Dr Rahal - 1591 Grafts - FUE - Repair

[mattj]

This patient was aged 21 and had had a NeoGraft procedure elsewhere. The previous surgeon had used large punches (we suspect at least 1.2mm), used multi-hair units in the hairline and the overall design was poor.

 

The goal of the repair was to remove the grafts that were placed too low (especially the multi-hair units) redesign the hairline and add density further back behind the previous work. He had lost hair since his previous surgery.

 

A 0.8mm punch was used to remove the hairline grafts as well as for the donor extractions. The zone of extractions avoided as much as possible the previous area of large punches to balance out the donor.

 

Post-op photos were supplied by the patient at 9 and 10 months.

 

Surgery Type: FUE

 

Recipient Area Treated - 37cm

Total Grafts - 1591

Total Hairs - 2830

Recipient Graft Density - 43 grafts/cm

Recipient Hair Density - 76.5 hairs/cm

 

Graft Breakdown:

Single Hairs - 513 grafts

Two Hairs - 917 grafts

Three Hairs - 161 grafts

Four Hairs - 0 grafts

Average Hairs Per Graft - 1.8

Edited May 3, 2018 by mattj

[Melvin- Admin]

Wow what an impressive repair. Highlights the importance of doing research first, before having surgery.

[JohnCasper]

Very nice job helping this guy out with a relatively low number of grafts used. Bad transplant design with a large punch size is not a good combination. Nice work and thanks for sharing.

[Cheddar]

I feel bad for this guy. The original transplant was brutal. The repair is good, but unfortunately the hairline does not look natural. I think Dr. Rahal did the best he could with the mess the other doctor created.

[Sparky00]

I need a similar procedure in that I need already transplanted hair redistributed by FUE. Although it's probably hard to tell could you please tell me if you think the extracted hair grew well for a second time when it was implanted?

 

It looks like it did but all the growing grafts could have been virgin ones taken from the back.

[Sparky00]

I feel bad for this guy. The original transplant was brutal. The repair is good, but unfortunately the hairline does not look natural. I think Dr. Rahal did the best he could with the mess the other doctor created.

 

I think it looks very natural. You don't think it looks natural in what way?

[harryforreal]

No, the repaired hairline does not look natural. The original "surgeon" should have his medical license revoked.

[mattj]

I work for Dr Rahal so my opinion might be seen as biased, but I think this result looks as natural as any other.

Hopefully the patient will either make it back to the clinic or meet with Dr Rahal somewhere, so that better quality photos can be taken.

[mattj]

Important note: When doing repair at the hairline, the goal is to remove larger plugs but not incur more scarring.

 

Since the pluggy grafts often contain 3-5 hairs per graft and in order to get the whole graft out, you need to use a larger punch.

 

However, we want use the smallest punch possible, typically .75 or .8 mm punch, in order to minimize any scarring at the hairline. With this small punch you cannot always get the whole pluggy graft in the first go, and will occasionally need to go back to remove any pluggy grafts left behind.

[Bill - Seemiller]

Matt,

 

Looks like another homerun for Dr. Rahal. Thanks for posting as usual.

 

Best wishes,

 

Bill

[JayLDD]

Saying this as someone who would easily put Rahal among the very best of hairline surgeons in the world, it definitely doesn't look natural for a number of reasons.

 

Like Matt hinted at clearly there are (many) multi-grafts from the first surgery of which partially remain in front of the new hairline and look unnatural, almost looks like there are two separate hairlines going on. New hairline seems way too flat and low too, especially when the density isn't perfect this is an issue and you can see in some pics strange partings in the low density areas. The hair seems slightly kinkier and thicker than what you'd expect in a natural hairline too but that's not always avoidable in terms of the donor.

 

Obviously hugely better than how it began and a difficult case, but its definitely imperfect.

[mattj]

The position of the new hairline was dictated by the old hairline, which was indeed placed too low. The new hairline has been raised as much as possible through careful removal of many of the old 'plug' grafts. It's possible to see in the immediate post-op photos where they were extracted.

 

The purpose of presenting this case is that there are many clinics out there still performing sub par surgeries, and if they don't use microscopes to sort out the singles from the doubles from triples, after FUE extraction, then you will be at risk of multiple hairs in the hairline. This is much worse if one uses an inexperienced clinic.

 

Also note that the after photos were taken at around 9 months. The transplanted hair is often 'kinky' at this stage (mine was) and it relaxes over time.

 

In a virgin scalp with proper technique you should get a result like this: