Repair case using a combined HT and Hair system- Dr. Taleb Barghouthi- Vertex Hair Clinic

[DrTBarghouthi]

Dear community,

This is a rather unusual case to share but the aim is to highlight some possibilities in hair restoration for patients with depleted donors or higher expectations of density or both. This 45 year old gentleman had two failed FUE procedures starting in 2011. He had around 5500-6000 FUE grafts harvested elsewhere leaving him with an obviously depleted donor and near zero growth. He even tried SMP but that even ended up fading and color migration, leaving a blue/green discoloration. 

The patient desired full coverage and although reasonable regarding his failed procedures and accepting of the fact that his options are very limited, I suggested a combination approach of both a Hairline and defined zone transplant along with a custom made hair system for the remainder of the hair loss area. I do believe that hair systems are evolving nicely, however, I still think that the hairline part of it can look unnatural and awkwardly dense and that mainly due to manufacturing technicalities. I often refuse suggesting a full hair system without having an existing soft or natural hairline. This technique involves good planning in order to take the measurements for the hairsystem a month or two after the transplant is done, making sure that we have recorded measurements before, during and after the procedure. 

The donor area was clearly depleted for a decent FUE or even FUT. He had no interest in getting any FUT scars so that reduced the options further. We managed to cherry-pick around 1400 FUE grafts from the entire donor. Although he had a good beard, we were reluctant to harvest from it since all of these grafts are going on the hairline and did not want to risk any unsightly grafts. 440 single hairs were placed in the transition zone and the remainder in his defined zone. We covered around 1.5 cm area with the transplant and the measurements of the hair system were then taken 6 weeks after bearing in mind these measurements. 

6 months later, the transplanted hair started growing enough to cause a nice blend in the front. We decided to go ahead with applying the system at this stage, knowing that he will still get even better camouflaging when all transplanted grafts grow. The photos of the final results are taken 6 months after the HT and at the time of application of the system. 

I just thought that this case can probably provide some additional insight to what can be done to ensure as close to natural results as possible even given the limitations of donor depletion or even having demanding clients who need full and dense coverage. In a typical scenario, such patients will be usually refused surgery, but in those who understand their case well, such options can be very rewarding and pleasing. 

 

Before Surgery:

 

 

 

Immediately after: 

 

6 months of HT growth:

 

 

Combined application of hair system: 

 

[Britanium]

Wow such a interesting case! It’s nice to see that a natural hairline was created as it now looks looks really good. 

[Melvin- Admin]

Very interesting case, I’ve always thought those extremes that aren’t candidates could always opt for a partial system. Great presentation 👏🏼

[OliverAtom]

Wow!!! First time I see something like this 🙉 and ... it looks SOOOO good!

Patient has to be really happy.
Congratulations!!!

[Gatsby]

Congratulations. I was also offered this solution to my MPB a few years ago. The reason I opted out of this was because after 25 years of wearing a hair piece I was no longer interested in wearing one. This answer however does solve the hairline problems associated with hair pieces (although they have come of age recently). As long as a patient is willing to continue wearing a hair piece this is an excellent choice. Thanks for sharing.

[Al - Moderator]

This is the sort of idea that I wanted when I went for my first hair transplant as I was already wearing a hair piece prior to that. The biggest issue with a hair piece is the front is always noticeably fake unless you have curly hair like Gatsby and can hide the hairline. I wanted the front half transplanted and wear the hair piece for the crown and then maybe 20 years later when I was into my 40s and didn't worry so much about the crown being thin I'd get rid of the hair piece and do a thin transplant to the crown so it wasn't completely bald. Today with body hair grafts being available I could have had several thousand grafts done on the crown. I was discouraged from this plan by the Dr who insisted that I could have a full head of hair with just hair transplants. I wish I would have gone with the frontal transplant and crown hair piece. I would have had a full head of hair for the past 30 years instead of being bald all that time. This is definitely something some guys with extensive loss should consider.

 

Edited October 22, 2020 by BeHappy

[DrTBarghouthi]

Thank you all for your positive feedback. It is really a tough decision when you feel you’re getting someone to commit to a hair piece for long. Definitely a case by case scenario. Nonetheless, I often tell patients that there’s a fine line between being happy or not with a hair piece and this is almost always the hairline. What we have to understand is when a hair piece is put on, the transition-unlike a transplant- is immediate and sudden. Psychologically our brain might not accept any exaggerated changes especially if there is a slightly unnatural appearance. A transplanted section in front of a hair piece serves both to make the hairline natural but also puts the patients mind at ease as he knows he has nothing “fake” in front. 

[voxman]

Excellent work and execution.  The hairline and matching piece are totally indistinguishable.

[Bamboo]

This looks amazing. Congratulations.

 

The patient obviously wanted quite a dense outcome. Would the surgery/system work as well if only a light density is required.

 

I wear a light density system with which I am generally happy apart from the hairline, for the reasons you’ve outlined. 
 

I would prefer a much softer low maintenance hairline that I could comb backwards with visible scalp etc. 

 

Is this just as easy to achieve?

[DrTBarghouthi]

Thank you. Yes I think a transplanted hairline is the only way to achieve a realistic hairline. No system does that in my opinion. Please feel free to share some photos if you like. 

[ssimpson7511]

On 10/22/2020 at 4:09 AM, BeHappy said:

This is the sort of idea that I wanted when I went for my first hair transplant as I was already wearing a hair piece prior to that. The biggest issue with a hair piece is the front is always noticeably fake unless you have curly hair like Gatsby and can hide the hairline. I wanted the front half transplanted and wear the hair piece for the crown and then maybe 20 years later when I was into my 40s and didn't worry so much about the crown being thin I'd get rid of the hair piece and do a thin transplant to the crown so it wasn't completely bald. Today with body hair grafts being available I could have had several thousand grafts done on the crown. I was discouraged from this plan by the Dr who insisted that I could have a full head of hair with just hair transplants. I wish I would have gone with the frontal transplant and crown hair piece. I would have had a full head of hair for the past 30 years instead of being bald all that time. This is definitely something some guys with extensive loss should consider.

 

True the hairline is the toughest part, what really helped me was going grey...no knots and i'm amazed how it looks, there's just no way you can tell.  Having said that there's people with jet black hair who wear completely slick back Hair pieces and look incredible.  Hair pieces like HT's have progressed so much over the past 2 decades.

 

 

[Rafael Manelli]

This is great. I would really love to see closeups, wet photos and a comb through video of this. 

Personally I wonder if you should go for most aggressive and idealistic hairline if you take this approach...

[bigmistake]

Hi @DrTBarghouthi Firstly, I really like the work you are doing with Verteporfin. In this particular case was the height of the hairline from the glabella after the surgery, because in the photos you have marked 9 cm on the upper line. Was the hairline removed and moved to a higher position ? 

[DrTBarghouthi]

Thank you sir. 9 cm is the height from the glabella to the beginning of where the hair system will be placed. It is important to have a fixed distance so we can always apply the system in the exact same place to fit the shape of the head properly and to know that we are placing it right behind the transplanted area. 

[DrTBarghouthi]

We transplanted the area under the 9 cm as seem in the photos. 

[bigmistake]

1) Can a hair piece be made so that it looks age appropriate as the patient ages.

2) If the patient does not wear a hair piece, will this hairline look unnatural or do people go bald behind the hairline as well ? 

[CharlesBarkley]

Fantastic result with this combo. HT + Hair system

[juneja]

 This guys looks like a young man. Good! 

[DrTBarghouthi]

On 3/22/2023 at 6:10 PM, bigmistake said:

1) Can a hair piece be made so that it looks age appropriate as the patient ages.

2) If the patient does not wear a hair piece, will this hairline look unnatural or do people go bald behind the hairline as well ? 

It would depend on the case. In some cases you have to make sure the patient knows that not wearing the piece might be odd looking or require a buzz cut. It can be made age appropriate using even grey hair or less density to a certain extent. 

[bigmistake]

@DrTBarghouthi Can the patient grown the transplant hair long and slick them back to cover his midscalp and crown.  Something like this:

https://coolmenshair.com/wp-content/uploads/balding-long-hair-1.jpg

 

https://www.indiatimes.com/amp/health/tips-tricks/hiding-that-bald-patch-with-a-man-bun-well-you-could-be-risking-losing-more-hair-321769.html

Edited April 16, 2023 by bigmistake