Dr. Vladimir Panine

BUSA - this patient has already requested a2nd procedure to fill in the crown. I usually like to wait 1 year to let everything heal and mature from a previous surgery. He will most likely be having his 2nd session sometime at the end of this year.

This 27 year old gentleman came to me with the goal of rebuilding his hairline and adding as much density and coverage as would be possible. After establishing his medical history and understanding the progression of his hair loss, I diagnosed his condition as Androgenetic Alopecia (male pattern baldness), ruling out any other possible dermatological or medical conditions which can cause hair loss. I explained to him that we need to take his age, present degree of hair loss and possible further hair loss into consideration when creating a surgical plan. I indicated that it would be best to create a conservative hairline that will look good for him at 27 but also look good as he ages. As we discussed all of his options, I pointed out that with one procedure I would be able to add more coverage through the frontal 1/3 to ? of his scalp. If he wanted more coverage than that, he would need a 2nd procedure. During the procedure, I was able to harvest 3,480 grafts. The break down was as follows: 1,425 single hair grafts, 1,906 two hair grafts and 149 3 hair grafts. I used a significant amount of single hair follicular units which allowed me to create a very natural hairline. This action will allow him to comb his hair without anyone detecting that he has had anything done. These are his result 8 months post-op. The patient is extremely happy with his result and mentioned that he has received many positive comments about his appearance.

This 68 year old gentleman had a several procedures completed in the 80’s which were completed utilizing “plugs”. He was unhappy with the look of the “plugs”. His goal was to have a much more natural look and also fill in the mid and crown area. I determined that the work would need to be done in 2 separate procedures. During the first procedure we concentrated on softening the hairline and filling in the frontal 1/3 of the scalp. In the second session we added more to the frontal hairline and concentrated on the mid and crown area of the scalp. During his first procedure we placed 3,290 grafts. The break down was as follows: 1,845 single hair grafts, 1,445 two hair grafts. I used a significant amount of single hair follicular units which allowed me to create a very natural hairline. This action will allow him to comb his hair without anyone detecting that he has had anything done. On his 2nd procedure we placed 3,016 grafts off which 1,536 were single hairs, 1,218 were 2 hair grafts, and 262 3 hair grafts. These are his results 2 year post-op. The patient is extremely happy with his result.

Densedream, I was surprised to read your post stating that were unhappy with your results. You had contacted me 8 months after your second procedure stating that you were satisfied with the results. In fact you even sent us some pictures of the progress at that point, which looked good. I have attached the pictures of your hair prior to your 2nd procedure, post op graft placement, and the pictures you sent me. I would have to say your pictures your results looked very satisfactory at the 8 month mark. Because of the unpredictable nature of MBP you could of lost more of your native hair. I would be interested to here other peoples comments after reviewing your results.

VIDEO INTERVIEW - This 31 year old gentleman had a hair loss pattern similar to a class 4V on the Hamilton Norwood hair loss scale. After establishing his medical history and understanding the progression of his hair loss, I diagnosed his condition as Androgenetic Alopecia (male pattern baldness), ruling out any other possible dermatological or medical conditions which can cause hair loss. His goal was to rebuild his hairline and add as much hair to the frontal 1/3 as possible in one procedure. The patient’s goal was well suited to his needs and therefore I planned the surgery accordingly. A total of 4,622 grafts were used. The break down was as follows: 1,924 single hair grafts, 2,225 two hair grafts and 473 three hair grafts. These are his results 18 months post-op. The patient is extremely happy with his result as you can hear in the video interview.

Thank you for the kind words, paddyirishman!

This 46 year old gentleman had a hair loss pattern similar to a class 5 on the Hamilton Norwood hair loss scale. After establishing his medical history and understanding the progression of his hair loss, I diagnosed his condition as Androgenetic Alopecia (male pattern baldness), ruling out any other possible dermatological or medical conditions which can cause hair loss. This patient had two main goals that we focused on. First was to rebuild a conservative hairline that would be age appropriate now and as he ages. The second goal was to add as much density as was possible in one procedure to the frontal 1/3 of his head. After discussing all of the options with the patient, he elected to go with a FUE procedure and I planned surgery according to his priorities. A total of 3,042 grafts were used. The break down was as follows: 1,401 single hair grafts, 1,245 two hair grafts and 396 three hair grafts. I used a significant amount of single hair follicular units which allowed me to create a very natural looking hairline. This action will allow him to comb his hair and style it however he chooses, without anyone detecting that he has had anything done. These are his results 1 year after his procedure. The patient is extremely happy with his result and is planning a second procedure to add more hair to the mid-scalp. I will update his album after his second procedure is completed.

This 32 year old gentleman had a hair loss pattern similar to a class 3 on the Hamilton Norwood hair loss scale. After establishing his medical history and understanding the progression of his hair loss, I diagnosed his condition as Androgenetic Alopecia (male pattern baldness), ruling out any other possible dermatological or medical conditions which can cause hair loss. His goal was to rebuild his hairline. He wanted something that would be age appropriate now and as he continues to age. In addition, he wanted to add as much hair to the frontal 1/3 as possible in one procedure. The patient’s goal was well suited to his needs and therefore I planned the surgery accordingly. A total of 2,152 grafts were used. The break down was as follows: 1,155 single hair grafts, 802 two hair grafts and 195 three hair grafts. I used a significant amount of single hair follicular units which allowed me to create a very natural hairline. This action will allow him to comb his hair without anyone detecting that he has had anything done. These are his results 1 year post-op. The patient is extremely happy with his result. He does understand that he might need an addition procedure if he would like more density or does have any further hair loss down the road.

This 25 year old gentleman had a hair loss pattern similar to a class 3 on the Hamilton Norwood hair loss scale. After establishing his medical history and understanding the progression of his hair loss, I diagnosed his condition as Androgenetic Alopecia (male pattern baldness), ruling out any other possible dermatological or medical conditions which can cause hair loss. His goal was to rebuild a conservative hairline that would be age appropriate now and as he continue to age. In addition, he wanted to add more density to the frontal 1/3 of his scalp. The patient’s goal was well suited to his needs and therefore I planned the surgery accordingly. A total of 2,789 grafts were used. The break down was as follows: 1,059 single hair grafts, 1,730 two hair grafts. I used a significant amount of single hair follicular units which allowed me to create a very natural hairline. This action will allow him to comb his hair without anyone detecting that he has had anything done. These are his results 8 months post-op. He should see some more improvement over the next 4-6 months. The patient is extremely happy with his result. That said, he does understand that he might need an addition procedure if he would like more density or does have any further hair loss down the road.

This 24 year old gentleman had a hair loss pattern similar to a class 4v on the Hamilton Norwood hair loss scale. After establishing his medical history and understanding the progression of his hair loss, I diagnosed his condition as Androgenetic Alopecia (male pattern baldness), ruling out any other possible dermatological or medical conditions which can cause hair loss. His goal was to rebuild a conservative hairline that would be age appropriate now and as he ages. In addition, he wanted to add as much hair to the frontal 1/2 as possible in one procedure. The patient’s goal was well suited to his needs and therefore I planned the surgery accordingly. A total of 4,349 grafts were used. The break down was as follows: 1,655 single hair grafts, 2,597 two hair grafts and 97 three hair grafts. I used a significant amount of single hair follicular units which allowed me to create a very natural hairline. This action will allow him to comb his hair without anyone detecting that he has had anything done. These are his results 7 months post op. The patient is extremely happy with his result. He does understand that he might need an addition procedure if he would like more density or does have any further hair loss down the road.

This patient was a 42 years old man who had a procedure completed 2 years ago by another doctor. Unfortunately, he did not receive the density that he was expecting from that procedure. After establishing his medical history and understanding the progression of his hair loss, I diagnosed his condition as Androgenetic Alopecia (male pattern baldness), ruling out any other possible dermatological or medical conditions which can cause hair loss. During our discussion I gathered that the patient’s goal was to add as much density as possible to the frontal 1/3 of his scalp. After examining his donor area I felt that I would be able to get enough grafts to make a considerable difference, but that he would not have the density that he had before his hair loss. I discussed this with the patient to ensure that he understood what was and was not possible. The patient elected to proceed with surgery to gain as much density as possible. A total of 2,487 grafts were used. The break down was as follows: 1,033 single hair grafts and 1,454 two hair grafts. I used a significant amount of single hair follicular units which allowed me to create a very natural hairline. This action will allow him to comb his hair without anyone detecting that he has had anything done. This patient was also made aware that he might need additional procedures if his hair loss continues. These are his results 1 year post-op. The patient is extremely happy with his results.

hairlosscpa, Thank you for the kind words. I was very pleased with the result myself.

This patient was 24 years old and a class 3 pattern of hair loss. After establishing his medical history and understanding the progression of his hair loss, I diagnosed his condition as Androgenetic Alopecia (male pattern baldness), ruling out any other possible dermatological or medical conditions which can cause hair loss. His goal was to rebuild his temples, hairline and add as much density to the frontal 1/3 as possible. After examining his donor area I felt I would be able to get enough grafts to be able to make a vast improvement on the appearance of his hair. The patient’s goal was well suited to his needs and therefore I planned the surgery accordingly. A total of 3,827 grafts were used. The break down was as follows: 2,164 single hair grafts, 1,412 two hair grafts and 251 three hair grafts. I used a significant amount of single hair follicular units which allowed me to create a very natural hairline. This action will allow him to comb his hair without anyone detecting that he has had anything done. This patient was also made aware that he might need additional procedures if his hair loss continues. He has decided to go on Finasteride 1mg to control further hair loss. These are his results 10 months post op. The patient is extremely happy with his results.

This 57 year old gentleman had previously had 2 hair transplant surgeries over 25 years ago and was uncomfortable with the way his hair was looking. He came to me seeking a solution that would improve the appearance of his hair. After establishing his medical history and understanding the progression of his hair loss, I diagnosed his condition as Androgenetic Alopecia (male pattern baldness), ruling out any other possible dermatological or medical conditions which can cause hair loss. The patient wanted to reconstruct his hairline and add as much density to the frontal 1/3 as possible. After examining his donor area, I felt that I would be able to get enough grafts to make a vast improvement on the appearance of his hair. A total of 3,448 grafts were used. The break down was as follows: 1,529 single hair grafts, 1,445 two hair grafts and 474 three hair grafts. I used a significant amount of single hair follicular units which allowed me to create a very natural hairline. This action will allow him to comb his hair without anyone detecting that he has had anything done. These are his results 10 months post-op. The patient is extremely happy with his result and has indicated that this was the best decision he ever made and wished he had done it years ago.

This 49 year old gentleman had a hair loss pattern similar to a class 4 going into a class 5 on the Hamilton Norwood hair loss scale. After establishing his medical history and understanding the progression of his hair loss, I diagnosed his condition as Androgenetic Alopecia (male pattern baldness), ruling out any other possible dermatological or medical conditions which can cause hair loss. His goal was to rebuild a conservative hairline that would be age appropriate now and as he ages. In addition, he wanted to add as much hair to the frontal ? as possible in one procedure. The patient’s goal was well suited to his needs and therefore I planned the surgery accordingly. A total of 4,658 grafts were used. The break down was as follows: 1,932 single hair grafts, 2,577 two hair grafts and 149 three hair grafts. I used a significant amount of single hair follicular units which allowed me to create a very natural hairline. This action will allow him to comb his hair without anyone detecting that he has had anything done. These are his results 1 year post op. The patient is extremely happy with his result. He does understand that he might need an addition procedure if he would like more density or does have any further hair loss down the road.

Also, I would like to thank Rootz, Questionmark, Voxman and LosAngeleshair for their kind comments.

Davidla, when performed properly, both FUE and FUT procedures should produce excellent results. Choice of procedure depends on your particular situation. In general, you can obtain more follicular units (FU) with FUT, the trade-off is the possibility of a linear scar in the donor area. I use trichophytic closure and get minimal scarring. The other major point is that with FUE procedure the yield of FU can be lower than with FUT. Since I personally remove FUs and personally place them, I have not seen that much of a difference in the yield between FUE and FUT. The third point is the amount of FUs that you can harvest - of course there is a range depending on many factors, surgeon, etc., but when I perform FUE I can do up to 3000 FUs versus 4500 FU with FUT. FUE is less uncomfortable, but patients have to shave their heads like they are signing up for the Marines, and it takes approx. a week to grow out, sometimes faster. My last FUE patient was back at work in 5 days. Finally, FUE is a more expensive procedure. Both procedures have pros and cons, and should be tailored individually during consultation.

This 27 year old gentleman had a hair loss pattern similar to a class 3 on the Hamilton Norwood hair loss scale. After establishing his medical history and understanding the progression of his hair loss, I diagnosed his condition as Androgenetic Alopecia (male pattern baldness), ruling out any other possible dermatological or medical conditions which can cause hair loss. His goal was to augment his hairline without bringing it down that much by adding density to the frontal 1/3 of his head. Taking his age and current/expected future hair loss into consideration we agreed upon a surgical plan that would be in line with his expectations/goals as well as working well with how he would like to comb/style his hair after the procedure. During the procedure I focused on reinforcing the patient’s current hairline and adding density to the frontal 1/3 of his scalp. A total of 2,166 FUE’s were used. The break down was as follows: 889 single hair grafts, 1,155 two hair grafts and 122 3 hair grafts. I used a significant amount of single hair follicular units which allowed me to create a very natural hairline. This action will allow him to comb his hair without anyone detecting that he has had anything done. These are his results 14 months after his first procedure and there will continue to be more improvement over the next few months. The patient is extremely happy with his result and is taking finasteride 1mg to control further hair loss. He does understand that he might need an additional procedure if he would like more density or does have any further hair loss down the road.

This 43 year old gentleman had a hair loss pattern similar to a class 4v on the Hamilton Norwood hair loss scale. After establishing his medical history and understanding the progression of his hair loss, I diagnosed his condition as Androgenetic Alopecia (male pattern baldness), ruling out any other possible dermatological or medical conditions which can cause hair loss. His hair was very fine, light brown, and was starting to turn grey. However, his donor area was above average, which allowed me to harvest quite a few grafts. His goal was to be able rebuild his hairline and add density to the frontal 1/3-1/2 of his scalp. In addition, he wanted to have a conservative hairline that would be age appropriate. Taking all of his concerns into consideration, we came to an agreement regarding the surgical plan. I reconstructed a hairline that would be suitable for his age. A total of 3,503 grafts were used. The break down was as follows: 1,260 single hair grafts, 2,025 two hair grafts and 218 three hair grafts. I used a significant amount of single hair follicular units which allowed me to create a very natural hairline. This action will allow him to comb his hair without anyone detecting that he has had anything done. These are his results 1 year after his procedure. The patient is extremely happy with his result and is taking finasteride 1mg to control further hair loss. He does understand that he might need an addition procedure if he would like more density or has any further hair loss down the road.

This 27 year old gentleman had a hair loss pattern similar to a class 3 on the Hamilton Norwood hair loss scale. After establishing his medical history and understanding the progression of his hair loss, I diagnosed his condition as Androgenetic Alopecia (male pattern baldness), ruling out any other possible dermatological or medical conditions which can cause hair loss. The patient’s goal was to be able rebuild his hairline and bring his temples down slightly. His goal was well suited to his needs and therefore I planned the surgery accordingly. I paid careful attention to the hairline so I could reconstruct a hairline that would be suitable for his current age but also look good as he advances in age. A total of 2,539 grafts were used. The break down was as follows: 918 single hair grafts and 1,621 two hair grafts. I used a significant amount of single hair follicular units which allowed me to create a very natural hairline. This action will allow him to comb his hair without anyone detecting that he has had anything done. These are his results 7 months post-op. There will continue to be more improvement over the next few months. The patient is extremely happy with his result and is taking Finasteride 1mg to control further hair loss. He does understand that he might need an addition procedure if he would like to add more density or has any further hair loss down the road.

This 62 year old gentleman had a hair loss pattern similar to a class 3 on the Hamilton Norwood hair loss scale. He previously had a procedure completed about 20 years ago by another physician and he was not very happy with his result. He did not feel that he had gained significant density from the procedure. He wanted to be able rebuild his hairline and bring his temples down slightly. After establishing his medical history and understanding the progression of his hair loss, I diagnosed his condition as Androgenetic Alopecia (male pattern baldness), ruling out any other possible dermatological or medical conditions which can cause hair loss. The patient’s goal was well suited to his needs. Based on our conversations I created and discussed my plan for his surgery; taking careful consideration when reconstructing an age appropriate hairline. A total of 2,716 grafts were used. The break down was as follows: 1,204 single hair grafts and 1,512 two hair grafts. I used a significant amount of single hair follicular units as it allowed me to create a very natural hairline. This action will allow him to comb his hair without anyone detecting that he has had anything done. These are his results 9 months after his procedure and there will continue to be more improvement over the next few months. The patient is extremely happy with his results.

johnboy71, aWidowsPeek, home1212, & Future_HT_Doc, Thank you for your kind words. I always appreciate feedback! aWidowsPeek- Call my office anytime and I'd be happy to go over the charges for the FUE procedures with you! Vladimir Panine, MD

This 30 year old gentleman had a hair loss pattern similar to a class 3 on the Hamilton Norwood hair loss scale. He previously had a small FUE procedure (650 FUE’s) back in 2009 with another doctor. He came to me with the hope of rebuilding his hairline and adding density to the frontal 1/3. After establishing his medical history and understanding the progression of his hair loss, I diagnosed his condition as Androgenetic Alopecia (male pattern baldness), ruling out any other possible dermatological or medical conditions which can cause hair loss. He elected to go with a FUE procedure. He did understand that when doing FUE’s we will not be able to do as many grafts as with a strip procedure. I also explained that if he wanted more density after this procures we could do another session a year down the road. The patient’s goal was well suited to his needs and therefore I planned the surgery accordingly. I discussed the hairline with the patient and conveyed to him that we would need to reconstruct a hairline that would be suitable for him now, but also something that will look good as he gets older. A total of 2,264 FUEs were used. The break down was as follows: 1,171 single hair grafts, 1,056 two hair grafts and 37 three hair grafts I used significantly amount of single hair follicular units which allowed me to create a very natural hairline. This action will allow him to comb his hair without anyone detecting that he has had anything done. These are his results 8 months post op after his first procedure and there will continue to be more improvement over the next few months. The patient is extremely happy with his results. This patient as also created his own web page at Hair Restoration Site for JC.

JimmyNeutron, I’m happy to answer any questions from members. You’re not being rude or negative you are just asking a question which may help you with your own future transplant; that is why we are all here. You’re planning on having a procedure that utilizes 3,500 grafts. Based on what you’re seeing with this patient, you’re worried that the 3,500 grafts you’ll be having placed over a larger area (not concentrated into the frontal section like this patient) won’t give you the dramatic result you’re expecting as this patient’ s results don’t appear dramatic to you. There are many factors that need to be taken into consideration when performing a hair transplant on a patient; age, present hair loss, expected future hair loss, the patient’s goals, whether the patient is currently or is planning on using Propecia or Rogaine, whether miniaturization has already occurred, and most important his/her donor availability. Prior to his surgery, this patient’s hair in the frontal region had already started going thru significant miniaturization. It was the reason that the patient kept his hair so short; when you try to grow out your hair that has started to miniaturize it looks very thin. This fact combined with the knowledge that the patient had not been using and did not want to start using Propecia or Rogaine makes a more dramatic result for this patient highly improbable. A lower hairline and temple restoration may leave the patient looking undesirable as they continue to lose hair as they don’t want to take Propecia. It’s a significant gamble to bring the hairline down any lower and restore more of the temple region – a risk that the patient didn’t want to take. The amount of density that is achieved in a procedure is determined by how many grafts are placed into a cm2 AND how many 1, 2 and 3 hair grafts were placed. A single hair graft contains one hair. A 2-hair graft contains two hairs. A 3-hair graft will contain 3 hairs. The amount of perceived density will go up when you’re using more 2 or 3 hair grafts because you’re moving more hairs with a single graft; it makes it look more dense. When doing hairlines it takes significantly more follicular units per cm2 since they are all single hairs. With this patient in particular he wanted a very natural hairline which means I needed to use significantly more one hair grafts. I used 1,307 single hair grafts, 2,652 two hair grafts and only 22 three hair grafts. Therefore if you compare his result with someone else’s result which is based on a procedure that used fewer one hair grafts and more two and three hair grafts you’ll see a big difference in density, holding all other factors constant. The total surface area transplanted on this patient was about 90 cm2. I transplanted approximately 1,500 single follicular units the frontal area, which was about 15 cm2. The remaining 2,500 grafts went into about 75 cm2, which is about 35 follicular units per cm2. The short answer is that the same number of grafts on different patients will look very different depending on the specific patient and the makeup of the grafts used in their procedure. I can’t stress enough that communication with your surgeon is key. He or she needs to know what is important to you, what you plan on doing in the future and a specific listing of your priorities as during your surgery they need to understand how you feel so they can implement your priorities not THEIR priorities. You may have to give up some density if your hairline is really important to you as you’ll need more single hair grafts. If you don’t want to take Propecia or Rogaine you’ll have to work with your surgeon to create a hairline that will look good as you get older given you will most likely continue to lose hair. I do understand your concerns about the amount of coverage that you will be getting with 3,500 grafts. I can’t say what kind of coverage that will give you without knowing more about your situation specifically. I encourage you to reach out to your surgeon to let him/her know what your expectations are in regards to the density and coverage you are looking for and have him/her tell you if it is achievable. I worked with this patient prior to surgery to explain the results that he would achieve and the limitations of the surgery (that he would need another session to pick up where we left off on this procedure). The patient was aware of his miniaturization and the other factors he decided for himself, like deciding he didn’t want to take Propecia or Rogaine. Therefore the result to him was dramatic becasue he knew all the factors he was up against. The communication is key. This patient is extremely happy with his results because we worked together to give him what he wanted out of what was possible.

Arrie, This patient could have another similar session of approximately 4,000 grafts and then have an FUE procedure using 2,000 grafts after that.