View Full Version : Brad Limmer, MD in San Antonio

Limmer HTC
12-01-2009, 02:06 PM
This case represents the difficult but common problem hair transplant surgeons are often faced with…what to do with a young man who is losing his hair? He initially presented 5 years ago at age twenty five, having just started Propecia and a family history of Norwood pattern 5-6 hair loss.
An extensive consultation was done, going over the pros and cons of both the medical and the surgical treatment of hair loss. He had recently started Propecia and agreed to add Rogaine to his daily regiment. He understood that if he did not continue medical therapy he would without a doubt continue to lose hair and most likely progress to a Norwood 4-5, maybe even a 6. I also told him that if he was not committed to medical therapy I would highly discourage transplantation.
With the need for medical therapy fully understood, I then consulted him about how to best approach his problem taking into account his young age and possible future loss. He understood his commitment to possible future hair transplants and was agreeable to a conservative restoration of his frontal region and no work to be done in the crown.
Basically my approach to a case like this is to help improve his situation but minimize the risk and need for additional transplants. So in young men the safest approach is enhancement of the frontal tuft.
By staying out of the corners/crown, even if he loses more hair he does not absolutely need to chase the loss because he would be progressing towards a natural isolated frontal tuft. Working in the temporal recessions or in the crown in someone so young or with an unstable pattern can commit someone to extensive future work, something I discuss extensively with my young patients.
So with all this and more discussed we moved forward with ~1100 grafts to the frontal tuft only. We did not blunt the temporal recessions. We did not work in the crown. He presented earlier this month one day past his 30th birthday and almost 5 years post op.
His post op photos show how well he has done not only from his transplant, but also with his medical therapy. He shows no sign of progression of his hair loss in the corners or crown.
In addition, I feel many of the miniaturized hairs in his frontal region responded to medical therapy. This is important to note, if he had done more on his initial procedure some of these miniaturized hairs might have been lost permanently, not having the chance to regrow.
With this knowledge and the passing of time I was now more comfortable widening out his frontal hairline, slightly blunting his temporal recessions and augmenting his anterior crown. We moved forward with an additional 1600 grafts earlier this month and he remains committed to medical therapy. Presented today are his original pre op photos from 01/2005 and his post op/pre op 2nd HT from 11/2009.