2004 graft FUT session by Dr. Parsley

[Dr. William Parsley]

The patient is a 40y/o white male with less than average density in the donor area. Attached picture shows a 5x5mm area of the donor strip preop, revealing less than 70 follicular units/cm2, also showing some miniaturization. Hairline and planted density were conservative to preserve donor supplies.

[Mick from Farjo]

Dr Parsley,

 

This is an excellent approach and a fine outcome, especially when looking at all the circumstances.

 

Mick

[TC17]

Dr. Parsley, perhaps I'm misunderstanding your write up, but is this man experiencing miniaturization throughout his entire donor? If so, with his relatively young age, relatively high degree of present balding and what appears to be fine donor hair, why decide to operate on him at all?

[Dr. William Parsley]

TC17

Good question. This fellow has some miniaturization but most of the follicles are terminal follicles and he has a predominance of multi-haired grafts. When deciding on surgery, I look at the occipital and parietal zones to determine the coverage. If see-through, then he is not a candidate. If I think I can remove 50% of this hair without cosmetic problems, then he might be a candidate. I also look at the total area of the good donor zone, look for retrograde hair loss and possible future extension of loss into the occipital zone and the parietal humps. I don't want to do a transplant that has an expiration date.

For this patient the design is conservative- relatively high hair line and transplanting only into the frontal zone, midscalp and parietal humps. I feel he has enough donor hair to accomplish this task. No doubt his hair will thin with age- as will all of our patients- but I feel his hair design will continue to be a positive.

Let me know if this answers your question. Thanks.

[TC17]

Dr. Parsley,

 

Thank you for responding. I'm certain that you did a thorough examination of this patient before agreeing to perform surgery on him, and that you made the decision to operate only after careful consideration. I'm not trying to impugn your credibility or throw you under the bus here with these questions, I'm just curious.

 

Isn't the fact that this patient is already showing some signs of donor site problems a big red flag? Granted, it may not be severe (yet), but how is it that you can be confident that his donor site won't turn into a bigger problem in 10 or 20 years? Perhaps my own observations have clouded my judgment, but I look at my own dad who had MUCH more hair than many people I see getting transplants on this site at comparable ages, and yet at age 60 he is still losing hair and he is almost a NW 7. Obviously I don't know what his hair looked like upon magnification, but I can see that when he was 40, he had more hair than this gentleman.

 

Should I take from this patient that at age 40 it is possible to accurately predict the extent to which a man will bald? Or, was this transplant done not knowing the future, but planning for a worst case scenario of NW 7?

[Dr. William Parsley]

Nearly every patient I see has some degree of miniaturization in the donor area. I look for coverage that the donor hair is giving and I also look for the number of follicles in each follicular unit. If there are a predominance of 1 and 2 hair FUs, then that is beyond miniaturization and goes into actual loss of hair. I don't transplant these patients.

I expect the donor hair to weaken with age as it will with all patients. HRS doctors generally try to transplant with the worst case scenario on our patients as we can't predict confidently the ultimate hair loss on our patients.

The age of the patient when starting hair restoration is critical- in design and also in final outcome. But there are no guarantees at any age, particularly young patients.

 

 

Dr. Parsley,

 

Thank you for responding. I'm certain that you did a thorough examination of this patient before agreeing to perform surgery on him, and that you made the decision to operate only after careful consideration. I'm not trying to impugn your credibility or throw you under the bus here with these questions, I'm just curious.

 

Isn't the fact that this patient is already showing some signs of donor site problems a big red flag? Granted, it may not be severe (yet), but how is it that you can be confident that his donor site won't turn into a bigger problem in 10 or 20 years? Perhaps my own observations have clouded my judgment, but I look at my own dad who had MUCH more hair than many people I see getting transplants on this site at comparable ages, and yet at age 60 he is still losing hair and he is almost a NW 7. Obviously I don't know what his hair looked like upon magnification, but I can see that when he was 40, he had more hair than this gentleman.

 

Should I take from this patient that at age 40 it is possible to accurately predict the extent to which a man will bald? Or, was this transplant done not knowing the future, but planning for a worst case scenario of NW 7?