Dr. Timothy Carman

We frequently are asked by prospective patients how the procedure will appear immediately following surgery. This patient underwent a 2176 FU graft procedure, and his one day post op photos are shown here.

MrBrian- I think it would be a good idea for you to give finasteride (1mg/day) a try as well. There is a great deal of posts on this site regarding it's positive results- As well, it protects against some forms of prostate cancer. Both meds (finasteride and minoxidil/rogaine) need a full year of use in order to give them a fair trial to see if they will work for you, but the overall percentages are way in your favor that they will!!!

RC- Thanks for taking the time to review our work!!

thank you both!!

This patient is a 49 year old male who presents with loss of the frontal hairline as well as density in the frontal forelock and crown area. His donor area has a relatively thinner density than the average 100FU/cm2, his being approx 70FU/cm2. This yielded a total of 2063 FU grafts as follows: 502 one's; 1525 two's; 36 three's. We chose to concentrate on the frontal area on the first procedure, with a plan to address the crown in a subsequent session. Here, at eight months, he can expect about 15-20% further growth into the one year mark. I like this case as it illustrates how the variability in the colour and texture of the patient's natural hair characteristics can aid in the appearance of cosmetic density, especially at low transplant numbers.

Patient is a 43 year old male with androgenic alopecia affecting the Frontal forelock, hairline, bilateral temporal points, and crown. 3301 FU grafts were placed: 1198 ones; 1803 twos; 300 threes. At this point, patient has about 75% growth present, and can expect continued increases in both density of numbers of grafts and hair shaft diameter as well.

Given your age, and your family history, I personally would not perform surgery in your case. While you indeed feel that you "won't care" as it were to "wear a piece" or "take your chances" later on down the road, I feel quite strongly that one of my roles as a physician is to first and foremost "do no harm". While it it not a good feeling to lose ones hair, there is one situation that feels far worse: that's being in your thirties or forties with a transplant that was poorly planned and feeling as though you have to hide under a hat forever. I feel it is my responsibility NOT to contribute to that sceanario. I would recommend finasteride and/or minoxidil at this time only.

For what it's worth, the donor location looks fine to me.

This gentleman presented with generalized thinning predominantly affecting his crown, frontal forelock, hairline, central core posterior to the frontal forelock and anterior to crown, along with recession of the bilateral temples and lateral margins. Further, his donor density had a lower density than normal, specifically about 70 FU/cm2. Our goal was to recreate a completed hairline which would frame his face, while increasing the frontal forelock density and raise the lateral margins to meet the frontal forelock and central core areas. His intention would be to style his hair back as he had done his entire life, and in doing so he would get mileage out of a hair mass that is styled over his rather large surface area (Approx. 120 cm2). This case represents the challenges of getting maximum cosmetic density from a relatively lower number of available grafts. The change is subtle, yet we think it represents a natural appearing improvement from baseline.

Mike- I took a look at your photos- At 7 mos, you may just be one of those individuals that is behind the "normal" growth curve- I would agree you should usually be seeing more growth, but I would still sit tight and be patient and let things unfold. I would not recommend any surgical intervention until at least 1.5 yrs post this procedure. Hope that helps- Dr Carman

This patient is a 28 YO male with androgenic alopecia affecting his hairline, frontal forelock, and crown. He has maintained his lateral "hump" areas bilaterally relatively high bilaterally, and has some residual hair in the frontal forelock. Our primary goal was to recreate his frontal-temporal hairline, frontal forelock. The result is from placement of 2742 FU grafts; 1010 one's; 1630 two's; 102 three's.

Thread has been updated to show the One Year Post Op results in this 66 YO female patient.

Very well said- And I am very happy to hear of your daughters continued progress-

For body hair transplants I recommend Dr Umar, located in California.

While I understand your sentiment, those late night infomercials did a great deal to spread the word that the days of "plugs" and unnatural results could be a thing of the past. They really provided a good service to the public, and all in the specialty (patients and doctors alike) ultimately benefited in a very positive way.

This patient is a 34 YO male with male pattern hair loss in the crown area. PreOp photo is taken after patient had been on finasteride for a little over a year. The amount of grafts placed was calculated by taking the area needing coverage, and utilizing an average density 40-45 FU/cm2. Given result at 10 months, the patient can reasonably expect that he has about 80% of his grafts visible, so that he should get another 20% increase in density. As well, over the ensuing 6 months to 12 months after the 12 month post op mark, the hair will continue to increase in caliber, which will also add significant cosmetic result to his procedure outcome.

Jim- In my experience a "bigger" or "smaller" head cuts both ways; A "bigger" head usually means a larger surface area from which donor can be extracted = more grafts. This sounds good at first, however, there is usually more surface area exposed that needs coverage, so it kind of cancels out the "larger" number of grafts available. And vice versa with a "smaller" head. What is really key to the issue you bring up is the relative proportions of donor to recipient in any given patient. Hence, simply measuring peoples' heads won't yield useful information for you. Perhaps this is why the forum members are requesting photos- and I concur- the information that will be communicated is what matters: What is (what I like to call) your Relative Supply to Demand Ratio? That will be more apparent from photos than random head measurements, and this will aid you in getting the information you really are after, I think.

Newcomer- First and foremost, the forum members here are just that- former, current or prospective patients here to help to the best of their ability. You have received a number of useful insights, the most pertinent of which I would second: take a deep breath, step back from the issue, and look at what is RIGHT with your result. 1) It appears you have good coverage from your procedure, as best as I can tell from the photos (I may be missing any "pre" photos- I don't see any here). That is quite a salient positive to focus on. 2) You do not have a linear scar to be concerned about, as your HT was done FUE- another plus, something you planned on that again, went well. 3) At nine months, you have probably 70-80% growing at this time. This means that in addition to the good coverage you see now, you can expect another 20-30% in the months to come!! I understand your concern, and make no mistake, I am NOT trying to make light of your situation. That said, please remember, as the previous members have already stated (more or less) that: 1) You are still QUITE EARLY in your transplant result to make any meaningful critical judgments, other than the positive ones I mentioned. 2) While coarse hair can imply damage which may have occurred during the procedure, it also can occur in patients as a temporary phenomena which will "settle down" over time. Again, now is NOT the time to rush to judgment and implicate the resolve or competency of your surgeon. 3) At some point in your thread you stated you didn't want to go back to your surgeon for an opinion "for obvious reasons" (or something to that effect)- All I can offer is that this borders on the irrational, absent anything other than your emotional reaction to your situation. If he/she is a recommended surgeon from this HTN site, then, IMHO seeking his/her advice and counsel is exactly what you should be doing at this point. IMHO, your situation is better served envisioning your surgeon as your ally, and not the adversary you seem to have created. People in general are more apt to go the distance for someone they perceive to be "positive" in nature, rather than those who convince themselves the glass is half empty, or worse, that they are somehow a "victim". So, take it easy, go see your surgeon, but most of all- chill out and be patient- the odds are better(i.e., greater chance) that things will work out good rather than bad. Grow well- I think it will all work out, from what I can see so far.

Congratulations!!!!

This is a 46 YO patient who presented with advanced androgenic alopecia affecting the frontal hairline, frontal forelock, bilateral temples and crown. In addition, he presented with a donor area that was relatively sparse at 70 FU/cm2 (normal being 100 FU/cm2). This presentation is common, and accordingly, in order for the transplant to be "successful", ultimately IMO, we need to choose between concentrating on EITHER the hairline/FF or the crown, but not both. Just "spreading them everywhere" in a desperate attempt at "doing everything at once" can lead to a dilution of the stronger effect that transplanting a limited number of grafts CAN have, as seen in this case. Although limited to only 2000 FU grafts, concentrating on the frontal hairline and frontal forelock as the primary goal can provide a dramatic change in ones appearance as the grafts grow in. This patient in fact scheduled a second procedure, where now we will address the thinning that occurs behind this area, anterior to the crown. I guess the key point I want to communicate is the importance that each procedure should be "stand alone", even if other procedures are planned, but especially if, for whatever reason, the patient cannot undergo future procedures. The patient is not left in an "in progress" condition.

Actually, that's not quite true, in the sense that "the only way to correct the situation is to extract and re-transplant them". In actuality, transplanting in subsequent sessions with hair placed in the "right" orientation can go a long way in cosmetically correcting the appearance. Care needs to be taken in placing the subsequent grafts to avoid injuring the grafts from the first procedure; we have done a number of cases such as this one presented with very good results. So, while it is true once planted the angles are what they are, complete removal would not, in my opinion, be the only solution- IMHO that would actually make the situation worse- scarring, loss of some of the grafts with removal/replacement; technical issues regarding puting hair back into same areas where it was removed in that same session, etc etc etc.

Thank you all for your supportive comments. Bleachcola- His density varies, as ones density does in nature, from a high of around 45 FU/cm2 to about 25 FU/cm2 at it's least dense-

TC17- Thank you very much. Your comments are much appreciated. Below is a link to the video of this patients donor scar; I hope to include these on future patients as well. http://www.youtube.com/watch?v=rtCzyFsYjKc

Patient is a 23 year old male who was experiencing a loss in definition of his frontal hairline, along with generalized thinning in the frontal and posterior frontal forelock as well as the crown. This case illustrates that transplantation can proceed in the younger patient when a prudently designed conservative hairline is created, and caution is exercised with respect to transplanting the crown. If it is the patients desire to take medication (finasteride) as part of their "battle plan", I advise they wait at least one year prior to considering transplantation of the crown. In this patient, the crown has not been transplanted, and there is a subtle, but cosmetically significant improvement over the baseline presentation. As for the hairline in this example, a conservative approach is utilized, in that there is moderate recession, and density is created to match this design. The goal here is to gain a natural appearance, replacing weak, fading hair with healthy growing follicles. The adage of "less is more" applies here, and the added feature of coarse asian hair characteristics further requires careful balance between hairline contour, density, and graft size selection. This result will provide a workable scenario in the distant future, should this patient experience hair loss in the higher Norwood stages, as it is a design he can easily "grow into", that is, it should age well with him, working with his future changes, not against him. I feel this concept is a critical one in the hair transplant procedure. Also, it should be noted he is at the 9 month mark, and therefore has at least another 20-30% growth to come. 2084 total FU grafts; 753 = 1's; 1291 = 2's; 43 = 3's. Tricophytic closure.

Generics can vary widely-possibly in more ways than appearances alone as well, I believe.