Dr Carman 2510 FU over two procedures

**Dr. Timothy Carman** · March 2, 2012

When initially evaluated in our office in early 2010, this 29 YO patient was concerned about density in his frontal and midscalp area. Although on propecia, he felt he was continuing to experience loss. He had a previous procedure done about a year prior wherein grafts were placed so as to recreate his younger hairline. Although happy with the result, he was concerned about the generalized thinning. On exam, the most striking feature was the tightness of his scalp- his laxity was very low, and his donor density only about 70 fu/cm2. In addition, his scar from the previous procedure was 4mm in some areas. The concerns we discussed were the low donor to recipient ratio (a supply demand picture that was low on supply and high on demand!), as well as concerns regarding future loss. We also discussed my concerns with a recreated hairline as low as it was, as that created a larger area of "demand" both on numbers of grafts as well as density (lower hairlines, in general, are denser when naturally occurring). A factor in his favor is a hairloss familial history that does not include thinning in the crown.

After discussion of these concerns, we agreed on focusing on increasing the core density in the frontal and midscalp areas, cautiously utilizing the donor area, aware of the low yields available, and the scar excision required on our first procedure.

The first three photos are at consult.

The next three are 1.3 years post procedure one with us: Ellipse 24 x 0.9 cm. 1271 Total, 885 1’s; 717 2’s; 181 3’s.

The last five photos are 5 months post procedure two with us: Ellipse 12 x .5-.6 (right); 9.5 x .5-.7 (Left). 1239 Total.

This is an example of subtle yet satisfying results that may be seen with slow, conservative planning. Because of the thinner strip size, his second two procedures were not complicated by large scarring areas, and his donor should be able to accommodate one future procedure if needed.