This medical case study presents the successful management of grade 3/4 androgenetic alopecia in a 36-year-old male patient using the Big-FUE technique. The procedure involved 4,302 grafts, advanced slit creation with sapphire blades, precision implantation using the K.E.E.P implanter system, and structured PRP therapy during follow-up. The patient achieved optimal cosmetic density and natural hairline restoration within 12 months.
This case highlights protocol-driven planning, graft survival optimization, and long-term maintenance strategies followed at a leading hair restoration center widely recognized as the Best Hair Transplant Clinic in India.
Patient Information
-
Name: Tejashman Mud
-
Age: 36 years
-
Location: Odisha, India
-
Diagnosis: Grade 3/4 Androgenetic Alopecia
-
Duration of Hair Loss: 7–8 years
The patient presented with progressive frontal recession extending toward the mid-scalp and partial crown involvement. There was a complete loss of natural hairline definition.
Clinical Background
Associated Scalp Condition
-
Mild dandruff
-
Dry scalp
-
No scarring or inflammatory dermatosis
Medical History
-
No diabetes
-
No hypertension
-
No asthma
-
No chronic systemic illness
-
No ongoing medication
Surgical & Allergy History
-
No prior major surgery
-
No history of drug or food allergies
-
No keloid tendency
Previous Treatment
The patient had tried Ayurvedic hair oils without clinical improvement. No medical therapy such as minoxidil or finasteride was previously used.
Consultation & Pre-Operative Assessment
The patient consulted at Hairfree Hairgrow Clinic, where Dr. Jinkal Kunjadiya, a dermatologist and hair transplant surgeon, evaluated him.
Preoperative Evaluation Included:
-
Dermoscopic donor area assessment
-
Hair shaft diameter evaluation
-
Donor density calculation
-
Scalp laxity and vascularity assessment
-
Expectation counseling
-
Informed consent documentation
The donor area showed average density with black, mildly thin hair shafts. Based on the Norwood classification, a Grade 3/4 pattern was confirmed.
A surgical plan was designed, focusing on:
-
Natural age-appropriate hairline
-
Maximum density in the frontal third
-
Balanced coverage toward the mid-scalp
Surgical Planning
-
Date of Procedure: 18 July 2023
-
Technique: Big-FUE (Follicular Unit Extraction)
-
Total Grafts Extracted: 4,302
-
Estimated Surgical Time: Approximately 5 hours
The treatment plan included staged PRP therapy and long-term medical maintenance.
Surgical Procedure Details
1. Hairline Design & Recipient Area Planning
Hairline mapping was performed in the upright position to ensure anatomical accuracy. Special emphasis was placed on:
-
Symmetry
-
Temporal angle correction
-
Natural irregularity
-
Ethnic hairline pattern preservation
Recipient zones were marked and photographed for documentation.
2. Anesthesia Protocol
A modified local block anesthesia technique was used.
-
Pre-anesthetic sensitivity test: Negative
-
Minimal discomfort reported
-
No intraoperative pain
The patient remained hemodynamically stable throughout the procedure.
3. Slit Creation (Recipient Site Formation)
Slits were created using sapphire blades:
-
1.2 mm blade for hairline zone
-
1.4 mm blade for density zones
Magnification loupes ensured angle precision. Correct angulation (30–45 degrees in the frontal region) was maintained to replicate natural hair growth direction.
This step is critical for aesthetic density and natural flow.
4. Graft Extraction
Extraction was performed using:
-
0.8 mm serrated titanium punch
-
Motorized FUE system
-
Magnification assistance
Graft Handling Protocol
-
Immediate placement in chilled preservation solution
-
Maintained at 4°C
-
Stored in Gro Factor medium to enhance survival
Graft Analysis
-
Total grafts: 4,302
-
20% single follicular units
-
80% double and triple follicular units
-
Medium thickness
-
Black pigmentation
Extraction time: 2 hours 30 minutes
No transection beyond acceptable surgical limits was observed.
5. Graft Implantation
Implantation was performed using the K.E.E.P. implanter system.
Benefits:
-
Reduced graft handling
-
Controlled depth placement
-
Improved survival rate
-
Uniform density
Implantation time: Approximately 2.5 hours
The frontal zone received higher density packing for cosmetic impact.
Immediate Post-Operative Care
-
Sterile dressing applied
-
Antibiotics and anti-inflammatory medications prescribed
-
Detailed washing protocol explained
-
Personal follow-up coordinator assigned
No immediate complications occurred.
Post-Transplant Timeline & Outcomes
0–3 Months: Shedding Phase
-
Physiological telogen shedding observed
-
Approximately 20–25% shedding per month
-
Donor area healed without scarring
-
First PRP session at 2 months
This phase is expected and indicates follicular cycling.
3–6 Months: Early Growth Phase
-
Regrowth began around month 3.
-
70–80% visible growth by month 6
-
Improved hairline definition
-
PRP sessions at months 4 and 6
Hair shaft thickness continued to improve.
11–12 Months: Final Result
At 12 months:
-
Complete hairline restoration achieved
-
Natural density observed
-
No cobblestoning or pitting
-
Uniform direction and angle
Maintenance protocol:
-
Topical minoxidil
-
Multivitamin supplementation
-
Booster PRP every 3 months
The patient reported high satisfaction and improved confidence.
Clinical Significance
This case demonstrates:
-
Effective use of Big-FUE in Grade 3/4 baldness
-
Importance of graft preservation
-
Strategic hairline design
-
Structured PRP integration
-
Long-term maintenance planning
High graft survival and natural aesthetics reflect standardized protocols and surgical precision.
Why Protocol-Driven Centers Matter
Successful outcomes in advanced baldness depend on:
-
Surgeon expertise
-
Donor management strategy
-
Angle control
-
Temperature-controlled graft storage
-
Evidence-based postoperative care
These factors distinguish high-quality centers recognized as the Best Hair Transplant Clinic in India, where patient safety, documentation, and long-term follow-up are prioritized.
Conclusion
Tejashman Mud’s case illustrates how advanced FUE technology, proper planning, and expert execution can reverse Grade 3/4 baldness effectively. With 4,302 grafts and a structured follow-up protocol, the patient achieved natural, dense, and sustainable results within one year.
This case reinforces the importance of choosing an experienced surgical team and a protocol-based approach for optimal hair restoration outcomes.