Dr. Hasson/7061 Grafts/Two Sessions/6 Months

[Jotronic]

This local patient came in for a second procedure to take care of the crown after his first procedure for the front. 2728 grafts were used in the second procedure and this allowed Dr. Hasson to create a new whorl pattern that is completely natural. The result is at six months post-op.

 

HD video will be posted later this week.

 

 

 

 

 

[NEWHAIRPLEASE]

What a small case ! Ha. Jk jo. These 7000 graft cases just seem small now. Lol

Looks great. I'm sure this guy is thrilled with his result.

[aaron1234]

The guy looks a 100 times better. Good hair style and length too, making good use of the shingling effect for sure.

[chrisdav]

The guy looks a lot better now and I am sure he is happy.

[RCWest]

He looks like a totally different person! Great job on getting 7000+ grafts on a borderline NW7 with sparse donor hair!

[Jotronic]

Just a reminder, this was in two sessions, not one:)

[Davis91]

Want...video...now...such a good job.....

[azazelgs]

Joe,

 

Don't get me wrong this result is amazing but I want to ask something. Is it patient's choice or does Dr.Hasson always prefer high hairlines? In many cases of hasson&wong, the only thing that I don't like is the high hairlines. It seems like with 7k grafts , a patient can get 1-2 cm lower hairline.

 

Please don't get me wrong ,I'm not trying to be offensive and I am a true fan of H&W work but this I needed to ask.

[chrisdav]

I am sure Joe will answer this , but I would have thought on someone with extensive hair loss, it would be foolish to be put a lower hairline as this ultimately would mean that the surgeon has more area to cover, which would then reduce the possible coverage/grafts per cm^2 on the rest of the head.

 

It is the sensible, age appropriate and the right thing to do as this gentlemen is not 26 years old like me

[azazelgs]

chrisdav,

 

I'm 26 as well:) All I'm saying is with that no of grafts I'm sure a lower hairline can be build. I don't want to be comparative but check out Dr. Rahal's hairlines. They are relatively lower than h&w's.

[orlhair1]

Great result........he looks like a different person.

[Jotronic]

Is it patient's choice or does Dr.Hasson always prefer high hairlines? In many cases of hasson&wong, the only thing that I don't like is the high hairlines. It seems like with 7k grafts , a patient can get 1-2 cm lower hairline.

 

 

This is a fair question. It is a collaboration. The patient absolutely can choose the hairline they want but only within reason. If it is too low for their particular case then we will make an alternative suggestion. I can't count how many times patients have said "can you put just a little bit in the crown?" or " Can you lower the hairline just a bit?". These are honest requests but the one thing we cannot lose sight of is that we are working with a set amount of hair so any time we take some hair to do "just a bit" here or there we are taking hair away from another area that could use that hair just as much. In other words, we're robbing Peter to pay Paul.

 

Did you know that to lower a hairline 1mm it takes approximately 150 grafts? That means that to drop a hairline a scant 1cm can take a whopping 1500 grafts! Obviously this also depends on hair type, scalp color - hair color contrast and other factors but you get the idea. To simply drop a hairline takes more hair than you many realize and when we're dealing with a patient that is as bald as this patient was we haven't the luxury of having our cake and eating it too. Compromises must be made to get the biggest cosmetic benefit and to lower this patient's hairline would mean that the crown or the top would have less coverage or density than he has now.

 

I don't want to be comparative but check out Dr. Rahal's hairlines. They are relatively lower than h&w's.

 

Well, I can appreciate your observation but I am pretty confident that no matter how good Dr. Rahal, or any other doctor for that matter,may be I'm pretty sure he can't create hair out of the ether. That is precisely what anyone would have to do in a case like this unless the patient opted for less coverage in the crown and that is where it is up to the patient and the doctor to come to an agreement. Of course, the one thing to remember is that the hairline can always be lowered at a later date but for a patient like this having a low hairline is really of no concern and of course I believe it is easy to see why.

[Davis91]

Comparing this case to a typical Rahal hairline is a bit silly. Dr. Rahal's hairline are often so dense because he packs a lot of hairs into small areas. This guy would have a frontal hairline like Elvis and nothing much behind it. I presume Dr. Rahal would not recommend his "typical" hairline on this guy and would give him a high hairline not too far off where H&W put it.

 

That being said, there may be philosophical differences on how each approaches planting in the hairs, including the hairline. When I had my first consult with Dr. Rahal and we discussed H&W, Dr. Rahal said he implanted his hairs at an angle closer to the scalp (a more extreme angel, closer to horizontal than H&W)) for better effect when combed backwards, as he felt that the angel used by H&W makes it easier for overhead light to shine against the scalp.

[mahhong]

This is a great result! Even though 7000 grafts sounds (and to some extent is) a lot, this guy is pretty much somewhere between a NW6/7 and that makes even 7,000 grafts a precious commodity. I think the hairline looks fine; it's age appropriate and is certainly an improvement on the starting position!!

 

Joe, out of interest, do you know if this guy has any donor hair left? I'm just curious because of the extent of his balding and what you've managed to achieve despite that fact. I wondered if there was even more left in the bank for any further work if needed or wanted.

[StaggerLee123]

It seems to me that a lot of Dr. Rahal's work is on younger guys that want to dense pack their hairlines and temples. To compare this older gent to some of Rahal's younger patients is comparing apples to oranges. Ths patients hairline looks very appropriate for his age and level of baldness. Nice work.

[RecedingTide]

Well this gent may have the option of another strip of 1500 if he did want to address the hairline. Even if he had no more by strip he could always tap into another 1500-2000 FUE for the hairline if that was his desire.

 

It's important not to go to low with the hairline initially. You need to get the coverage up to a level the patient is happy with and make sure there is enough left for the end stage of baldness. Once that is achieved then you can look at what's left donor wise if you did want to lower the hairline. However if you did it the other way around and went with the low hairline at the beginning you could run out of hair and be trouble when it comes to the crown.

 

Would be great if Joe could discuss the angle of the hair placement and what Dr. Rahal sees as a stylistic difference between himself and Dr. Hasson and Dr. Wong. It's an interesting topic for sure.

 

Anyways you really couldn't go wrong with any of those docs. I am interested about the issue of overhead lights and the angle of placement. I always thought that H&W achieved the best coverage. If someone wanted the best of both worlds they could go to H&W for their coverage and once stripped out could avail of the 1500-2000 left by FUE with Dr. Rahal for the dense hairline. Seems like a good approach to me.

 

Lastly just to prove Hasson and Wong do awesome hairlines when the patient can afford the high densities donor wise.

 

http://www.hairrestorationnetwork.com/eve/164744-dr-hasson-dense-packing-1999-grafts-3-5-years.html

 

And also Dr. Rahal can do awesome megasessions for great coverage.

 

http://www.hairrestorationnetwork.com/eve/161303-dr-rahal-patient-6228-grafts-fut.html

 

If I didn't give the docs names you might guess the hairline one was Dr. Rahal and the megasession was H&W. Both outfits are tops.

[Jotronic]

RecedingTide,

 

Would be great if Joe could discuss the angle of the hair placement and what Dr. Rahal sees as a stylistic difference between himself and Dr. Hasson and Dr. Wong. It's an interesting topic for sure.

 

Well, I won't speak for Dr. Rahal of course but I will speak about how we approach angle and direction of placement. It is quite simple actually - we place the new grafts at the same angle and direction as the native hair in the immediate vicinity of the recipient site. Using custom cut blades as dictated by the lateral slit technique allows for complete control of this. In some cases where there is aggressive loss we may angle the grafts flatter against the scalp for better coverage but this is nothing new or unique and in fact using custom cut blades allows for this better than any needle. In general we tend to stick with what Mother Nature intended as this allows for the best result. The hair styles naturally, lays naturally and behaves naturally.

 

About five or six years ago I made a video showing how the lateral slit technique compares to using needles. I used a melon for the demonstration. The problem with this video was that it was shot before we (or anyone else) were using HD video. This new video will be in full HD and will blow your mind. I hope to shoot it this weekend.

[RecedingTide]

Nice reply Joe. I was thinking even on an extensively bald scalp there is a coverage vs. volume battle going on with angle of placement. If you go flatter you can get better coverage and block more light but if it's more like what the native hair was like you'll get a more voluminous appearance from the front and sides but may let a little more light through when looking top down.

[Jotronic]

RT,

 

Keep in mind there is a limit to how flat a graft can be placed even when using flat blades which allow for the flattest (?) placement possible. If one is slick bald placing the grafts very flat may be counterproductive as styling options will be severely limited. The nice thing about using flat blades is that there is more of a layering of the grafts which makes for better coverage regardless of whether or not the angle varies a few degrees but there is not enough of a difference to let a "little more light" through.

[Gandolf]

chrisdav,

 

I'm 26 as well:) All I'm saying is with that no of grafts I'm sure a lower hairline can be build. I don't want to be comparative but check out Dr. Rahal's hairlines. They are relatively lower than h&w's.

Going any lower in the hairline for this guy would have been a mistake. He was able to go from having practically nothing on top to having good coverage all over. This wouldn't have been possible with a lower hairline.

 

On an unrelated note, in the before pictures he looks like my calculus teacher from HS. He looks 100x better in the after pics!