Dr. Jerry Cooley

Thanks, I appreciate the feedback!

This patient has evolving IVA pattern hair loss. We performed 2,864 grafts (1-601, 2-1461, 3-766, 4-36; 5,965 hairs). He is shown one year later.

We put 350 single hairs into the scar. Thanks for your comments

If you consider that almost 200cm2 of scalp was covered with 8000 grafts, that only comes to 40 grafts/cm2. Of course the grafted density is higher in certain areas, and lower in others. I don't think he lost much native hair, which was pretty weak in the midscalp and crown to begin with. I think he would have looked good stopping after 4000 grafts but he wanted a lower more youthful hairline. This involved going to 7cm hairline with significant work in the temples, which requires alot of grafts. Most people won't need this many grafts (or don't have the donor or budget). One of the main reasons I presented it is to show that FUE after FUT is a good strategy for some patients to move alot of grafts and cover the linear scar from FUT. Thanks for the comments.

This patient is in his mid 30's. Initially, his goals were to restore the frontal zone including a conservative, natural hairline and to add a little density to the midscalp and crown. We did 4000 grafts by FUT and he is shown at 9 months. He was very happy and wanted to lower the hairline some more. We did a little over 2,500 grafts by FUT and he is shown 1 year later. Although he could have stopped there, he wanted to do more, in fact as much as I thought was possible. Given this was his last procedure for any forseeable time, we opted do FUE. We performed over 2,000 grafts, and grafted the frontotemporal hairline, crown, and linear donor scar from FUT. Over the three procedures, we performed 8,630 grafts (16,792 hairs) He is shown 1 year later. Given the contrast between his hair and scalp, I don't think his donor area would have looked as good if all of the grafts had been taken by FUE.

We performed an FUT of 2,544 grafts on this patient (1-729, 2-1398, 3-417; total hairs= 4,776). The 1's and 2's were focused in the 'corners' (frontotemporal angle), and 2's and 3's were placed in the frontal core for density. He is shown 13 months post op. He declined medical therapy.

This patient has type VI baldness, with an area of hair loss over 200 cm2. We performed two FUT sessions totalling 6,511 grafts (1-1710, 2-3218, 3-1338, 4-245 = 13,140 hairs). He is shown two years after the second.

I really like this result. Nice job.

Spanker ACell comes only as a powder or sheet; saline can be added to the powder to make a suspension (it does not go into solution). You're right about ACell scars being softer, more vascular. In my opinion, it would help with future grafting. Thanks for your comments Dr Cooley

Spanker I suspect it would depend on the strip scar itself. Fairly narrow and typical scars may not show much visible difference. I think the wider and all around uglier the scar, the more the benefits of ACell would become apparent. It also would depend on proper use of the ACell. Some docs who claimed it didn't do anything weren't using it properly. You have to ensure that a sufficient amount of ACell particles are adhering to the graft and place these into slightly bigger sites to allow the particles to remain attached to the graft. Dr Cooley

This patient had a large, aggressive skin cancer removed from his right temple many years ago. This was repaired at the time with a split thickness skin graft from his arm. He had been to another clinic and received a hair transplant with poor results. We performed FUT of 1,353 grafts (1-366, 2-653, 3-334; total hairs = 2,674). He is shown 8 months later. The hair is till growing in and the appearance will continue to improve for the next 6 months. There is not only good growth of the grafts but a noticeable improvement in the texture and appearance of the underlying skin. Part of this just from the grafts, but I also believe it is from the use of ACell to coat the grafts. ACell has the ability to help prevent scarring and also improve existing scar tissue.

This patient, who has very fine hair, started on finasteride and minoxidil. We performed FUT: 4,016 grafts (1-1027, 2-2082, 3-839, 4-68; total hairs = 7,980). The results, shown 18 months later, represent both the grafting and medical treatment. We coated the grafts with ACell and this creates a subtle benefit by inhibiting microscarring around the grafts and promoting the formation of healthy capillaries. One effect of this is better preservation of miniaturizing hairs around the graft. The close up photo shows the strong healthy grafts mixed in with thinning hair around it. Without ACell, the microscarring can lead to knockout of these fine hairs. Keeping them around creates an 'underbrush' that contributes to the final result.

This patient was started on finasteride and had FUT consisting of 3,708 FUs (1-1217, 2-1984, 3-473, 4-34 = 6,740 hairs). We also performed PRP/ACell treatment with the FUT. He is shown 10 months later. As is often the case in my Indian and Asian patients, there was a lower #hairs/graft count compared to my Caucasian patients. This is often compensated for with better than average hair quality.

This patient presented six years ago with type V hair loss and was started on finasteride. We performed FUT consisting of 2,800 grafts to his frontal scalp. He returned a year later and we performed 3,711 grafts to the midscalp, crown, and hairline. I did not see him for many years till he returned recently to add some more to the crown. In the first two procedures, he received 6,511 grafts (13,140 hairs). Notice the changes in the hair over the years. He has very fine hair but after the first procedure, it appeared a little thicker and was very wavy. We sometimes see these changes in the first year of new hair growth. Over time, it settles down and blends in with the rest of the hair.

I'm commonly asked how long PRP (+/- ACell) lasts. I think it depends on the patient and if their balding is rapid or slow, if they are on finasteride, minox, other stuff, etc. Also, patients need to understand that the results of the treatment will vary from clinic to clinic, depending on what PRP system is used and the protocol the doctor follows. Having said all that, PRP seems like a good idea for you when you have your procedure. If your doc recommends a booster at 6-7 months, I would follow their recommendations. PRP targets miniaturizing hairs so yes, it's particularly good for diffuse thinners. Good luck!

Thanks for your comments. Yes, his entire scalp was treated, including the FUE donor sites.

This 40 year old patient has diffuse pattern thinning and wanted some overall thickening as well as filling in to the fronto-temporal areas and the bridge behind the frontal tuft. He was reluctant to start finasteride and wanted a conservative approach. We performed FUE consisting of 624 grafts (1-223, 2-401) and a PRP/ACell treatment to the entire area. At 8 months, we performed a second PRP/ACell procedure. He is shown at 12 months. The grafts were planted at conservative densities by patient preference given he was not on any medical therapy. Photos are pre-op, post-op, 1 week post-op, and 1 year post op. Given he wasn't on any other hair treatment, the improvement is entirely due to the PRP and FUE.

This patient underwent FUT with 3,539 grafts (1-895, 2-=1785, 3-859 = 7,042 hairs). He is shown 15 months later. He did not take finasteride.

Thanks for the comments. No, this patient did not have PRP/ACell. We were not doing that as frequently then, but would have recommended now.

Hi Tom We would still have your chart and I'd be happy to talk with you on the phone. Dr Cooley

About 80 cm2.

The back part was over 100 sq cm2. I should clarify that this includes both the "crown" and "midscalp". So the 3/4's went into the crown, and quite a few 2's went into the midscalp. Thanks for your comments.

Harry Sorry for the delay in replying. Finasteride has a wide safety margin so no problems taking 2.5mg every day. I generally have my male patients take 1.25 mg every other day, but I have my older females take finasteride 5 mg every day. There are a lot of different ways to dose this medicine, and doctors disagree sometimes! Regarding your questions, most surgeons I know, including myself, use only 1 hair grafts right at the hairline. It is not unusual for FUE surgeons to not inspect or dissect FUE grafts under the microscope, and if they are good, this is not a problem. They know which grafts or 1's and which are 2's, etc. Small FUE removal of transplanted grafts generally leave no marks or scars. The same goes for electrolysis when done by an experienced person. I generally will use FUE on grafts with 2 or more hairs and electrolysis on 1 hair grafts that need to be removed. Again, I encourage you to discuss your concerns with your doctor. Good luck.

This patient is in his 40's and has type IV/V hair loss. We started him on finasteride and performed an FUT procedure consisting of 4,709 grafts: 1-885, 2-2028, 3-1253, 4-543; total hairs = 10,872. He had an above average hair/graft count. The 1's and 2's were placed in the frontal scalp and the 3's and 4's went into the crown. He is shown 15 months after surgery. The crown could use another pass but the patient is happy with his results at this point.

Sorry you're not happy with your results. Have you discussed your concerns with your surgeon? What is their response? If follicular unit grafts are created under microscopic dissection, they can be accurately separated into 1, 2, and 3 hair grafts. The size incision I make for 1 hair grafts usually won't accept 2 hair grafts and my placers know to be careful about this. Occasionally, we might see a 2 hair graft at the hairline and it is thought that sometimes a practically invisible telogen follicle can be 'hiding' in what appears to be a 1 hair graft. We don't see this very often though. A 'mini-graft' refers to a graft with 3-5 hairs, and is an older term from the pre-microscopic dissection days. It would have more than one follicular unit in it; today, if a graft is created under the microscope and contains two follicular units, it is usually called a 'double follicular unit' not a mini-graft. It would be pretty rare for a doctor to use microscopic dissection and make 3 or 4 follicular unit grafts (or did you mean 3 and 4 hair grafts?) The techniques I use to repair and correct hairlines would include using 1) FUE to remove grafts at the hairline or 2) electrolysis, which often works well to turn 2 and 3 hair grafts into one hair. It just depends on the situation. I've heard of some doctors using laser hair removal to correct hairlines but I have never done this. Again, I encourage you to discuss your concerns with your doctor. Good luck.