Augmenting existing hair pattern

[Guest Brad Limmer, MD]

This case presented last week for routine follow up and medication refill. I feel he represents a great case utilizing a conservative surgical approach, combined with medical management (patient on finesteride but declined using Rogaine).

As often noted, many on the forum seem to preach max graft numbers for every case. Encouraging many guys to believe more is absolutely better. But with those increased numbers come potential complications, and in this case it would be temporary/permanent loss of some of his existing hair that can be saved by medical therapy.

Shown are his pre op and post op photos after performing standard follicular unit micrografting. Just fewer than 1200 grafts were placed deep in his temporal recessions and behind his remaining frontal tuft. He did not want to change his hairline, only augment his existing pattern.

We harvested 15 sq cm of donor with a f.u. density of 80 grafts/ sq cm using standard elliptical donor harvest, double layered closure with absorbable sutures, and microscopic dissection of the grafts. The grafts were placed using the stick/place method in 0.6 - 0.9 mm coronal/laterally oriented recipient sites. His post op was not complicated, nor did he experience any shedding of hair in the recipient zone.

His post op photos (taken 2 days after having a hair cut) show excellent growth of grafts and retention of pre existing hair. Would more grafts have made him look any better? Both the patient and I feel, minimal at best. His donor area photos show him to be able to wear his hair very short (see through) and even in spite of his high color contrast (light skin vs. dark hair) you cannot see his scar.

Patient plans to continue medical therapy and hold off on additional grafting at this time. This shows that a dramatic change can be made for many patients while curbing cost and risk. If he had been a full blown Norwood pattern 3A, I would have recommended 2500-3000 grafts. But being that his pattern was stable and he was committed to medical therapy we were able to add an appropriate number of grafts to his existing hair obtaining a full and completely natural look.

Brad Limmer, MD/jac