1784 FUE grafts- Dr. Taleb Barghouthi/Vertex Hair clinic

[DrTBarghouthi]

Dear community,

This is a 28 year old gentleman who had an FUE procedure done in April 2021 . He is a NW 4 pattern with a family history of the same. His donor area is of good quality.  We did around 1784 grafts for both the frontal and temple recessions. He used finasteride intermittently but is not being compliant with it. He was recently switched to topical finasteride/minox 5%

 Photos were taken  at around 7.5 months from surgery. He was advised to strictly comply as delay of any further progression is vital and would help with any early thinning in frontal and ms zones. 

Surgical details:

FUE 0.8 mm punch

Hairline :400 refined single hairs

2's" 450

3's: 699

4's: 235

Average of 2.43 hairs/graft. 

Sites made using 0.8 mm and 1.4 mm Sapphire blades. 

Before photos: 

Planning:

 

Immediately after:

 

 

10 days after: 

7.5 months after:

 

 

Comparison photos: 

 

 

 

 

Combed back photos: 

 

 

[Britanium]

Very nicely done 🤩 thanks for posting @DrTBarghouthi🙏

[Zoomster]

Very nice work ..you can see he can still look forward to further maturing of what’s already grown in ..

He must be very happy .

[Future Hair Doc]

Awesome results and a great demonstration of graft preservation. Thank you for sharing

[Curious25]

Nice improvement with such little grafts. 
 

Is your philosophy within hair restoration to be conservative in general, or were you working with limited donor in this case ? 
 

By no means a critique, I’ve just noticed your results to be less aggressive designs, using low graft numbers relative to the amount of loss that patients present with. 

[DrTBarghouthi]

13 minutes ago, Curious25 said:

Nice improvement with such little grafts. 
 

Is your philosophy within hair restoration to be conservative in general, or were you working with limited donor in this case ? 
 

By no means a critique, I’ve just noticed your results to be less aggressive designs, using low graft numbers relative to the amount of loss that patients present with. 

Thanks for the comment. It does depend on the case to be honest. I always believe that adding more in the future is a safer option for the patient given that no one can predict future hairloss or even compliance with maintenance meds. So making an improvement with a more conservative number can come handy in the future. This gentleman is in his late 20s. Donor is good but not great, so I’m sure he may be looking for mid section or even some frontal or crown work in the future. Having an aggressive hairline for him at this stage might prevent him from reaching his full goals. If there happens to be room to lower it in the future then that’s no problem ofcourse. 

[Curious25]

57 minutes ago, DrTBarghouthi said:

Thanks for the comment. It does depend on the case to be honest. I always believe that adding more in the future is a safer option for the patient given that no one can predict future hairloss or even compliance with maintenance meds. So making an improvement with a more conservative number can come handy in the future. This gentleman is in his late 20s. Donor is good but not great, so I’m sure he may be looking for mid section or even some frontal or crown work in the future. Having an aggressive hairline for him at this stage might prevent him from reaching his full goals. If there happens to be room to lower it in the future then that’s no problem ofcourse. 

Just a question out of curiosity - and this isn’t specific to you, or this case . . If a patient opts for a frontal hairline restoration such as this gentleman, and a higher, more mature hairline is deemed to be the best approach at the time; if in 5-10 years down the line, and the patient has maintained with little to no further loss, and wishes to then lower his hairline - would this have essentially created a waste of utilising the band of single and finer haired grafts in the original restoration, and they will now serve less of a cosmetic purpose in what would become more of a mid section of the patients hair? Or would it be best practice to re-extract these same singles, and re-utilise them in the new hairline? 

[LaserCaps]

13 minutes ago, Curious25 said:

Just a question out of curiosity - and this isn’t specific to you, or this case . . If a patient opts for a frontal hairline restoration such as this gentleman, and a higher, more mature hairline is deemed to be the best approach at the time; if in 5-10 years down the line, and the patient has maintained with little to no further loss, and wishes to then lower his hairline - would this have essentially created a waste of utilising the band of single and finer haired grafts in the original restoration, and they will now serve less of a cosmetic purpose in what would become more of a mid section of the patients hair? Or would it be best practice to re-extract these same singles, and re-utilise them in the new hairline? 

You do bring up an interesting point.  If the patient arrives for the first time, and does want to address the hairline, the doctor will try to use the finest hair he can find, regardless of the location.  It is important to remember, there is no such thing as a hair line.  It is a transitional zone that eventually develops into something. (At that point the doctor, nor the patient, know if there will be a second procedure).  In the old days hair from the nape was used but soon thereafter doctors noticed retrograde.  Scars were becoming noticeable and patients were losing the grafts that came from that area. So now hair is harvested from behind the ear.  Years later, as per your question, if the patient returns to lower the hairline, the same process will apply.  

No, it was not a waste of time....If the patient enjoyed the results, the grafts did serve their purpose.  They will still add density to whatever future work the patient decides to have down the road. (Next time you do a consultation, have the doctor use a scope, to show you the different groupings of hair throughout the whole head.  You'll notice an array of groupings, even single hairs). 

[Melvin- Admin]

Fantastic results 👏🏼

[DrTBarghouthi]

2 hours ago, Curious25 said:

Just a question out of curiosity - and this isn’t specific to you, or this case . . If a patient opts for a frontal hairline restoration such as this gentleman, and a higher, more mature hairline is deemed to be the best approach at the time; if in 5-10 years down the line, and the patient has maintained with little to no further loss, and wishes to then lower his hairline - would this have essentially created a waste of utilising the band of single and finer haired grafts in the original restoration, and they will now serve less of a cosmetic purpose in what would become more of a mid section of the patients hair? Or would it be best practice to re-extract these same singles, and re-utilise them in the new hairline? 

Agreed with @LaserCaps. If a hairline is lowered down the line, the transitional single hairs can stay there and as they are surrounded by other groupings of hair, they wouldn’t influence the density. It is less effective to extract them all than to leave them blend with the new lowered hairline.

[Montreal]

thats not alot of grafts why do most the surgeons use 2500grafts for the hairline

Edited December 8, 2021 by Montreal

[Curious25]

10 hours ago, DrTBarghouthi said:

Agreed with @LaserCaps. If a hairline is lowered down the line, the transitional single hairs can stay there and as they are surrounded by other groupings of hair, they wouldn’t influence the density. It is less effective to extract them all than to leave them blend with the new lowered hairline.

I understand about the ability to create a transition zone, so there not being an issue with it standing out as such. My point more so was, if one was to restore a patient from a ‘blank canvas’ . . then they wouldn’t place a band of singles and finer hair in this mid section of the design, as it wouldn’t make sense - therefore retrospectively, if hairline lowering is carried out on a patient at a later date, their graft utilisation and efficiency wouldn’t be as good as what a pre planned full restoration of a patient would provide ? 

[DrTBarghouthi]

47 minutes ago, Curious25 said:

I understand about the ability to create a transition zone, so there not being an issue with it standing out as such. My point more so was, if one was to restore a patient from a ‘blank canvas’ . . then they wouldn’t place a band of singles and finer hair in this mid section of the design, as it wouldn’t make sense - therefore retrospectively, if hairline lowering is carried out on a patient at a later date, their graft utilisation and efficiency wouldn’t be as good as what a pre planned full restoration of a patient would provide ? 

Well if you think about it, if someone goes for future hairline lowering, the previous hairline is in no way considered mid scalp. It will still be part of the frontal zone. The single hairs in the old hairline will be forming 2-3 mm band which will not be noticeable when you create more singles and multiples in front of them. 
I guess the question is: what would look more obvious? An  aggressively low hairline with ongoing loss further back and the inability to provide nice overall density OR the unnoticeable band of single hairs in the frontal zone?

 

[Curious25]

43 minutes ago, DrTBarghouthi said:

Well if you think about it, if someone goes for future hairline lowering, the previous hairline is in no way considered mid scalp. It will still be part of the frontal zone. The single hairs in the old hairline will be forming 2-3 mm band which will not be noticeable when you create more singles and multiples in front of them. 
I guess the question is: what would look more obvious? An  aggressively low hairline with ongoing loss further back and the inability to provide nice overall density OR the unnoticeable band of single hairs in the frontal zone?

 

That makes sense. Thank you for taking the time to answer Dr. 

[DrTBarghouthi]

You’re welcome 🙏🏻🙏🏻

[JohnCasper]

Nicely done.  Thanks for sharing the results. 

[stephcurry30]

Great conservative result

[Montreal]

more doctors should suggest this conservative approach for people receiding 

[DrTBarghouthi]

An Update Of the above case at 13 months.

 

 

 

[A Fue Good Men]

Thanks for sharing. And thank you for the great before and afters with similar lighting. Well done

[RTC]

Really love how subtle this is. That guy was pretty much the exact same Norwood as me with same style of hair loss. If only I saw you instead of Asli Tarcan!