Dr Cooley 2,312 grafts +PRP/ACell

[Dr. Jerry Cooley]

This young patient looks much older than his age due to hair loss. We started him on finasteride/minoxidil and performed FUT surgery consisting of 2,312 grafts and PRP/Acell treatment. The grafts consisted of 1-640, 2-1286, 3-339, 4-47 = 4,417 hairs and were placed at the hairline and frontal core only. He is shown at 10 months. The synergistic effects of these treatments is well demonstrated here. I see the PRP/ACell procedure as intended to have a 'kindling' effect, to jumpstart hair growth. We always want to have something in place to maintain the hair growth, whether that is finasteride/minoxidil or alternative treatments.

[hairshopeing]

Great result!!!

[harryforreal]

Dr. Cooley,

 

I am trying to learn more about surgeons' techniques for implanting follicular units. May I assume that you are implanting follicular units of 4 or less hairs? If not, what is the largest number of hairs in a follicular unit you would implant? And what type of pattern do you use to implant follicular units? For example, in Mickey85's post about hair transplant basics, he has a diagram entitled "Simplified graft placement protocol" which shows dispersal of FU's of 1, 2, and 3 hairs in three distinct regions.

 

http://www.hairrestorationnetwork.com/eve/170490-hair-transplant-basics.html

 

Also on Shapiro's website there is diagram with a slightly different dispersal pattern:

 

Recipient Sites

 

Thank you for any input and insight you can offer.

[Mickey85]

Dr. Cooley,

 

I am trying to learn more about surgeons' techniques for implanting follicular units. May I assume that you are implanting follicular units of 4 or less hairs? If not, what is the largest number of hairs in a follicular unit you would implant? And what type of pattern do you use to implant follicular units? For example, in Mickey85's post about hair transplant basics, he has a diagram entitled "Simplified graft placement protocol" which shows dispersal of FU's of 1, 2, and 3 hairs in three distinct regions.

 

http://www.hairrestorationnetwork.com/eve/170490-hair-transplant-basics.html

 

Also on Shapiro's website there is diagram with a slightly different dispersal pattern:

 

Recipient Sites

 

Thank you for any input and insight you can offer.

 

Hey there Harryforreal, I just noticed your post. In regards to my 'simplified graft placement protocol' I have to say it is just that, simplified hehe. The point of it was just to give a general overview of the basics of what grafts go where but in reality, the '1' hair zone is much too large in the photo I used. It was just to give an idea and was used for clarity. The Shapiro photo is much closer to what is really used however.

[harryforreal]

Thanks, Mickey, for the clarification!

 

[Dr. Jerry Cooley]

Dr. Cooley,

 

I am trying to learn more about surgeons' techniques for implanting follicular units. May I assume that you are implanting follicular units of 4 or less hairs? If not, what is the largest number of hairs in a follicular unit you would implant? And what type of pattern do you use to implant follicular units? For example, in Mickey85's post about hair transplant basics, he has a diagram entitled "Simplified graft placement protocol" which shows dispersal of FU's of 1, 2, and 3 hairs in three distinct regions.

 

http://www.hairrestorationnetwork.com/eve/170490-hair-transplant-basics.html

 

Also on Shapiro's website there is diagram with a slightly different dispersal pattern:

 

Recipient Sites

 

Thank you for any input and insight you can offer.

 

In this patient, we used 1-3 hair grafts planted in a fairly standard distribution pattern. In the attached photo, I marked the zones. The 1's start the hairline, from temple point to temple point, then the 2's, and the 3's were placed centrally, in the frontal core.

 

There are other variables to consider in planning graft numbers and distribution. This patient is in his 20's and I wanted to make sure plenty of hair was left in his donor bank for future needs, hence the graft density was not overly high. He was very committed to medical therapy and wanted the strongest hairline he could reasonably achieve.

 

Thanks for your interest. Let me know if you have other questions.

[harryforreal]

Thank you, Dr. Cooley.

 

My hair transplant has many 2 unit grafts along the hairline and in the "1-zone" you've designated in the attached picture. I am not happy about it. Makes it difficult to part without looking a bit off, and the overall look is a bit pluggy and not nearly as dense as I wanted. I was very specific to the doctor: "I don't want to be able to see an inch into my hairline". My exact words. I'm trying to gain insight into why my doctor chose to use these 2 unit grafts at the front of the hair line so extensively.

 

Is it possible that if a tech implanted them, the doctor might have thought upon examination they were all 1 unit grafts?

 

Also, is there a medical standard for what constitutes mini-grafts? Are 3 and 4 unit grafts mini-grafts? Or FU's? Or both?

 

And finally how might you go about making surgical adjustments/repair? I know that's a bit hard to comment on without a pic to look at - and they will be coming. I just want to upgrade my iphone 3GS to an iphone 5 sometime this week to take advantage of the superior HD camera in the iphone 5 (and, no, I am not promoting the iphone 5!).

 

Thank you.

[harryforreal]

Another question, Dr. Cooley (one of many more to come no doubt),

 

Is it possible to see pics of the transplanted hairline from straight on instead of at the 45 degree mark? I would like to see more pics of this gentleman's hairline from various angles. I have wavy/curly hair like this gentleman, but dark, sandy blonde. From the front I feel that hairs in my hair transplant hairline don't really match the color or calibration of the still intact finer single hairs on the sides of my face - but part of that is due to the many 2 unit grafts that look like a thicker, dark haired single. Very angering. I only came to this realization last Thursday after more than a year of plowing through the Hair Restoration Network forums and feedback from several other members.

[Dr. Jerry Cooley]

Thank you, Dr. Cooley.

 

My hair transplant has many 2 unit grafts along the hairline and in the "1-zone" you've designated in the attached picture. I am not happy about it. Makes it difficult to part without looking a bit off, and the overall look is a bit pluggy and not nearly as dense as I wanted. I was very specific to the doctor: "I don't want to be able to see an inch into my hairline". My exact words. I'm trying to gain insight into why my doctor chose to use these 2 unit grafts at the front of the hair line so extensively.

 

Is it possible that if a tech implanted them, the doctor might have thought upon examination they were all 1 unit grafts?

 

Also, is there a medical standard for what constitutes mini-grafts? Are 3 and 4 unit grafts mini-grafts? Or FU's? Or both?

 

And finally how might you go about making surgical adjustments/repair? I know that's a bit hard to comment on without a pic to look at - and they will be coming. I just want to upgrade my iphone 3GS to an iphone 5 sometime this week to take advantage of the superior HD camera in the iphone 5 (and, no, I am not promoting the iphone 5!).

 

Thank you.

 

Sorry you're not happy with your results. Have you discussed your concerns with your surgeon? What is their response?

 

If follicular unit grafts are created under microscopic dissection, they can be accurately separated into 1, 2, and 3 hair grafts. The size incision I make for 1 hair grafts usually won't accept 2 hair grafts and my placers know to be careful about this. Occasionally, we might see a 2 hair graft at the hairline and it is thought that sometimes a practically invisible telogen follicle can be 'hiding' in what appears to be a 1 hair graft. We don't see this very often though.

 

A 'mini-graft' refers to a graft with 3-5 hairs, and is an older term from the pre-microscopic dissection days. It would have more than one follicular unit in it; today, if a graft is created under the microscope and contains two follicular units, it is usually called a 'double follicular unit' not a mini-graft. It would be pretty rare for a doctor to use microscopic dissection and make 3 or 4 follicular unit grafts (or did you mean 3 and 4 hair grafts?)

 

The techniques I use to repair and correct hairlines would include using 1) FUE to remove grafts at the hairline or 2) electrolysis, which often works well to turn 2 and 3 hair grafts into one hair. It just depends on the situation. I've heard of some doctors using laser hair removal to correct hairlines but I have never done this.

 

Again, I encourage you to discuss your concerns with your doctor. Good luck.

[harryforreal]

Hi, Dr. Cooley,

 

Again thank you for replying so quickly. I have been so emotionally distraught that I just needed to take some time off before returning to this forum.

 

It would be pretty rare for a doctor to use microscopic dissection and make 3 or 4 follicular unit grafts (or did you mean 3 and 4 hair grafts?)

 

I think I meant 3 or 4 follicular unit grafts. I find your statement that it would be pretty rare for a doctor to use microscopic dissection to make 3 or 4 follicular unit grafts of interest. I have a 4 unit follicular unit graft at the very front of my hair line almost directly above my right eye. This doctor claims to use "Advanced FUE" - and indeed the extraction process was with FUE; however the implantation technique seems primitive at best - the front part of my hair line is made up with many 2 unit grafts that make my hairline look tufted, harsh, and overall unnatural. Whereas a natural hairline is made of single hairs (I guess?), mine has a bunch of little "V" types all along the front (as well as further in); or if the 2 follicular unit grafts don't separate into a "V", then they stick together and look like an extra thick tree trunk. Either way it looks unnatural at the front, doesn't match the hairs on the side of my head, doesn't really lay properly either.

 

As for discussing my concerns with my doctor, no, I have not done this yet. I will, of course, but I want to gain insight as to what techniques constitute current medical practice in hair transplants. For example, might it be common medical practice for doctors performing FUE to NOT use a microscope to dissect hair units? Is there any "theoretical" or "practical" basis for using 2 unit grafts at the front of the hairline? And I see that on this sight you are listed as performing "Ultra Refined Follicular Unit Transplantation" - is this the description/qualification for using only single hair FU's at the front of the hairline? In other words, is it common medical practice for doctors performing FUE who are not described as performing "Ultra Refined Follicular Unit Transplantation" to place 2, 3, or even 4 FU grafts at the front of the hairline?

 

I am also curious how you can select donor hairs for individual placement at the front of the hairline to create a soft hairline (that is, thinner, finer hairs), especially if the donor hairs are shaved down during the FUE process - or is the type of individual donor hairs that re-grow after transplant pretty much a crap shoot: some thin and fine, others thick and stiff?

 

Also, when using FUE to remove grafts on the hairline, what type of scar is left? And when using electrolysis how often does it kill all the hairs in the graft? Is electrolysis so precise as to only target individual hair units and not accidentally kill all of the surrounding hair units?

 

Lots of questions, I know

 

Two last questions: I feel like I might like to travel to your clinic for a personal consultation. How far in advance is your clinic booked in the summer? And the second question is in regards to my prescription for Finasteride 5 MG. About 7 months after my hair transplant I asked my doctor to put me on Finasteride as I was concerned that the ingrowing transplant didn't look "proper" or adequately dense (he had told me originally that he didn't think it necessary as he didn't think I would have any more hair loss). The prescription says "Take 1/2 tablet by mouth everyday" - or 2.5 MG. But I have been reading on this forum that the standard dosage is 1.25 MG/day. Is there any danger to taking 2.5 MG daily for roughly 9 months now?

 

Thank you.

 

Sincerely,

 

Harry

[Gary1911A1]

Looks like great improvement.

[Dr. Jerry Cooley]

Hi, Dr. Cooley,

 

Again thank you for replying so quickly. I have been so emotionally distraught that I just needed to take some time off before returning to this forum.

 

 

 

I think I meant 3 or 4 follicular unit grafts. I find your statement that it would be pretty rare for a doctor to use microscopic dissection to make 3 or 4 follicular unit grafts of interest. I have a 4 unit follicular unit graft at the very front of my hair line almost directly above my right eye. This doctor claims to use "Advanced FUE" - and indeed the extraction process was with FUE; however the implantation technique seems primitive at best - the front part of my hair line is made up with many 2 unit grafts that make my hairline look tufted, harsh, and overall unnatural. Whereas a natural hairline is made of single hairs (I guess?), mine has a bunch of little "V" types all along the front (as well as further in); or if the 2 follicular unit grafts don't separate into a "V", then they stick together and look like an extra thick tree trunk. Either way it looks unnatural at the front, doesn't match the hairs on the side of my head, doesn't really lay properly either.

 

As for discussing my concerns with my doctor, no, I have not done this yet. I will, of course, but I want to gain insight as to what techniques constitute current medical practice in hair transplants. For example, might it be common medical practice for doctors performing FUE to NOT use a microscope to dissect hair units? Is there any "theoretical" or "practical" basis for using 2 unit grafts at the front of the hairline? And I see that on this sight you are listed as performing "Ultra Refined Follicular Unit Transplantation" - is this the description/qualification for using only single hair FU's at the front of the hairline? In other words, is it common medical practice for doctors performing FUE who are not described as performing "Ultra Refined Follicular Unit Transplantation" to place 2, 3, or even 4 FU grafts at the front of the hairline?

 

I am also curious how you can select donor hairs for individual placement at the front of the hairline to create a soft hairline (that is, thinner, finer hairs), especially if the donor hairs are shaved down during the FUE process - or is the type of individual donor hairs that re-grow after transplant pretty much a crap shoot: some thin and fine, others thick and stiff?

 

Also, when using FUE to remove grafts on the hairline, what type of scar is left? And when using electrolysis how often does it kill all the hairs in the graft? Is electrolysis so precise as to only target individual hair units and not accidentally kill all of the surrounding hair units?

 

Lots of questions, I know

 

Two last questions: I feel like I might like to travel to your clinic for a personal consultation. How far in advance is your clinic booked in the summer? And the second question is in regards to my prescription for Finasteride 5 MG. About 7 months after my hair transplant I asked my doctor to put me on Finasteride as I was concerned that the ingrowing transplant didn't look "proper" or adequately dense (he had told me originally that he didn't think it necessary as he didn't think I would have any more hair loss). The prescription says "Take 1/2 tablet by mouth everyday" - or 2.5 MG. But I have been reading on this forum that the standard dosage is 1.25 MG/day. Is there any danger to taking 2.5 MG daily for roughly 9 months now?

 

Thank you.

 

Sincerely,

 

Harry

 

 

Harry

 

Sorry for the delay in replying.

 

Finasteride has a wide safety margin so no problems taking 2.5mg every day. I generally have my male patients take 1.25 mg every other day, but I have my older females take finasteride 5 mg every day. There are a lot of different ways to dose this medicine, and doctors disagree sometimes!

 

Regarding your questions, most surgeons I know, including myself, use only 1 hair grafts right at the hairline. It is not unusual for FUE surgeons to not inspect or dissect FUE grafts under the microscope, and if they are good, this is not a problem. They know which grafts or 1's and which are 2's, etc.

 

Small FUE removal of transplanted grafts generally leave no marks or scars. The same goes for electrolysis when done by an experienced person. I generally will use FUE on grafts with 2 or more hairs and electrolysis on 1 hair grafts that need to be removed.

 

Again, I encourage you to discuss your concerns with your doctor. Good luck.

[Arrie]

Much respect to you Dr. Cooley for answering questions and your general contribution to this forum, THANKS!

[irishsailor]

This guy looks 10 yrs younger. Congrats to the patient, and congrats dr Cooley .

[Mp96]

The patient looks like a million bucks!!