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Dr. Cole - 900 FUE crown restoration, class 3v, 9 months post-op - Case M


#1

Hi forum viewers,

This patient had a class 3 vertex balding pattern and medium caliber, light brown hair with just average donor density of about 180 hairs per square centimeter. The patient’s goal was to thicken the vertex via CIT and regain a more youthful appearance. With CIT, we can harvest the best follicles and control how many grafts we transplant. Our patients choose CIT because it allows us to harvest donor resources more efficiently than strip and doesn’t produce the linear scar associated with strip. Dr. Cole treated this patient by successfully transplanting 900 CIT grafts. The hair’s growth pattern in the crown/vertex is helical and the inconsistent grain in the region is the reason that obtaining ideal coverage in the area can be difficult. At 9 months post-op, the patient now enjoys a more youthful appearance and can wear a very short hairstyle if desired.

Pre-op & immediate post-op

Pre-op & follow-up


#2

Great result for only 900 grafts!!! It gives me hope :slight_smile: can I see more pictures or more results like this?


#3

Very impressive for only 900 grafts. :ok:


#4

Looks great, totally natural.


#5

This is only 900 grafts and it looks quite decent covering the crown, granted it is a thin light density look, but as long as we are not greedy I see no reason why we cannot have hair transplant in our 20s.


#6

It appears to be very natural but I wish you had more pictures, you only have 1 “after” picture and it is kind of dark.


#7

It seems to be very nice according to the picture, this could have been one of the best 900 crown work ever, too bad you only have 1 pic and it’s all blurry. I assume it’s taken by the patient himself?


#8

need better pictures and add a video


#9

Nicely done. Without a doubt.


#10

Any more cases like this? Small # of grafts but big effect.


#11

» It seems to be very nice according to the picture, this could have been one
» of the best 900 crown work ever, too bad you only have 1 pic and it’s all
» blurry. I assume it’s taken by the patient himself?

NeverAgain and all,

It is difficult to see each follicle, but overall coverage is probably acceptable for 900 grafts. The patient was kind enough to allow us to post it so I thought it would be noteworthy as the crown is the “black hole” of the scalp. There are many clinics out there that would have transplanted around 2300 grafts in the crown of this patient. We prefer to strategically transplant a conservative amount of grafts in the crown because further recession can expand the perimeter of the balding area. I should definitely have more photos to share on this case in the very near future.


#12

» Any more cases like this? Small # of grafts but big effect.

Yes, here is another case where a small number of grafts were placed and a big effect was achieved.


#13

I think any hair transplant procedure should consider the immediate affects over one or two years and the long term affect over 10 or more years. It is often very important to young patients to graft their crown area. This can be a double-edged sword though and open a Pandora’s box later on. If you graft a crown with three and four hair grafts (or larger grafts for that matter), you achieve an immediate positive result. The problem is that crowns often get wider over time. This is especially true in those patients headed for a class 5 or 6. As the loss in the crown increases, the perimeter gets larger and the area between the original grafts and the natural widening border becomes separated by a bald zone. This can lead to an even worse scenario than being bald, as no man likes to appear as though he had a hair transplant. In addition the larger grafts themselves look like transplanted grafts when you loose the surrounding density. By making the grafts smaller, you reduce the initial coverage, but you create a safety net for later on. The smaller grafts will appear like an area of thinness rather than a dense grafted looking area surrounded by a sea of hair loss or bald skin. Of course it is possible to remove the larger follicular units at a later date and re-graft them, but this requires a subsequent procedure. Sometimes it is better to simply avoid the potential problem by focusing on a long-term solution rather than the short-term benefits of having hair. I always do my best to give my patients the options and explain the benefits and risks of both.

It is important to remember that the donor area is finite at this point and we simply cannot put our eggs into a basket that may never materialize in time such as hair cloning. It is best to hope for this rather than to depend on it. The donor area is like a supply of bricks. If you are going to need a larger home, you may not have enough bricks to build it. Therefore, you better plan on a smaller home from the beginning rather than planning for a larger home and coming up short with little recourse at a later date.

I am particularly concerned about some of the lower hairlines that I’ve seen lately. If a class 2 later becomes a class 5, he is going to look rather unnatural with a lower hairline and a large area of hair loss behind this. Of course this is much less of a risk in the middle age patient, but the middle age patient is going to generally be much happier with a mature hairline rather than an adolescent hairline. It is particularly hard to match the hair in the temple area where the hair is finer. Placing more coarse hair in the temples will lead to a disparity in hair caliber that becomes increasing unnatural as the temple area continues to move backward and the surrounding native temple hair becomes finer. Properly building the angles in this area is a must, as well. Temple work where the hairline meets the temple points has become increasingly popular. I think it is one of the most problematic situations I have seen in the past years and very frequently requires some sort of corrective work in patients who had this area grafted by physicians who often do not seem to understand the finer points required to successfully graft this region.
The bottom line is that we can often achieve a much better result by doing less and limiting patient expense. This effort to minimize work and cost often leads fewer surgeries in the future, not to mention a reduced cost later in life. Of course the option remains up to the patient, but I strongly encourage them to consider the long term consequences of hair transplant surgery as opposed to limiting one’s focus on the short term benefits.


#14

Dr. Cole,

Excellent post. Should probably be posted as its own thread.

Yours,
TheFittest

PS: I’ll see you in Atlanta one fine day to sprinkle those last few grafts. Time flies. :wink:


#15

As always you inundate me with compliments. They certainly help give meaning to life and invigorate the spirit.

It is good to chat with you online after so many years, Fittest. This brings up another topic. I recall that you wanted another procedure even though I felt confident we were finished unless you experienced more hair loss. Fortunately, you did not have an acceleration of hair loss and we have not needed the final large procedure you anticipated. Of course you also cannot predict how much hair it takes to make someone happy, but you can expect that two large, dense procedures in the same area will make 90% of all patients happy. A third smaller procedure will make 95% happy, but 5% will always want just one more procedure. Density alone does not seem to make this small percentage content.

When I finish a procedure, I generally tell patients to grow it out for a minimum of 8 months before they consider another procedure. Many already have planned the next procedure before the first one, but I encourage them to wait. The rationale for this is that it takes time for all the hairs in the grafts to grow. Once they start growing it takes time for the hair to reach a sufficient styling length. For the latter reason, 12 months of evaluation is even better than 8 months. It is quite true that after 8 to 12 months, the patients no longer see an emergent need for the next procedure and often gain a prolonged interval between procedures.

Of course I would love to see you again anywhere, but I hope you will not require another procedure. My objective remains to get as many off the hair restoration train as possible. Currently, we are planning a new facility in the Dominican Republic, which will be focused on reduced costs. We have trained a number of physicians now including the clinics in Brussels, HDC in Cyprus, and the clinic in Korea. All of them are performing outstanding work. I expect the same of the facility in the Domincan Republic. It is still in its infancy though and it will take a little longer to work out the logistics there.


#16

» I think any hair transplant procedure should consider the immediate affects
» over one or two years and the long term affect over 10 or more years. It
» is often very important to young patients to graft their crown area. This
» can be a double-edged sword though and open a Pandora’s box later on. If
» you graft a crown with three and four hair grafts (or larger grafts for
» that matter), you achieve an immediate positive result. The problem is
» that crowns often get wider over time. This is especially true in those
» patients headed for a class 5 or 6. As the loss in the crown increases,
» the perimeter gets larger and the area between the original grafts and the
» natural widening border becomes separated by a bald zone. This can lead to
» an even worse scenario than being bald, as no man likes to appear as though
» he had a hair transplant. In addition the larger grafts themselves look
» like transplanted grafts when you loose the surrounding density. By making
» the grafts smaller, you reduce the initial coverage, but you create a
» safety net for later on. The smaller grafts will appear like an area of
» thinness rather than a dense grafted looking area surrounded by a sea of
» hair loss or bald skin. Of course it is possible to remove the larger
» follicular units at a later date and re-graft them, but this requires a
» subsequent procedure. Sometimes it is better to simply avoid the potential
» problem by focusing on a long-term solution rather than the short-term
» benefits of having hair. I always do my best to give my patients the
» options and explain the benefits and risks of both.
»
» It is important to remember that the donor area is finite at this point
» and we simply cannot put our eggs into a basket that may never materialize
» in time such as hair cloning. It is best to hope for this rather than to
» depend on it. The donor area is like a supply of bricks. If you are going
» to need a larger home, you may not have enough bricks to build it.
» Therefore, you better plan on a smaller home from the beginning rather than
» planning for a larger home and coming up short with little recourse at a
» later date.
»
» I am particularly concerned about some of the lower hairlines that I’ve
» seen lately. If a class 2 later becomes a class 5, he is going to look
» rather unnatural with a lower hairline and a large area of hair loss behind
» this. Of course this is much less of a risk in the middle age patient, but
» the middle age patient is going to generally be much happier with a mature
» hairline rather than an adolescent hairline. It is particularly hard to
» match the hair in the temple area where the hair is finer. Placing more
» coarse hair in the temples will lead to a disparity in hair caliber that
» becomes increasing unnatural as the temple area continues to move backward
» and the surrounding native temple hair becomes finer. Properly building
» the angles in this area is a must, as well. Temple work where the hairline
» meets the temple points has become increasingly popular. I think it is one
» of the most problematic situations I have seen in the past years and very
» frequently requires some sort of corrective work in patients who had this
» area grafted by physicians who often do not seem to understand the finer
» points required to successfully graft this region.
» The bottom line is that we can often achieve a much better result by doing
» less and limiting patient expense. This effort to minimize work and cost
» often leads fewer surgeries in the future, not to mention a reduced cost
» later in life. Of course the option remains up to the patient, but I
» strongly encourage them to consider the long term consequences of hair
» transplant surgery as opposed to limiting one’s focus on the short term
» benefits.

This is the best hair transplant advice I have read lately, just good honest medical advice, no sales pitch, no nonsense no hype.


#17

I really don’t know how you achieve such superb results with such a small number of grafts, but whatever it is you’re doing it’s proving to be highly successful, and a very different approach from others. You give hope to those of us that have a low donor availability or that will have low donor availability.

I’ve already commented that this paitent’s results were fantastic, but I would however like to see another photo of his crown taken from the back rather than the front as shown. I recently took photos of my crown and posted them here and I noticed the photos I took from the front showed more darker and less see-through. If you can somehow post a picture of his crown from the back at 45 degree angle we’d greatly appreciate it.

Keep up the excellent work and excellent advise!

» Hi forum viewers,
»
» This patient had a class 3 vertex balding pattern and medium caliber,
» light brown hair with just average donor density of about 180 hairs per
» square centimeter. The patient’s goal was to thicken the vertex via CIT
» and regain a more youthful appearance. With CIT, we can harvest the best
» follicles and control how many grafts we transplant. Our patients choose
» CIT because it allows us to harvest donor resources more efficiently than
» strip and doesn’t produce the linear scar associated with strip. Dr. Cole
» treated this patient by successfully transplanting 900 CIT grafts. The
» hair’s growth pattern in the crown/vertex is helical and the inconsistent
» grain in the region is the reason that obtaining ideal coverage in the area
» can be difficult. At 9 months post-op, the patient now enjoys a more
» youthful appearance and can wear a very short hairstyle if desired.
»
» Pre-op & immediate post-op
»


»
» Pre-op & follow-up
»
»


#18

» As always you inundate me with compliments. They certainly help give
» meaning to life and invigorate the spirit.

It’s just credit where credit is due, Dr. Cole. I’ve seen a lot of HT in-person and I’ve got your HT-work on my head. Very few HT’s sit like yours. Very few HT’s fall softly like yours. Most HT’s I’ve seen look subtly stuck on the head and the hairlines are obvious. I’ve even seen botched attempts at “irregularity.” Mock subtlety, you might say.

You’ve gotten bashed a lot these past few years, and for what? most of it seemed like bullsh*t – none of it having anything to do with what matters to me: how good is the work? is the work natural looking? I don’t give a damn about anything else!

I have to wear this surgery on my head for the rest of my life. Progress in biological science is absolutely unpredictable, so I assume I may never see a viable HM. That means what I see is what I get. So every day I thank God I went to you for my HT work. I don’t care about anything outside of this. Period.

» It is good to chat with you online after so many years, Fittest. This
» brings up another topic. I recall that you wanted another procedure even
» though I felt confident we were finished unless you experienced more hair
» loss. Fortunately, you did not have an acceleration of hair loss and we
» have not needed the final large procedure you anticipated. Of course you
» also cannot predict how much hair it takes to make someone happy, but you
» can expect that two large, dense procedures in the same area will make 90%
» of all patients happy. A third smaller procedure will make 95% happy, but
» 5% will always want just one more procedure. Density alone does not seem
» to make this small percentage content.

Yeah, I wish now I would’ve made it easier on myself and not done my procedures year after year after year. Last time I was there you were happy to see me go. :stuck_out_tongue: You were rolling your eyes when I talked about the next procedure --before I was even out the door. But I was ignorant then. I’ve been pleasantly surprised at how much better my HT has gotten with the last few years of rest. The texture is finally uniformly right. The scalp needs rest from trauma.

That said. I am a greedy, ambitious, unrelenting bastard and I will not stop! :smiley: Just kidding. When I mentioned above about “sprinkling” a few last grafts, I meant what I wrote. There are some very small areas that could be addressed. We’re talking very low 100’s of grafts. If that. Just finessing the very front hairline which we’ve always planned to leave for last.

No HT is perfect; in fact, every HT, even the best of them, leaves a great deal to be desired. Young guys should stay the hell away. But for adults with plenty of disposable dough, time to burn and a certain shameless vanity, superb HT can help. A very little Dermmatch in my hair and some good styling product and I have a seemingly full head of hair. No one can tell, not even in the glare of a windswept high noon.

But how sweet it would be never to think about this nonsense at all. Alas – once you get HT you are on the hair restoration train for life, whether you like it or not. So all you youngsters realize that before you get cut.

But if you must do HT and I can’t talk you out of it, Dr. Cole is my choice of surgeon. That hasn’t changed.

TheFittest


#19

Hey Fittest time for you to show your Cole results.


#20

Good point from Dr. Cole as to why most doctors do not recommend doing the crown first. I never thought about that before .