Dr. Brad Limmer (San Antonio)

[Limmer HTC]

The case presented shows the progression of a 29 year olds’ transplant procedure to blunt his temporal recessions. Per usual, extensive pre op consultation was performed regarding the use of medical management and ensuring that he understood not only all aspects of the procedure, but the long term implications of transplanting the corners in someone who is young.
A primary concerns is continued loss of hair in the frontal region/in behind the newly grafted hairline. If this occurs, he will have to do additional procedures to chase that loss. He is a good candidate as his hairline was reasonable stable and he showed no evidence of miniaturization or pull test positivity within the frontal tuft, midscalp or crown. If any of these areas had shown instability, I would have advised against transplantation at this time, encouraged medical management and reassess in 6-12 months.
The series of photos depict his pre op, 1 month post op, 4 months post op, 13 months post op and immediate post op photos following a smaller second procedure to gain the additional density I felt he needed to overcome his high contrast (very dark hair versus very white skin).
The pre op photos show his deep asymmetric temporal recessions and high contrast between hair/skin color. His 13 month post op photos show the nice results obtained from planting ~450 grafts in each temporal recession at a density of 46-50 grafts per square cm. Note, no mid frontal hairline work was performed.
It is nice to be able to show the one and four month post op photos and they highlight a couple of things that don’t show up when you only have pre op/final result photos shown. At one month post op he has a nearly invisible scar that is already hidden by the prior trimmed hair regrowth. In the grafted zone some hairs remain and he continues to have a little redness. Patients need to know that while the redness usually goes away sooner, those with very fair skin can have prolonged redness with dense packing (the denser you pack, the more trauma, then the longer the redness can last).
Finally, the four month post op photos show the redness has abated and his grafted hairs are showing the typical early regrowth. Note how fine and soft the hairs appear at this time. Over the next several months they not only gain length, but also the shaft diameter thickens as seen in the 13 month final result photos.

Brad Limmer, MD/jac