Dr Nakatsui, 1532 grafts to temples and temple points in a younger man

[Dr. Thomas Nakatsui]

Hi all,

 

This is a patient who recently came in for follow-up a little over one year post op. He was a young man in his 20s who was concerned about hair loss in the temples and temple points. This is the type of patient that I am very cautious with as there is a risk that transplanting these areas can eventually lead to an unnatural appearance that cannot be fixed.

 

In this case, this patient was very concerned with his hair loss. He always wore a hat and avoided situations where he would have to take his hat off. It was affecting how he lived his life. He did have a lot of things going for him as there was no family history of significant hair loss and the rest of his hair was great with good density and coarseness of the hair throughout the rest of his scalp. After discussing the potential risks of doing this transplant in detail and after giving this considerable thought, he decided he wanted to proceed with the procedure.

 

We performed a transplant of 440 single grafts, 874 double grafts, and 217 big grafts, for a total count of 1531 grafts. He was extremely pleased with the results and remains comfortable with the risks.

 

I have attached his photos below.

 

Dr N

 

 

 

FRONTAL VIEWS

 

 

 

RIGHT SIDE

 

 

 

 

 

 

LEFT SIDE VIEWS

 

 

 

TOP VIEWS

 

 

 

 

 

ADDITIONAL IMMEDIATE POST OP VIEWS

[Slickers]

Big improvement. nice result

[Davis91]

Hi

 

Could someone detail the risks as referred by the doctor for educational purposes.

[MTL30]

i like it,how many grafts by cm2

[Slickers]

Hi

 

Could someone detail the risks as referred by the doctor for educational purposes.

 

As in you don't know what the risks are or you think someone should highlight them?

[chrisdav]

Nice work doc.

[Davis91]

As in I would like to know what are the risks in the doctor's opinion because I see this approach all the time nowadays by docs--hitting the corners.

[TommyLucchese]

I believe the risks are potential further loss and wasted grafts in the temples that could have been better off saved for any necessary future procedures.

 

I had 2000 grafts for the hairline/frontal third but it was more conservative, the sort of circular/band type hairline because I'm 23 and if propecia stops working I'll probably need those extra grafts in years to come.

 

This is undoubtedly a great result though, hair looks awesome and the change is massive. Bet he's thrilled.

[Dr. Thomas Nakatsui]

Thanks for all the comments. I appreciate the positive feedback and the patient is indeed very happy with his results.

 

Further to the question regarding potential risks, I think that TommyLucchese addressed this very well.

 

In general, the more aggressive (i.e. youthful) the hairline desired, the more risky it is to have it done. Firstly, aggressive hairlines use up a lot of grafts that you can never get back. Secondly, people who maintain dense, youthful hairlines generally have good hair all over and look odd if they have thinning of the crown in the presence of a low frontal hairline. On the other hand, if they have a dense but less agggressive/youthful hairline, they can get away with thinning of the crown without much difficulty.

 

If there is minimal future hair loss, there is no real difficulty in touching this up. However, if there is significant future hair loss, this can be a problem if the patient has insufficient donor numbers, density, or laxity (although FUE may be a way around insufficient laxity). This is the gamble that patients face when lowering the hairline at a (relatively) young age.

 

Don't know if this is clear or not, but this is how I think about it.

 

Thanks,

Dr N

[Bill - Seemiller]

Dr. Nakatsui,

 

I appreciate you taking the time to recognize and share the risks associated with transplanting on a young patient and lowering their hairline. Hopefully, this patient won't see significant hair loss like other members of his family. This patient might want to further minimize his risks of future hair loss by considering medication like Propecia and Rogaine. Did you speak with him about this?

 

Thanks for all the great work you do and for providing super high resolution pictures, including close-ups showing these results.

 

Bill

[Dr. Thomas Nakatsui]

Hi Bill,

 

Thanks for your comments.

 

Fortunately for this patient, he does not have a family history of significant hair loss so the odds seem to be in his favor at this point.

 

I did discuss finasteride and minoxidil with the patient at his initial consultation, as I do with virtually all patients. I cannot recall whether he is on either of these medications at this time, but he is aware they may be helpful in delaying further hair loss.

 

Thanks,

Dr N