*VID/PICS* 2,000 Graft Hairline Case / Feller & Bloxham / Dr. Blake Bloxham (NY)

[Dr Blake Bloxham]

Last week, I discussed the importance of individual planning when it comes to hairline transplantation. I touched upon how things like a patients age, likely progression of hair loss, adherence to preventive medications, and current level of hair loss all come into play.

 

I then shared a case where I performed a 2,200 graft hairline (and frontal scalp) transplant on a young patient with a fairly significant amount of loss in the front, a hesitation towards certain medications, and a fairly high likelihood of future loss. In that patient, I took all of this into consideration and designed a more conservative, feathered hairline plan that would serve him well in the long-term and put us in a good position for future surgery. I'll put a link up at the end.

 

So today I wanted to share another hairline case that again utilized an individual and unique approach, but is very much the opposite of the first patient. Based on this patient's age, family history/physical exam, adherence to medications (which he was on long before surgery), and facial shape/hair type, I designed a more aggressive approach. I utilized around the same number of grafts -- 2,000 -- and did a dense pack hairline rebuild.

 

Below are images sent in by the patient (and left completely untouched) at the 12 month mark. They are included with some "befores" and intra-operative shots for comparison.

 

This can be compared with the other case to show how hairline transplantation must be individualized. No two patients are the same and there is no "one size fits all" approach. Many factors must be taken into account, but it usually results in happy patients if everything is closely analyzed and a well-strategized plan is executed.

 

Here is the other "opposite" hairline case for comparison: 2,200 Graft Hairline / Dr Bloxham

 

Enjoy and Happy Holidays!

 

Video:

 

 

Pictures (attached):

[harryforreal]

Nice outcome, Dr. Bloxham. FUT?

[Dr Blake Bloxham]

Thank you for the kind words.

 

Yes, this was done as an FUT (as was the other hairline case). I forgot to include this information!

[Sean]

Well planned. Good yield. Nicely executed.

[Dutchie]

Undetectable hairline. Great work

[Dr Blake Bloxham]

Sean and Dutchie,

 

Thank you!

[hsrp10]

That's some very dense work Blake, I think there's a new density king in N. America for sure. :cool:

What is the transplanted density in grafts/cm2 in this case, and what is the maximum you plant in your "as much as possible" procedures?

 

Very impressed

[Dr Blake Bloxham]

HS,

 

Thank you for the kind words. I'm an absolute believer in dense packing. There is a definite "right" way to do it and you need to be safe and not overwhelm the tissue, but there is no doubt that the dense "frontal band" (like I did on this patient) can make a result a true "home run."

 

I try not to focus on numbers when it comes to slits (or grafts) per cm^2. I know it probably sounds a little counter intuitive, but a lot of it comes down to 1) the overall goal, 2) the way the tissue is responding to the dense packing during slit creation, and 3) the patient's follicle size/hair type. Three is especially important; for patients with very fat follicles that grow thick, coarse hair, 45 grafts/cm^2 will provide as much, if not more, density than someone with thin follicles (and therefore finer hair) at a density of 55 grafts/cm^2 -- for example. If you tried to pack them both at 55 or 60 grafts/cm^2, you could run into some issues with overwhelming the tissue with the guy who has the fat follicles. But if you tried to pack them both at 45 grafts/cm^2, the guy with the finer follicles may not get that thick, dense look. So I kind of take all of this into account, create an appropriate blade size (I use all cutom cut blades with lateral incisions), and go as dense as I can while still maintaining a safe and "correct" look. And this refers more to the multis compared to the singles. Singles you can be a little tighter in general, but that's a whole other discussion!

 

I'll throw up some pictures I have of slits before grafts were placed. It will probably clarify the correct "look" I'm describing a little more clearly.

 

I think you're referring to the maximum graft number I would transplant in an "AMAP" or "as much as possible" procedure? Again, it really depends on the patient. This is an FUT approach, so it really comes down to how much I can safely extract from the back as a strip. I probably take a little more time than most in the morning figuring out my margins for the strip. The goal, in my mind, is to maximize the yield without compromising the closure. So once I know the maximum dimensions of the strip, the patient's density determines how much "AMAP" they will really get.

 

For some, it may be 3,000 or 3,500. For others, it may be up to 5,000 or more. And I know there is some controversy when it comes to cases of this size, but I do believe it is ethical as long as it as done as an FUT -- because of my views on FUT and how it preserves the donor.

 

Hope this helps! Again, thank you for the kind words.

[hsrp10]

Thanks for the detailed reply!

That adds a lot to take into consideration other than just the number game for sure.

 

Three is especially important; for patients with very fat follicles that grow thick

Have you seen cases where patient's with finer caliber hair also have thicker or somewhat fat follicles?

Or is it just the coarse hair types who have the large follicular tissue?

 

Looking forward to the pics when you have time.

[Dr Blake Bloxham]

HS,

 

Yes, I have. I've seen patients with finer caliber hairs have more "splayed" follicles (multis) at the bulbs which necessitated larger slits; I've also seen patients with fatter hairs have slimmer bulbs and require smaller blades/slits (I've actually seen this several times in Indian patients); and it feels like I've seen all manner in between! Averages being averages, however, it usually holds that individuals with finer hairs have smaller FUGs and vice versa.

[YouOnlyLiveOnce]

Looks like he's got a nice result. IMO he should go shorter on the sides and use some product to tame/style it.