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This 46 year old man presented with a history of having undergone a 1500 graft FUE hairline restoration.  His previous surgeon promised a “no-shave” restoration so as to comply with his desire to maintain an inconspicuous appearance postoperatively.  The patient complained that there was little if any density gain from his first attempted restoration.  His request upon presentation was to restore frontal coverage and a reasonably defined hairline.   

His examination revealed scant frontal coverage with no semblance of a frontal hairline.  His donor area revealed two distinct “strips” where FUE harvesting had been performed.  Presumably, long hair had been maintained above and below each linear harvest zone for the intended goal of “hiding” his procedure.  The grossly unnatural appearance of the donor area surprised and disappointed the patient. 

A secondary repair procedure was recommended, once again using FUE harvesting, but designing the harvest to blend the harsh appearance of the donor site scar pattern.  A conservative session of 1500 grafts was recommended in an attempt to remain cautious because the etiology of the first session’s low yield was not fully apparent.  Of note is that the patient was reluctant to use a shaved approach for the donor harvest, which prompted my comment, “You did that once before and look how it turned out”.  Harvesting was confined to areas above and below each prominent FUE-strip-pattern scar.  Graft placement was performed using a no-shave, stick-and-place technique.  The restoration focused on hairline definition and generalized frontal density enhancement. 

Presented here are two-year postop results.

 

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Preop Front

 

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Preop Left

 

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Preop Right

 

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Preop Hairline Plan

 

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Postop Front 1

 

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Postop Front 2

 

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Postop Top 1

 

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Postop Top 2

 

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Postop Top Part View

 

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Postop Left 1

 

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Postop Left 2

 

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Postop Left 3

 

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Postop Left Comb-back View

 

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Postop Right

 

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Postop Right Comb-back View

 

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Preop Donor View

 

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Immediate Postop Donor View

 

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Immediate Graft Placement View

Edited by Dr. Raymond Konior
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9 hours ago, 911fan said:

Looks like he harvested from the crown region?

I wouldn't call that the crown, but yes it is outside the typical FUT "strip" zone.  If the patient has healthy hairs without signs of miniaturization then they are viable FUE grafts. The doctor would be able to see that with magnification.  This also helps avoid the appearance of an over harvested area in the donor region (e.g. the FUE strips from the patient's first surgery at a different clinic). 

Edited by aaron1234
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