32 year old male, showing results one year after HT#1, which consisted of 1210 grafts, using "combination" approach with mostly FU's and MFU grafts in central regions.

very impressive for 1210 grafts

Unless I'm missing something...that's a pretty impressive result with that graph total.

Maybe it's his hair type or the way he's styling it.

Some docs would have shaved him and that would be the typical 4000 + graph job.


MH

yeah.. me too feel thats too good for 1210 grafts... experts what say???

Very nice. I think it looks impressive with the small number of grafts too. Thanks Betsy for posting Dr. Pawlinga's work. Do you have hair count by chance?

His hair count was 3150, and his hair was unusually coarse in the donor area, which in our experience makes a big difference in how full even one or two sessions appears.
Betsy

Note: I am employed by Saratoga Hair Transplant Center.

That looks great. Do you have any pics that show the roots, or grafts at the scalp?

I ask because you said it was a combination of FU's and MFU's, and I'm not sure what a MFU is.

I dont want to be a negative nancy, but there is no way in hell that thats only 1200 grafts. Unless hair cloning is now available! Dont get me wrong the results look great, but 1200 grafts is not even enough to establish the hairline for this gentleman. He may have coarse hair but come on!

a nice looking result,but im with dakota on the low graft count.unless that is,he is caked in concealer?

Betsy,

Welcome to our discussion forum.

There is no question that there is an improved appearance especially given the graft/hair count and good hair characteristics, but how much at this point is difficult to tell from the pictures

The problem I have with the above is the that hairstyle in the before pictures have the sides combed down whereas in the after, some of the thick natural hair on the side is combed over the transplanted hair which is adding to the appearance of density.

Adding a "top down" after picture like you did with the before picture (sides combed down) would be extremely helpful to get a better understanding of what 1200 grafts and 3150 hairs can accomplish on this patient.

Thanks,

Falc

I think if some bright light was put on the angle of the last pic you would see the real deal

I don't think there is any mystery here at all. Betsy referred to "MFU" in her write up. For those of you who don't know, that means "Multi Follicular Unit" also known commonly as MINIGRAFTS.

To achieve this much of a signficant cosmetic improvement with only 1200 grafts (and it IS an amazing improvement which this patient must be ecstatic about) the sizes of the grafts must be quite large compared to true follicular units.He must have a very large caliber hair.

My concern would be that the final result may appear a bit stalky when the hair is not properly styled. It is because of this that the industry moved onto true follicular unit grafting and abandoned minigrafting.

In some patients everything just comes together and the results turn out to be very impressive as in this patient's case.

Doc, Are there some instances when it's OK to still use minigrafts ?

Just to add, that though I tend to lean in favor of true follicular unit grafting, some first-rate physicians such as Dr. Ron and Paul shapiro occasionally use a small number of multi follicular units (or minigrafts) in certain areas of the scalp. They believe it can help increase the illusion of hair density and when surrounded by follicular units, will appear quite natural.

Best wishes,

Falc

I'd like clear up a comment regarding the types of grafts we use. There are various techniques of using true follicular units, double follicular units and multi follicular units. While I have seen very natural looking results from some clinics - such as Dr. Beehner and Dr. Vance Elliott using MFU's, we at SMG do not use MFU's. We have used (DFU's) double follicular units in the past and still continue since time and time again they appear completely natural and only help to create more density in the areas needing density. These grafts are rectangular in shape with hairs lined up in a row (so they never appear pluggy). We also plant other 3 & 4 hair fu's within these DFU area. Our DFU's are uniform in size and have 4-6 hairs. Some may wonder why use dfu's at all when they can be cut down to true follicular units and planted either very close to the next graft or spread out to cover more areas. We use a limited number of DFU's in a small critical area and have plenty of other two, three, & four hair grafts to spread over the areas needing grafts. In reality, it would be hard to beat what nature created - getting two hairs closer than what appears in nature.
There are many clinics who gave mfu's and dfu's a bad name, but in the right hands - they can help produce wonderful end results.

As for Dr. Pawlinga's work, since he worked under Dr. Beehner and they now work beside each other, I trust that he knows how to use a combination of mfu's and fu's to help create a nice natural coverage. Even though the graft count is on the small side, the hair count gives a different picture. Is there an improvement? I think so, and I'm betting this patient also thinks so.

Janna,

I appreciate your explanation.

But it is also important for members to understand that double follicular unit grafts containing 4-6 hairs however, are still minigrafts.

I have spoken to Dr. Paul about this publicly and he has posted some compelling patient photo examples using the occasional DFU that look spectacular. I therefore feel that in some patients, if used minimally, they may be of some benefit.

I say "may" because I am not convinced that they can provide any additional appearance of density since the number of hairs are still the same. In my opinion based on logic, with strategic placement of the follicular units, one can achieve the same illusion of density with the same number of hairs as those who use a few DFUs.

I admit that I do have some concerns that using too many DFUs, especially with shorter hair styles may appear pluggy. I am certain however that Dr. Ron and Dr. Paul strategically place them in such a way that this is not an issue.

I would certainly feel comfortable in their surgical chair any day.

Falc

In reading carefully Janna's description of their DFU grafts, this is almost an exact description of what we use when we use "MFU Grafts" in our practice. They are cut under a 10x power microscope and usually only by one of our nurses who "specializes" in her task of doing this for us, and they are only used centrally, and with many, many FU's bordering in all directions on the periphery, especially at the hairline, where we average around 450 FU's per session. There are a couple of arguments for using these types of grafts: It is a less expensive way to move hair in these central areas for patients whose hair characteristics are favorable for non-detectability; In studies done to date, the individual follicles contained within them survive at a higher rate than individual FU's; There may be less trauma to the scalp per follicle placed - if you can insert two more hairs by only slightly extending the length of an already tiny slit incision, this may be better than two separate incisions; Lastly, at a subsequent session, because of the spacing used, it is easier to place the next sessions MFU grafts without any risk of hitting any previously placed follicles.
We mainly use these grafts in projects where a fairly large square area of scalp is being filled in. If it is less than a third of the typical male pattern baldness area, such as the frontal region, our first choice now is to dense-pack with FU's.
Mike Beehner, M.D.
Mike Beehner, M.D.