Dr. Cam Simmons – 3155 follicular unit and family follicular unit grafts in front

[Cam Simmons MD ABHRS]

This 32 year-old man had thinning for 8 years. He had finer than average, dark brown hair and light skin. In addition, he had fewer 3s and more 1s than average. These hair characteristics make it challenging to achieve good visual density without using up too many grafts in too small an area. Fortunately, he had good donor density.

We transplanted 3155 grafts from a mature hairline that starts just above his natural hairline. Where possible, we combined two small follicular units that were close enough together into one graft, as long as that graft would still fit into a regular incision. These combined grafts were counted as one graft and have been referred to as follicular unit family grafts. He was fortunate that he had enough donor density that we could reach the target graft number (3000) despite combining a few hundred follicular units into “family” grafts. We could have used only follicular unit grafts and placed them closer together but then he would be paying for more grafts and his hair would not have looked any denser.

He uses Minoxidil but declined to take Finasteride. One day he will lose the natural hair below his transplanted hairline so the transplanted hairline will take over. For now they blend together.

[NEWHAIRPLEASE]

Big improvement!! Looks great Dr Simmons!!

[wb280]

excellent result!

[Dutch]

Nice result especially considering the area covered. Any immediate post op pics?

[Blake Bloxham]

Dr. Simmons,

 

Great transformation. It seems like this patient was pretty unique, but I'm glad to see the "family follicular units" worked well. Do you utilize this technique often? I'd assume most of your patients have far more 2-3 units grafts compared to single units. I'd be interested to hear more about the technique.

[Cam Simmons MD ABHRS]

Dr. Simmons,

 

Great transformation. It seems like this patient was pretty unique, but I'm glad to see the "family follicular units" worked well. Do you utilize this technique often? I'd assume most of your patients have far more 2-3 units grafts compared to single units. I'd be interested to hear more about the technique.

 

Thanks Everyone

 

Blake, I almost always do pure follicular unit transplantation and use the grafts as they come. A usual patient might have 55% 2s, 30% 3s, and 15% 1s but some with finer hair have 4s or even 5s.

 

My mentor, Dr. Seager, called these combination grafts "follicular family units" but they could also be called "double follicular units" or "dfus". I really only use them when someone has the unfortunate combination of fine hair and small natural follicular units (and when we can create these "ffus" and still get enough grafts to cover the area.) It is important that only small follicular units that are close together get combined so that you don't end up with a minigraft that requires a big slit for planting.

 

We didn't keep an exact count but I would estimate that of 3155 grafts no more than 300 were follicular family units. It was a way to bump up his "3s" and reduce the number of "1s." Fine 1-haired grafts are great in a hairline but don't give much coverage in the dense zone of the transplant.

 

I should also mention that what you see first is his thinning natural hairline which is below the level of the transplanted hairline. His natural hairline was lower than where a mature hairline should be (imo) but it will eventually recede up to the transplanted hairline, which will be denser than his current hairline.