 grafts

Frontal Scalp, 600 grafts

Mid Scalp, 595 grafts

Right Temple, 200 grafts

Left Temple, 200 grafts

Right Parietal, 100 grafts

Left Parietal, 100 grafts

Photos shown below are pre op, and 8 months post op.

This patient was satisfied with his first session of 1,939 grafts, and preferred not to exceed 2000 grafts.

The grafts were planted in the following areas:

Hairline, 600 grafts

Frontal scalp, 550 grafts

Mid Scalp, 439 grafts

Right Temple, 175 grafts

Left temple, 175 grafts

Photos shown below are pre op, and 7 months post op.

Thank you.

Normally, we would do another session, however the patient is extremely satisfied with his results and did not want another session.

This patient was satisfied with his first session of 1,717 grafts, and had the Follicular Unit Strip procedure.

The grafts were planted in the following areas:

Hairline, 500 grafts

Frontal scalp, 500 grafts

Mid Scalp, 367 grafts

Right Temple, 100 grafts

Left temple, 100 grafts

Right Parietal, 75 grafts

Left Parietal, 75 grafts

Photos shown below are pre op, and 9 months post op.

This patient had a total 3,394 grafts over one session with Follicular Unit Strip harvest.

The grafts were planted in the following areas:

Hairline, 600 grafts

Frontal scalp, 800 grafts

Mid Scalp, 594 grafts

Right Temple, 250 grafts

Left temple, 250 grafts

Right Parietal, 225 grafts

Left Parietal, 225 grafts

Upper Crown, 450 grafts

Photos shown below are pre op, and 12 months post op.

This patient had a total 3,848 grafts over two sessions with Follicular Unit Strip harvest.

The grafts were planted in the following areas:

Hairline, 1000 grafts

Frontal scalp, 925 grafts

Mid Scalp, 823 grafts

Right Temple, 450 grafts

Left Temple, 450 grafts

Parietals, 200 grafts

Photos shown below are pre op, and 16 months post op.