Hairline Repair by Jerry Cooley MD, using 1529 grafts via FUE

This patient is in his early 30’s and had an FUE procedure of 2000 grafts at another clinic one year prior. He was unhappy with the unnatural look of the transplant.

There were several noticeable problems with the prior work:
1) The hairline was placed too low and straight.
2) There were two and three hair grafts at the very front line.
3) The grafted area was not blended into the existing hair, leaving a halo effect.
4) There was no blending into the temporal area, creating an unnatural fronto-temporal angle. Simply adding more grafts might have given improvement but would also have worsened the front heavy appearance.

After discussing the options, we agreed on a combination of FUE grafting combined with bilateral ‘mini’ hairline excision to raise the lateral frontal hairline. This involves tiny FUT strips on either side of the hairline. Along with temporal grafting, this created a more natural fronto-temporal angle. Grafts were also concentrated behind the prior grafts to better blend into the existing hair.

A total of 1,529 grafts were placed (1-361, 2-783, 3-385). PRP/ACell was also performed to provide some overall thickening. The patient is shown one year later. He was extremely pleased with the result.

This case demonstrates one of the problems we are now seeing more commonly in the FUE era. Doctors are mistakenly believing that advances in FUE are giving them the freedom to make more aggressive hairlines. We are seeing more and more young patients with inappropriately low hairlines and significant donor depletion from FUE. This patient is young and has diffuse thinning throughout his scalp; the fact that he has been on finasteride for several years should not lead to a more aggressive approach. I generally place my hairlines at 7-8 cm from the eyebrows. If I were treating him for the first time, I would have recommended a conservative hairline with good density throughout the front half of the scalp. Unfortunately, once an aggressive approach has already been taken, our hands are tied and we have to do the best we can.

The hairline excision helped place the lateral aspects of the frontal hairline in a more natural location, but it leaves thin white lines that are visible on close inspection. To repair prior work, we also can remove old grafts via FUE and do selective electrolysis. None of these repair techniques are perfect and each have their particular drawbacks. It is far better to do it right the first time!

https://www.youtube.com/watch?v=M-g95slaI7E