Dr. Mike Beehner; 3265 grafts; patient with low donor density

[Dr. Michael Beehner]

This man in his mid-30's presented with slightly below average density in the rear scalp area and even less density along both of the side donor areas over the ear. He had two sessions of "combination grafting" (FU's and DFU's) over a two year period and presented for his third session the day these "after" photos were taken. 2620 of his grafts were FU's and 501 were DFU's. A large part of our goal was to create some density in the "frontal core" so that a viewer could not "see through" his hair. He was pleased with the results of the first two sessions and recently had 1286 FU's placed, with some of these coming from FUE from the rear occipital area where the density wasn't as low.

Mike Beehner, M.D.

[PupDaddy]

Dr. Beehner,

 

This is beautiful hairline and frontal core work for a patient with challenging donor issues -- and an interesting approach involving FU's, double FU's, and even some FUE. Please update us on his progress from his most recent procedure.

 

I seem to recall that you wrote a paper about the use of double or multiple FU's behind the hairline transition zone. I'm wondering how this approach achieves greater density when, presumably, these larger grafts can't be as densely packed as 2-hair and 3-hair single FU's. Also, would I be right in assuming that patients receiving double or multiple FU's with this combination approach can't carry off as short a haircut as patients with a "pure" FUT transplant because the larger grafts and space between them would become apparent? Last question (and then I'll shut up): Do you make slit recipient sites for these double or multiple FU's with blades, or do you make round recipient sites with punches -- and why?

[Dr. Michael Beehner]

Thanks for your comments. Regarding your questions about when I decide to use MFU grafts and how I decide which type of recipient site to make, I'll try to answer.

First of all, I will list those situations in which I use ONLY FU GRAFTS:

 

a) Small frontal area is the only area in need of filling in

b) Crown/vertex filling in

c) If patient's hair "characteristics" are not favorable. A good example is a man with very coarse, dark hair set against a pale scalp.

d) All temple work

e) All females with mild to moderate level of hair thinning

 

When do I like to use "COMBINATION GRAFTING" (70% FU'S AND 30% MFU"S)

a) MOST MALE PATIENTS WHO APPEAR LIKELY TO ADVANCE TO A U-SHAPED NORWOOD VI PATTERN. When a man has a clear-cut, classical "U-shaped" or horseshoe-shaped area of hair loss (which covers an awful lot of the men who come to me), I like to use these 4-6 hair grafts in the inside portion of the frontal and mid-scalp regions. They give wonderful visual density. I only use these when I am confident that the patient intends to come for two sessions, as this level of density makes it relatively undetectable.

It is important, when using these grafts, to angle them acutely so that they shingle over each other, magnifying the density effect. They have to be small, usually averaging around 5 hairs per graft, and they have to be close to each other. Using depth-control in making the sites is important, to insure that the skin's blood supply is not damaged. Their distribution has to be what I term "regular irregularity". This basically means that they do not appear in any way to be in "rows," and yet they are equidistant from each other. Three years ago I did an overall review of all studies done to date on FU and MFU graft growth, and came up with 40 of them, with 6 featuring MFU grafts and the rest FU's. The FU's averaged out to 89.3 % being present around a year later. The MFU grafts averaged near 100%, and one study that looked only at the fate of third-session grafts placed in between the grafts placed previously, showed a 94% survival of these. Their growth is very predictable and you can count on it. FU's can be less predictable, and every hair surgeon I know has admitted this that I am aware of. Occasional poor growth is a fact of life with FU's.

The other reason is that they save the patient money. I charge the same amount for one of these grafts as I do for a 1-hair FU graft. As I said, I use MFU grafts mostly to cover a lot of the square area in the frontal and midscalp area, excluding the "crease" areas, the front hairline zone, and the crown border in back. So a typical Norwood VI patient at his first session would receive 600 FU's in the hairline, 200 FU's along each crease, and 400

FU's at the rear border for a total of 1400 FU's. I then usually place between 450 and 500 MFU grafts in the large inner area.

With moderately severe or shiny bald scalps, I prefer to use small 1.3mm wide round recipient sites. If I am concerned about damaging any native hair present in the area, then I use "sagital" slits, usually 1.9mm in length. For females I almost always use these slit sites. The hairs within these grafts are exactly in the relationship they are on the person's scalp. They are not compressed within the site, but have room to exist as they did before. For the slit sites, we cut the grafts so they are somewhat long and thin in contour, when viewed from the top - to prevent compression. In real tight scalps, slits don't work as well, and removing a small amount of the scalp to allow them room is often necessary.

The final answer is that, to fill in the front 3/4 of the scalp with hair, I have the choice of performing around 1800-1900 grafts (4500-5500 hairs, depending on density and number of hairs per FU) OR my other choice to the patient is to place 3500 FU's. The first choice is half the cost and moves almost as many hairs. Almost all patients of most doctors end up having a second procedure, whatever the method used. And in the final analysis, I find that two sessions (sometimes three) of the MFU grafts blocks the light from the scalp better than all FU grafts. There is less of a "see-through" look. This is my personal experience. Incidentally, I always offer an all-FU option to every patient.

I think it's important to understand that each hair surgeon is an artist, and he or she will have his own approach that yields the most natural and dense appearing result on his patients. This has worked for 24 years for me. It's predictable and I can count on good growth. Most of my patients are middle-class and can afford this approach better. It is stress-free and creates happy patients.

You mentioned something about whether MFU grafts are detectable if they later wear their hair very short. All transplants are basically creating the "illusion of density." We don't restore the original density they had when they were 10 years old. If someone says they intend to buzz their hair down to a "flat top," I would probably tell the patient he should do all FU's and he would need at least one extra session (and hopefully has a lot of useable donor hair) to create very high hair numbers on the top of his head to make up for the lack of shingling.

Mike Beehner, M.D.

[Rootz]

Immediate post op pics would be huge. Otherwise I could see how the transformation presented here could have been achieved in ~1500-2000 grafts.

 

To break it down. The improvement at the crown seems marginal (arguably non existent). The improvement around the sides of the head seems small and could very well be accounted for by differences hair style/length/picture technique. That leaves the frontal hairline... at a glance the pictures tend to exagerrate the improvement there. The comparison of pics 1 and 2 might lead you to initially believe he has a full head of hair... but in reality it's a very flattering shot in that the frontal hairline is combed up blocking the view of the balding areas behind. Pic 7 (pre) and pic 6 (post) have a similiar thing going on, pic 7 is actually a top down shot (showing more balding areas) whereas pic 6 is more level (allowing the frontal hairline to block the view more).

 

Anyways, I think this is probably pretty decent.

[Pulpedfiction1]

Rootz,

 

I am the patient in those pictures. While I do not have a full head of hair (and won't even after 3rd and final HT grows in), Dr. Beehner's work has greatly changed the course of my life.

 

The hairline is very strong, and does give the illusion from a frontal perspective of a full head of hair. That alone is leaps and bounds above where I was 3 years ago prior to beginning my HT journey. The side profile has also dramatically changed for the better.

 

Yes, density approaching the crown is low...but when my hair is long (currently ~3.5" in length), it 'shingles' quite nicely to cover the thin spots.

 

Given the issues with my donor, I'm elated to have come this far. My 3rd HT has just begun growing in (currently at nearly 4 months post-op), and am optimistic that the 1,300 additional grafts will allow me to brush my hair straight back, as I used to prior to my hair loss rapidly accelerating in my early 30's. Even if I can't get away with that hair style, I'm fine with the one you see in the photos, albeit grown significantly longer.

 

The net result is that I am far more self-confident today than when I presented to Dr. Beehner 3 years ago. I no longer obsess over my hair. I no longer spend 20+ minutes in front of the mirror in a futile attempt to cover a bald spot the size of a half-dollar. I no longer let my hair loss cripple my social interactions. Mission accomplished, as far as I'm concerned. Thank you, Dr. Beehner.

 

 

 

 

Immediate post op pics would be huge. Otherwise I could see how the transformation presented here could have been achieved in ~1500-2000 grafts.

 

To break it down. The improvement at the crown seems marginal (arguably non existent). The improvement around the sides of the head seems small and could very well be accounted for by differences hair style/length/picture technique. That leaves the frontal hairline... at a glance the pictures tend to exagerrate the improvement there. The comparison of pics 1 and 2 might lead you to initially believe he has a full head of hair... but in reality it's a very flattering shot in that the frontal hairline is combed up blocking the view of the balding areas behind. Pic 7 (pre) and pic 6 (post) have a similiar thing going on, pic 7 is actually a top down shot (showing more balding areas) whereas pic 6 is more level (allowing the frontal hairline to block the view more).

 

Anyways, I think this is probably pretty decent.

[home1212]

very nice, natural and aesthetically pleasing hairline, congrats - Pulpedfiction1.

 

I"m only 2 months post and have decided to keep my hair real short until transplanted hairs starting kicking in, but before the HT, like you, I used to spend so much wasted time styling and trying to make myself look like i had hair, when in fact I was pretty bald! If for nothing else, it feels pretty liberating just being natural and as I am.

[TakingThePlunge]

Well done Dr. Beehner and congratulations to Pulped! The transformation here is substantial and I can see why it's been so life-changing. Enjoy!

[Pulpedfiction1]

Thank you, and best of luck with your growth. Going forward with a HT is a large commitment of both financial and emotional resources, but the progress that usually comes around months 6-8 makes it all worth it.

 

I'm in complete agreement about how natural Dr. Beehner's work is. I work with teenagers; so if anyone was going to make comments about 'fake hair', it would most certainly be them. Not a thing in 3 years! Prior to starting on the HT/Finasteride course, I'd get the regular 'why are you young yet going bald' questions though, of course!

 

 

 

very nice, natural and aesthetically pleasing hairline, congrats - Pulpedfiction1.

 

I"m only 2 months post and have decided to keep my hair real short until transplanted hairs starting kicking in, but before the HT, like you, I used to spend so much wasted time styling and trying to make myself look like i had hair, when in fact I was pretty bald! If for nothing else, it feels pretty liberating just being natural and as I am.

[Torn]

Pulpedfiction1 how are you progressing at this point ? I'd be interested in seeing some after photos. I'm considering another procedure myself and Dr B is on my short list.

 

Grow well....

[Pulpedfiction1]

Actually just saw Dr. Beehner the other day.

 

I'm at nearly the 8 month mark, and am very happy with the results. Everything looks extremely natural.

 

I do not have a full head of hair, but the 'frontal forelock' pattern that Dr. Beehner used in my case really gives that illusion.

 

I keep my hair short on the sides (1"), and long (5"+) on the front. The additional grafts from my 3rd procedure have really helped create that layering effect to easily cover any remaining frontal thinning.

 

The scar from my 3rd procedure did stretch on one side. However, Dr. Beehner was kind enough to offer a complementary scar-revision on the small section of the scar that stretched. Over and done with in 30 minutes..very impressive.

 

I'll put up photos by the end of the week.

 

I'd recommend getting a consult with Dr. B if you haven't done so already. He's a really nice guy and is very much a straight-shooter.

 

 

 

 

 

Pulpedfiction1 how are you progressing at this point ? I'd be interested in seeing some after photos. I'm considering another procedure myself and Dr B is on my short list.

 

Grow well....

[Torn]

Couldn't respond earlier as I and others weren't able to access the forums. Anyway, glad to hear you're happy with the results. Looking forward to seeing some photos.

 

Yes Dr B is on my short list, and I will probably meet with him sometime this year.

 

I'm assuming you're in the NY region, as am I. Of all the Drs available to you here in NY why did you choose Dr B ?

 

Thanks for sharing your story...

 

Torn

 

 

 

 

Actually just saw Dr. Beehner the other day.

 

I'm at nearly the 8 month mark, and am very happy with the results. Everything looks extremely natural.

 

I do not have a full head of hair, but the 'frontal forelock' pattern that Dr. Beehner used in my case really gives that illusion.

 

I keep my hair short on the sides (1"), and long (5"+) on the front. The additional grafts from my 3rd procedure have really helped create that layering effect to easily cover any remaining frontal thinning.

 

The scar from my 3rd procedure did stretch on one side. However, Dr. Beehner was kind enough to offer a complementary scar-revision on the small section of the scar that stretched. Over and done with in 30 minutes..very impressive.

 

I'll put up photos by the end of the week.

 

I'd recommend getting a consult with Dr. B if you haven't done so already. He's a really nice guy and is very much a straight-shooter.