Dr. Jerry Cooley

In this patient, we used 1-3 hair grafts planted in a fairly standard distribution pattern. In the attached photo, I marked the zones. The 1's start the hairline, from temple point to temple point, then the 2's, and the 3's were placed centrally, in the frontal core. There are other variables to consider in planning graft numbers and distribution. This patient is in his 20's and I wanted to make sure plenty of hair was left in his donor bank for future needs, hence the graft density was not overly high. He was very committed to medical therapy and wanted the strongest hairline he could reasonably achieve. Thanks for your interest. Let me know if you have other questions.

This young patient looks much older than his age due to hair loss. We started him on finasteride/minoxidil and performed FUT surgery consisting of 2,312 grafts and PRP/Acell treatment. The grafts consisted of 1-640, 2-1286, 3-339, 4-47 = 4,417 hairs and were placed at the hairline and frontal core only. He is shown at 10 months. The synergistic effects of these treatments is well demonstrated here. I see the PRP/ACell procedure as intended to have a 'kindling' effect, to jumpstart hair growth. We always want to have something in place to maintain the hair growth, whether that is finasteride/minoxidil or alternative treatments.

This young woman presented with female pattern hair loss. She had been taking spironolactone for a couple years with some improvement in the rate of hair loss but no regrowth. We performed FUT 2,246 grafts ( 1-648, 2-1220, 3-358, 4-20; 4,242 hairs). We placed the grafts in an L-shaped zone covering the frontal third and left part. She is shown 15 months post op.

We now offer and recommend PRP/ACell to anyone undergoing a hair transplant with us who has significant areas of thinning (miniaturization), either in the area to be transplanted or elsewhere. In other words, the purpose is to thicken thinning hair, not necessarily beef up the results of the transplant (for which we use ACell on the grafts, and liposomal ATP as a post op spray). My observations were summarized in the update (link provided by Taking The Plunge). In short, we find that on average, we can expect moderate hair thickening in those with significant miniaturization; some get better than average results, some get less than average. I think the degree and duration of benefit likely depends on 2 factors: underlying genetic programming, and what medical maintenance treatments are in place (i.e. better if the patient is on finasteride/minoxidil). I'm not familiar with the connection between collagen supplements and hair growth or wound healing. If you have any information, please share it! I am interested in the role of nutrition in hair loss, and in speeding up recovery from a hair transplant. To my knowledge, whey protein concentrate (undenatured) seems to be the best bet.

Absolutely beautiful result! Perfect.

Some doctors use the term "stem cell" hair transplants to describe PRP (platelet rich plasma) which does contain small numbers of stem cells. Other doctors are using adipocyte (fat) extracts from liposuction, which also contains stem cells, and implanting these in the scalp. I am not aware of any doctors performing cultured stem cell implants outside of a few research companies. There is great promise in stem cell tecnology, but unfortunately there is the potential for fraud and misprepresentation as well. Any doctor making these claims should be able to explain in detail what they are doing and what evidence they have that it works.

This young woman had long standing traction alopecia which began several years earlier, related to the use of hair extensions. We performed 911 FU grafts (1-147, 2-653, 3-94, 4-17; 1,803 hairs). She is shown one year later. We used ACell and and liposomal ATP in a post op spray.

I wish the early growth was a sure thing but it is not. We definitely see more patients now with early growth but there are so many variables determining early growth and final graft survival that there is no way a post op spray could guarantee a particular outcome. But because post op oxygen/ATP is a major variable, I consider the liposomal ATP a major advance. Thanks for all the feedback.

Please see my recent update on ACell in the Hair Loss Q&A blog. Performing full scale blinded, controlled studies on agents that might improve hair transplant results is exceedingly difficult if not impossible. To prove something is helping and that this result did not occur by chance, you need to study 50-100 patients with a split scalp design, and follow these patients carefully with good photographs and hair counts. Virtually no clinic could do this, and would you want to be one of these study patients where one half of your transplant came out looking different than the other half? Nevertheless, we can adopt practices and techniques that are safe and scientifically sound and begin reporting our clinical observations. This is what I have done over the years with holding solutions like HypoThermosol, PRP, ACell, and liposomal ATP. Other physicians who have also began using these are reporting improvements similar to mine. Although this is not scientific, this is exactly how progress in our field has occurred. Regarding ACell, I have used it for the last four years and noted consistent benefits with: reduced fibrosis (micro scarring) of the recipient skin, increased angiogenesis, and more robust looking graft growth. As an example of this, the attached photos show two FUE sites: one treated with ACell, the other not treated (control). When a vasodilator was applied to the skin to make the capillaries appear, the ACell treated side has numerous healthy capillaries whereas the control does not. What this means is that whether we are talking about ACell treated donor strip scars, FUE sites, or the grafted area and recipient skin, there will be more healthy blood flow and decreased fibrosis with the use of ACell, and this is a permanent effect, as proven with these photos 2 years after the surgery. It may be a subtle effect, but it is one more thing we can do to optimize our results and ensure that future transplants will be just as successful. Regarding ATP, this is a natural compound that is the energy source for cells. We need oxygen and glucose so our cells can make ATP, which then serves as the fuel for everything that goes on in the cell. Because hair follicle grafts lack their own blood supply for several days after a hair transplant, they have to absorb oxygen from a distance. If they don't get enough, they won't survive. By having my patients apply post op ATP, I have seen more consistent, and early growth. It is a special liposomal formula. I have been working with a company which has been developing this product and it will soon be on the market so other physicians and their patients can use it as well.

What I'm saying is that the anagen growth phase continued without a 3 month telogen delay. We can classify hair regrowth after a transplant according to when we see the hair growing: 1. Immediate growth: no shedding 2. Immediate growth with distal hair shaft narrowing (Pohl Pinkus hairs) 3. Early growth: shedding followed by immediate regrowth (no telogen); 3-6 weeks 4. Telogen delay (standard result): shedding, 3 month delay, then regrowth; 5. Delayed growth: shedding, delayed anagen 4-8 months This patient had #3. Obviously, the earlier the better!

The patient is in his early forties with 3A loss. We performed 2,612 FU grafts (1-417, 2-1,336, 3-716, 4-143; 5,809 hairs). We simultaneously performed PRP+ACell treatment and used ACell on the grafts. He used a post operative spray we helped develop containing liposomal ATP. He returned at five and half months for a check, demonstrating early robust growth. Not all patients grow in at this rate but we are seeing more of them with our enhanced protocol. The post op ATP provides the grafts needed energy until the capillaries are formed around day 5. The transplanted hairs measured about 5 cm, indicating no telogen delay.

About 1300 grafts, which included all of the 3's and 4's.

This patient wanted to restore hair in the crown and frontotemporal recessions. He has very fine hair but good density and hair groupings. We did 3,446 grafts (1-601, 2-1610, 3-1004, 4-231; 7,757 hairs). He is shown one year later. He is not on finasteride.

When you retrace his juvenile hairline from the front central point to the temporal point, you appreciate the significant degree of recession. This constitutes a '3' in my opinion, especially on his right side, but it is a subjective scale and others might call it a '2'. The area covered over 40cm2, so the average density is less than 50/cm2, but that includes transplanting into existing hair where the density would be 20-30. Some areas received as much as 60/cm2. Thanks for all the comments.

This patient is in his 30's and has type 3A frontal loss. He wanted the most aggressive restoration possible to address the frontal-temporal recessions. We performed 2,091 grafts (1-523, 2-1076, 3-492, 4,151 hairs). The after photos are at one year. There is a slight bit of 'kinkiness' to the new hair that will smooth out over the next 6 months. This is more agressive than I would normally recommend but met the needs of this particular patient.

This delightful lady is in her late 60's and came to see me about restoring her hairline. She reported that she always had a high hairline, and showed me childhood photos demonstrating this. But over the last 10 years, her hairline had begun to recede even more from female pattern hair loss. Her donor area was about average for what we see in our female patients, only about 50-60 FUs/cm2, mostly 1s and 2s. We harvested as much as we could get by strip, getting 2,807 FUs ( 1-736, 2-1594, 3- 441, 4-36, total hairs = 5,391). She stopped by the office monthly so we could take photos documenting her progress. Her last visit was at 14 months post op.

This middle aged patient has type VI hair loss. He has fine, straight hair and an above average donor area. He wanted as much coverage as possible. We opted to cut a portion of the grafts as double follicular units, ie two follicular units in one graft (average 4 hair/graft). Given that he has always worn his hair this long and was planning to continue doing so, this method was chosen. It would not be a good choice for someone with coarse hair or who wears a shorter hair style. Essentially, this allowed the patient to get an extra 1,000 grafts for the same fee. We did 4,236 grafts containing 5,305 follicular units: 1-708, 2-1444, 3-856, 4-151, 5-8, doubles- 1069 (avg 4 hair/graft) = over 11,000 hairs. We covered the entire scalp except for the very back crown. He is shown 2.5 years later.

The strategy with the density was to build up an attractive, feminine hairline with good density and blend backwards. The priority was the first few centimeters of hairline; in a male, we would choose a higher hairline and make sure we got sufficient density in the midscalp. She was told that more grafts may be needed to thicken the mid-scalp in the future, but the finasteride/minoxidil kicked in and it all blended nicely. She has no plans at this time for further work. ACell was used on the grafts, which has been standard practice for the last couple years.

This patient is in her early fifties and has female pattern hairloss; this has been made worse by wearing a hair system, which caused some further focal areas of hair loss. We performed 2,300 grafts (1-571, 2-986, 3-743, 4-102 = 4,874 hairs). She is shown approximately one year after the procedure.

In regards to placement and density planning, we put all the 3-5 hair grafts in the crown, and 1's and 2's along the part line in the mid and frontal scalp. For someone with baby fine hair like this, I want as much hair along the 'equator' of the crown, flowing both up and down, to provide coverage. Making the crown look thick is inherently difficult, and that much more so in someone with fine hair. I approach each case differently so I might do something different depending on the patient. Also, I've been recommending a product from Nioxin called Diamax for my patients with really fine hair. In the past, I haven't recommended Nioxin products but this one seems to have been developed with solid scientific research at Proctor and Gamble, and contains caffeine. I recommended it to this patient because any thickening of the hair shaft will be a good thing. Thanks for your interest in this case.

This patient has type IV hair loss and was mostly concerned with the crown. He was on finasteride to inhibit further loss. His hair was extremely fine. We performed 4,245 grafts by FUT: 1-701, 2-2067, 3-1211, 4-191, 5-75; 8906 hairs). The grafts were concentrated in the crown but did extend up into the midscalp and both part lines. Followup is one year later.

This patient has 3A class hair loss, very fine hair, but excellent donor density. We started finasteride and performed FUT of 1,838 grafts (1-425, 2-652, 3-410, 4-351; 4,363 hairs). Photos are two years postop. The results are due to an unusually high number of 3's and 4's as well as a great response to finasteride.

This patient is in his early 30's and had 2A pattern MPB. The clinical presentation did not suggest extensive hairloss in the future (although that's never for certain) so I felt comfortable with a more agressive design than I would usually do. We prescribed finasteride and did an FUT of 1,819 grafts (1-425, 2-790, 3-604, total hairs= 3,817). When I saw him at 9 months, I barely recognized him. Between the new hairline and hairstyle, his boyish face, and getting rid of the beard, he looked like a different person.

This patient has type IIIA hairloss pattern and underwent FUT: 1,281 grafts consisting of 1-320, 2-500, 3-393, 4-63, 5-5 for a total of 2,776 hairs. Photos are 10 months later.

This patient has type IIIA hair loss. He was started on finasteride and a procedure consisting of 2,119 grafts was performed: 1-593, 2-1110, 3-338, 4-74; total=4123 hairs. Photos are one year later.