Dr. Panine - Chicago Hair Transplant Clinic - 3,981 grafts @ 10 Months Post-Op

[Dr. Vladimir Panine]

This 34 year old gentleman had a hair loss pattern similar to a class 4v on the Hamilton Norwood hair loss scale. His goal was simple; rebuild his hairline and add density to the frontal 1/2. That said, he also wanted to be able to keep his hair short without anyone detecting that he had a procedure done.

I explained to him that he would have a dramatic result and his overall goals could be accomplished after one procedure. I also explained that if he wanted more density in the back ? he would need another procedure.

 

After establishing his medical history and understanding the progression of his hair loss, I diagnosed his condition as Androgenetic Alopecia (male pattern baldness), ruling out any other possible dermatological or medical conditions which can cause hair loss. During the discussion with the patient regarding his surgery I conveyed to him that my intent was to reconstruct a hairline that would be suitable for him now, but also something that will look good as he gets older. This is a critical issue which needs to be discussed when planning any work on the hairline.

 

A total of 3,981 grafts were used. The break down was as follows: 1,307 single hair grafts, 2,652 two hair grafts and 22 three hair grafts.

 

I used significantly more single hair follicular units which allowed me to create a very natural hairline. A natural hairline is essential in making a patient happy; it gives them confidence. When a patient has undergone a surgery they need to feel comfortable combing their hair/styling their hair in front of others as well as undertaking water sports or swimming around other people. A natural hairline cements this feeling of comfort and allows patients to experience a more carefree lifestyle.

 

These are the patient’s results 10 months post-op. There will continue to be more improvement over the next few months. As I’m sure you’ve gathered, the patient is extremely happy with his results.

 

 

 

 

[viper1969]

Dr. Panine excellent result as usual. I bet he is extremely happy.

[Blake Bloxham]

Nice transformation! Thank you for sharing.

[Arrie]

Dr. Panine

Very nice result and scar looks great. It appears as if the patients donor seems to be average to below average, what is your estimate on grafts available to this patient?

[KO]

Can you post a top-down photo please? Looks good.

[JimmyNeutron]

Decent results, is this what the patient asked for? For nearly 4000 grafts all in the front, I expected a much lower hairline, and if not, at least a denser look and some temple restoration. I know he asked for something that wouldn't be so obvious that he got a procedure done, but why did it take so many grafts just for those results?

 

I am not trying to be rude or negative, i'm just concerned because I am also a NW4 and I am getting supposedly 3500 grafts all over but these kinds of results that use a large amount of grafts and barely get anything done really scare me.

[Dr. Vladimir Panine]

Arrie,

This patient could have another similar session of approximately 4,000 grafts and then have an FUE procedure using 2,000 grafts after that.

[Dr. Vladimir Panine]

JimmyNeutron,

I’m happy to answer any questions from members. You’re not being rude or negative you are just asking a question which may help you with your own future transplant; that is why we are all here.

 

You’re planning on having a procedure that utilizes 3,500 grafts.

Based on what you’re seeing with this patient, you’re worried that the 3,500 grafts you’ll be having placed over a larger area (not concentrated into the frontal section like this patient) won’t give you the dramatic result you’re expecting as this patient’ s results don’t appear dramatic to you.

There are many factors that need to be taken into consideration when performing a hair transplant on a patient; age, present hair loss, expected future hair loss, the patient’s goals, whether the patient is currently or is planning on using Propecia or Rogaine, whether miniaturization has already occurred, and most important his/her donor availability.

Prior to his surgery, this patient’s hair in the frontal region had already started going thru significant miniaturization. It was the reason that the patient kept his hair so short; when you try to grow out your hair that has started to miniaturize it looks very thin. This fact combined with the knowledge that the patient had not been using and did not want to start using Propecia or Rogaine makes a more dramatic result for this patient highly improbable. A lower hairline and temple restoration may leave the patient looking undesirable as they continue to lose hair as they don’t want to take Propecia. It’s a significant gamble to bring the hairline down any lower and restore more of the temple region – a risk that the patient didn’t want to take.

The amount of density that is achieved in a procedure is determined by how many grafts are placed into a cm2 AND how many 1, 2 and 3 hair grafts were placed. A single hair graft contains one hair. A 2-hair graft contains two hairs. A 3-hair graft will contain 3 hairs. The amount of perceived density will go up when you’re using more 2 or 3 hair grafts because you’re moving more hairs with a single graft; it makes it look more dense. When doing hairlines it takes significantly more follicular units per cm2 since they are all single hairs. With this patient in particular he wanted a very natural hairline which means I needed to use significantly more one hair grafts. I used 1,307 single hair grafts, 2,652 two hair grafts and only 22 three hair grafts. Therefore if you compare his result with someone else’s result which is based on a procedure that used fewer one hair grafts and more two and three hair grafts you’ll see a big difference in density, holding all other factors constant. The total surface area transplanted on this patient was about 90 cm2. I transplanted approximately 1,500 single follicular units the frontal area, which was about 15 cm2. The remaining 2,500 grafts went into about 75 cm2, which is about 35 follicular units per cm2.

The short answer is that the same number of grafts on different patients will look very different depending on the specific patient and the makeup of the grafts used in their procedure. I can’t stress enough that communication with your surgeon is key. He or she needs to know what is important to you, what you plan on doing in the future and a specific listing of your priorities as during your surgery they need to understand how you feel so they can implement your priorities not THEIR priorities. You may have to give up some density if your hairline is really important to you as you’ll need more single hair grafts. If you don’t want to take Propecia or Rogaine you’ll have to work with your surgeon to create a hairline that will look good as you get older given you will most likely continue to lose hair.

 

I do understand your concerns about the amount of coverage that you will be getting with 3,500 grafts. I can’t say what kind of coverage that will give you without knowing more about your situation specifically. I encourage you to reach out to your surgeon to let him/her know what your expectations are in regards to the density and coverage you are looking for and have him/her tell you if it is achievable. I worked with this patient prior to surgery to explain the results that he would achieve and the limitations of the surgery (that he would need another session to pick up where we left off on this procedure). The patient was aware of his miniaturization and the other factors he decided for himself, like deciding he didn’t want to take Propecia or Rogaine. Therefore the result to him was dramatic becasue he knew all the factors he was up against. The communication is key. This patient is extremely happy with his results because we worked together to give him what he wanted out of what was possible.

[JimmyNeutron]

Thank you very much for your response Dr Panine, I appreciate it. I understand now. I have been using dutasteride 0.5mg a day for a year and minoxidil solution twice a day for 2 weeks, but I was on finasteride and rogaine foam for years before. My hair thickened up a little bit since last year and I've been having these little hairs growing on my temple corners lately, just for about 2 weeks now. Hopefully I have good thickening of currents hairs by the time of surgery.

 

Thank you for the informative response.

[bowl81]

That was certainly an informative response, what every newbie should know. Thank you for the very detailed photos and information. Great work!