Dr. Brad Limmer's 1250+ graft case committed to medical therapy.

January 29, 2010

The patient presented here dropped by my office over the holidays for the first time since his original transplant in December 2006. He will be 50 years old later this year and while he has had a nice result from his transplant, the reason I chose to present him is because he demonstrates the benefits that adjunctive medical therapy has for patients undergoing transplantation.

While not bald he has significant loss over a Norwood pattern IV-V (as seen in his preop photos). At the time of his original consult he was not using any medical therapy. After thorough counseling we decided what matched his goals best was to strengthen his hairline, plant his anterior mid bridge and initiate Propecia and Rogaine.

His procedure was relatively easy removing 14 sq cm of donor from his right parietal occipital scalp containing a follicular unit density of 90 grafts/ sq cm. The 1250+ grafts were then used to restore an age matched hairline and fill the anterior and mid section of his scalp.

Almost 3 years from the date of his transplant he re-presented to the office. He was very happy with his results both from his transplant and Propecia. While he had no problem with Propecia he ran out of it ~6-8 months ago and was now beginning to see some pull test positivity in the anterior crown (losing some of the positive gain he had gotten from Propecia).

After lengthy discussion he is recommitted to full medical therapy (Propecia, Rogaine, Nizoral shampoo and biotin) and plans to slightly lower and widen his hairline. Some crown work might be done, but if he responds to re-starting medical therapy it might not be needed. This case highlighting the benefits of being committed to medical therapy.

Included with his standard preop and post op photos are 2 from his posterior scalp from which the donor was taken. These are included for those concerned with donor scarring. He had just had his hair trimmed using a clipper with a #2 guard and while you can slightly see through his hair to his scalp, no visible scar can be seen.

Brad Limmer, MD/jac