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Case Presentations – Male

Double-Mega FUE

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Male Pattern 5

Male Density

Male Pattern 5-1/2

Hairline Design

Probably the most important part of the hair transplantation process is the design of the hairline. The objective is to make the person look as good and as natural as possible, whether male or female. A hairline that is slightly lower in the center of the forehead and slightly rises towards the corners will give the most attractive appearance for most men with oval heads. For men with wider brows and a more flat forehead, a more straight-across hairline will generally look the best and is commonly found in some Asian and Hispanic head shapes. This is frequently seen in Japanese and Korean persons, but note that Chinese and Vietnamese head shapes are more oval and similar to the typical Caucasian head shape. African head shapes can approach either the oval or the more flat brow appearance. Generally a female blush with rounded corners of the hairline is created when replacing a female hairline. This is especially true in women who have lost hair in the typical male 3 pattern, frequently occurring after menopause.

Case Presentation – Revising Old Plugs

Patient J.A. after five hair transplants of 200 round “plug” grafts done elsewhere (top) and after four transplants of 558 grafts by Dr. Elliott to refine the “plug” look (bottom).

If you have had old transplant plug grafts which are not angled well and are unsightly, and assuming you want more density because you may have lost more hair over the years, and you would like a properly designed natural hairline, this usually can be done (with sufficient donor hair). Most of the time, it is possible to harvest a strip through the little white scars of the old plug donor areas. We simply dissect the white scars out of the strip once we have it removed. It is usually most important to build a new hairline slightly in front of the old plugs so they are hidden and no longer seen. Similarly, it is frequently necessary to fill in along the part lines or in the crown of the head with the new smaller grafts to hide the appearance of old plugs from the back.

Progression of Hair Loss
Generally, a young man who is a Class 4 by age 21, will probably be a Class 6 by age 30. Sometimes there is not enough donor hair to transplant the entire head once one projects the size of the future balding area. Nevertheless, there is usually enough donor hair to do at least the hairline and the entire top of the head, leaving only a round spot in the back if there is not sufficient donor hair. If years go by and it turns out there is sufficient donor hair and the pattern is not as rapidly advancing as was suspected, at least a modest coating of hair can be put in the crown or vertex of the head, which will present a very nice appearance.

Hair Thinning in Old Age
When beginning transplanting on young men, it is best to decide where to put the hairline based on previous pictures, family pictures, and with the sense of what will generally make the person look the best. It is not necessary to create a receded hairline look in young men. There are plenty of men who have non-receded hairlines well into their sixties, the author being one. Note the pictures of the author’s grandfather, Dr. J.T. Waggener, from age 28 to age 100.

Dr. Waggener’s hair was quite thin at age 100, but with very little hairline recession present. Note that this thinning of old age is what is termed senile alopecia and probably results from the falloff in thyroid hormone and growth hormone in later life. It is not male pattern hair loss. If a young man has lost his hairline, it is not too early to put him on medical therapy and rebuild his hairline with a hair transplant. If donor is projected to be ultimately insufficient, transplanting must favor the front and top of the head.