Dr Cooley 3,582 grafts Lateral Hump repair

[Dr. Jerry Cooley]

This patient is in his mid-40’s and had hair transplant surgeries over 20 years ago. Fortunately, the original transplant was entirely competent mini-graft procedures that were well planned and state of the art for that time. The hairline fortunately had not been placed too low. His hair loss progressed over the years, leaving the transplanted hair as an isolated island. He was most likely a type IV or V when he had his original surgeries and he progressed to type VII. Despite the number of previous surgeries, I judged he had one good strip left. We performed one FUT of 3,582 grafts to fill in the side walls (‘lateral humps”) and to shrink the crown from the outside in. He is shown one year later with a much more normal appearance.

[Spanker]

This is a success story in that he had had an opportunity to end up much worse. 20 yr old procedure is a little scary but it was OK. Also the doc that put that placemention that conservative made it a win. He ended up a NW7. Lot of things going against this guy but lucky him it worked out.

 

If I hit a nw7 I'm just going to glue a system on top I think.

 

Lucky for this guy and good for him.

[TakingThePlunge]

Looks like this patient's luck continued when he found his way to a top doc for this repair. This is a happy ending for sure. Well done!

[Pete-from-Farjo]

Certainly looks like a challenging case. The patient must be delighted with this result.

[Melvin- Admin]

This is a fascinating case, there is a guy at my work that looks just like his before, it looks terrible, question Dr. Cooley, how many grafts were used to the lateral humps?

 

If I ever become Norwood 7 I think I'll shave my head, but i think in this gentlemens case if he were to do another 2,000 grafts FUE he could strengthen the lateral humps and hairline and look even better.

[wibbles180]

Was this guy on any hairloss meds ?

[Melvin- Admin]

Was this guy on any hairloss meds ?

 

To be honest hairloss meds does very little for Norwood 7's these guys sensitivity to DHT is through the roof so the 30-40% DHT that is still in your body even with meds is enough to continue hairloss. If you're Norwood 7 don't bother wasting your money on meds either plan for a procedure like this, shave your head, or like Spanker said get a hair system.

[esrec]

Much more impressive than the transformations we often see given the circumstances and context.

 

Does he have anything left in the bank?

[wibbles180]

Thanks for the info , how can you tell where you will end up though ? I'm 35 been losing hair since 17 very slowly , been on finasteride for 5 years but unsure if it will work long term so unsure if to commit to surgery or just shave down , I'll attatch a pic any advice would be greatly recieved

[Rashid36]

To be honest hairloss meds does very little for Norwood 7's these guys sensitivity to DHT is through the roof so the 30-40% DHT that is still in your body even with meds is enough to continue hairloss. If you're Norwood 7 don't bother wasting your money on meds either plan for a procedure like this, shave your head, or like Spanker said get a hair system.

 

 

I always wondered how it would look if a persons hair loss progressed.

It was good in this case but what if he did not have that strip what would he have done then?

[mosd]

so scary that we dont know how much hair we will lose.

 

But i guess that is life. We dont know whats going to happen tommorow.

[Davis91]

Wibbles

 

If you can and are willing, try shaving down now or get close to see how your head shape is with a close crop. That way you can say if your head shape is condusive to shaving you can plan for different types of options---eg if you want to keep if close you might want FUE.

 

At this point you likely would progress without finesteride to and NW5 maybe with high sides. If you wanted strip now you could do a 3,000 spread and get a great result if you are stable with your current crop.

[Dr. Jerry Cooley]

This is a fascinating case, there is a guy at my work that looks just like his before, it looks terrible, question Dr. Cooley, how many grafts were used to the lateral humps?

 

If I ever become Norwood 7 I think I'll shave my head, but i think in this gentlemens case if he were to do another 2,000 grafts FUE he could strengthen the lateral humps and hairline and look even better.

 

I understand this case may frighten a lot of guys. But remember it is very unlikely that someone will progress to type VII loss as seen in this case. He did not take finasteride and we can see what happens as the underlying genetics manifests over time. A more likely 'worst case scenario' for most people is to imagine what one will look like as a type V/VI.

 

In this case, about 2,000 grafts were used to rebuild the lateral humps, with the remainder used to fill in the front and 'shrink' the crown. I agree he could use an FUE to further refine his appearance. But he is so happy that he doesn't feel the need at this point. The photos don't fully convey the transformation from someone who looked unnatural from across the room to someone who looks relatively normal after a single procedure. Some men just don't have the head shape to pull off a shaved head look, and he definitely prefers the way he looks now to that. I always recommend young guys try shaving their head before doing a transplant to see if they like (or could live with) that look. If the answer is 'no', that helps in the decision making.

 

Thanks for all the comments.

[hairthere]

Amazing work here Dr. Cooley! That's a complete game changer for this patient.

[Melvin- Admin]

I understand this case may frighten a lot of guys. But remember it is very unlikely that someone will progress to type VII loss as seen in this case. He did not take finasteride and we can see what happens as the underlying genetics manifests over time. A more likely 'worst case scenario' for most people is to imagine what one will look like as a type V/VI.

 

In this case, about 2,000 grafts were used to rebuild the lateral humps, with the remainder used to fill in the front and 'shrink' the crown. I agree he could use an FUE to further refine his appearance. But he is so happy that he doesn't feel the need at this point. The photos don't fully convey the transformation from someone who looked unnatural from across the room to someone who looks relatively normal after a single procedure. Some men just don't have the head shape to pull off a shaved head look, and he definitely prefers the way he looks now to that. I always recommend young guys try shaving their head before doing a transplant to see if they like (or could live with) that look. If the answer is 'no', that helps in the decision making.

 

Thanks for all the comments.

 

Thank your for your response Dr. Cooley, I would be lying if I said I don't stay up at night picturing this happening to me, I wonder at what age did he realize he was destined for Norwood 7, I imagine he had his surgery in his 20's, but what age did the lateral humps begin to drop, I'll be 31 this year and Dr. Rassman said that the majority of men who are Norwood 7 can see a pattern by 30. Do you agrre or what's your thought on this?

[chris39]

Fantastic transformation and great to hear that the patient is delighted .

 

It's also a great example for the young as to why you shouldn't consider surgery at an early age / level of hair loss .

[delancey]

This is a success story in that he had had an opportunity to end up much worse. 20 yr old procedure is a little scary but it was OK. Also the doc that put that placemention that conservative made it a win. He ended up a NW7. Lot of things going against this guy but lucky him it worked out.

 

If I hit a nw7 I'm just going to glue a system on top I think.

 

Lucky for this guy and good for him.

 

What would you do if you hit a Norwood 6?

[Dr. Jerry Cooley]

Thank your for your response Dr. Cooley, I would be lying if I said I don't stay up at night picturing this happening to me, I wonder at what age did he realize he was destined for Norwood 7, I imagine he had his surgery in his 20's, but what age did the lateral humps begin to drop, I'll be 31 this year and Dr. Rassman said that the majority of men who are Norwood 7 can see a pattern by 30. Do you agrre or what's your thought on this?

 

I agree with Dr Rassman that most men who end up type VII will demonstrate some signs of this by age 30 (e.g. curly hairs around the ears, faint thinning low in the crown, etc). But obviously there are exceptions to the rule. Fortunately, type VII loss is uncommon.

[Melvin- Admin]

I agree with Dr Rassman that most men who end up type VII will demonstrate some signs of this by age 30 (e.g. curly hairs around the ears, faint thinning low in the crown, etc). But obviously there are exceptions to the rule. Fortunately, type VII loss is uncommon.

 

Thanks again Dr. Cooley for your informative response, I guess I do have some thinning above the ears and nape, commonly referred as retrograde alopecia, but my lateral humps appear quite strong and my crown hasn't dipped low, currently I appear just like the Norwood 6 pattern on the Norwood scale, but it's always a fear that I may become Norwood 7, but then I think who knows if I'll live another 10 years, sometimes we think so far ahead without remembering that tomorrow is never promised, do what we can to be smart about our procedures today but at the end of the day try not to worry to much.

[Rashid36]

I'm 35 years old and don't know if i will be norwood 7 but the signs are there

just don't know if i should risk a transplant?

[htreporter]

Dr Cooley

 

Great work! I really appreciate the cases you post. Not only these difficult repair cases, but also a lot of big mega session surgeries. I think there is a lot to be said for your scientific experimentation with things like Acell too.

 

Keep up the good work!