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This patient came into the office this week for a follow-up 10 months after his hair transplant. His before photos show his Norwood 4A pattern and his after photos show the result of a single procedure of 2790 grafts. When I showed him his before photos, he smiled and said, “I really did not see it grow, but I guess it did. Can you give me my before pictures so I can show them to my mom? She told me not to worry, it was looking so good“. Now he can show her (and all of you) just how good. His smile was quite heartwarming.

Click the photos below to enlarge.

Before:

After 2790 grafts:

Many of you hopefully know (or at least have read) about the Norwood Classifications for male pattern baldness. I wrote the question in the title of this post, because there is no such thing as a Class 8 patient. Norwood Class 7 is the highest balding pattern defined, but I want to discuss a patient that has an extremely advanced Class 7, so to get my point across I’ve defined the Class 8 term here. He has white skin and black hair with a very, very fine hair character. I had great trepidations when he came to me three years ago to get a transplant, because he had no good quality hair and the worst color contrast possible. One thing running in his favor was a donor density 25% higher than normal. He’s had three procedures with me over the years. First one was 3908 grafts, then 3177 grafts, then 1525 grafts… for a total of 8610 grafts, and as the density dropped with each procedure, the yield also dropped. Of interest, his scar was minimal and the rest of the donor fringe area maintained its height to reflect the dropping density of the fringe hair with each successive hair transplant. He is tickled over the results and could not be happier. The fine hair is see-through, but he loves to comb it and keep it styled.

Click the photos below to enlarge.

Before:

After 8610 grafts:

A few weeks ago he came in and we tried an experiment. We applied concealers (Toppik) to try to manage the see-through hair. The results of this experiment can be seen in 3rd set of photos below. What we concluded was that the concealers made him appear too thick and if he dyed his hair a light brown and then used Toppik, his overall look might be better. His eyebrows are light brown, so that would fit.

After 8610 grafts (and Toppik):

This is a very important piece for BaldingBlog and the first time this patient has agreed to show his results on the Internet. In my opinion, this is one of the best “miracles” we have pulled off in this practice. It took courage for him (see his before picture) to trust me to make this happen and I was honored with his faith in me. With good doctor/patient communication, almost anything is possible. This man is soft spoken and often comes to our open house events to speak with patients and show off his results in person.

Here’s the side-by-side of his before and after (8610 grafts over 3 hair transplant procedures and Toppik), and you can see the results are just amazing!

Hi Doctors,
I’m schedule for surgery with Dr Pak and the last time I was there I forgot to ask to see an example of what I might look like a week or so after surgery. I’m taking a week off from work since I have a ton of vacation time saved up anyway so I’m not concerned about what my scalp will look like during that time. I just didn’t want to go back to work with a swollen head or something. Can you post some photos of a patient that Dr Pak has done? Thanks

Here’s a recent patient of Dr. Pak’s that has agreed to show his full face (and results) to the world. He’s very excited about the future of his hair, and although these photos are only 10 days out of surgery, you can see that he’s on the right track. There’s no redness, no scabbing, no swelling (nor did he have any swelling immediately after the procedure)… things are looking great. This is typical with follicular unit transplantation surgery in the hands of an experienced doctor and team, and of course with proper aftercare washing. The patient has a Norwood Class 6 hair loss pattern and had a single procedure of 2468 grafts. I’d like to point out that the grafts were kept at a 1/4″ length at the time of transplant.

Click the photos below to enlarge.

Before:

10 Days After:

I am a 22 year old female that since i was 14 years old i have been having a bald spot on the side of my head, it use to be the size of a quarter and as time has gone by it has grown bigger, i have also started balding from the other side as well. i am very scared of having alocepia. i have not tried any medication like rogaine for women or have not gone to a dermatologist because i am embarrased of this problem because i am soo young to be worrying about balding. this balding issue has affected my self esteem. i just want to receive some sort of answer before facing a dermatologist. i sent some pics of my problem you can use them for your site just please make sure my face is blocked and i remain anonymous. thank you for your time

First off, thank you for give us permission to use your photographs. I like being able to offer visitors to this site a chance to see precisely what they’re reading about.

It appears that you have a condition called triangular alopecia. This is a genetic condition which can be treated with hair transplantation very successfully. There is no need to suffer as you are. I would be happy to see you for a consultation.

Hello Dr,

First of all,,,a Fantastic/helpful blog. I am 50 years old. I visited 10 different hair transplant surgeons and decided to go with a doctor in Northern California. I think you hit the nail on the head, when you say ‘you have to feel RIGHT about the surgeon’. I did an FUT for 3000 grafts about 1 month ago, and everything has gone great. We just have to wait and see now as to what will be the outcome.

I wanted to contribute ’something’ to your blog,,,so I decided to send photos of my scar before and after application of a masking black lotion (COUVRE). It takes 1-2 minute, it will not come off with water and it is practically invisible from about 12″ away. The photos were taken by my wife. I keep my hair at 1/4″ length (I know I can go to #2 clippers and still mask it good). I send these photos for folks whom are worried about having the surgery and wanting to keep their hair short.

Now to my questions. I am on Propecia (4 months now) and Rogaine. I also have the laser comb, but I am hesitant to use it, fearing it might damage the ‘babe grafts’. What do you recommend to your patients regarding this scenario. I truly believe the comb works, not as much as the hype, but it DOES work (for me anyway). The question is, can it hurt the newly transplanted/asleep grafts

My second question is related to a comment my surgeon made prior to surgery. I asked, what percentage of the grafts are normally expected to survive. The reply was 113-120%!!!! It was explained by my surgeon that they do not believe in ‘dense packing’ of grafts in a CM2 and by inserting no more than 40 grafts (or was it 40 hairs?!), it insures the growth of all grafts + some regeneration of already dormant follicles!!! I found that pretty interesting, what is your opinion on this?!

Thanks again for all your great help on the blog, keep up the great work

Masking/concealing agents like Couvre can work “miracles”, as your photos demonstrate. There are two surgical solutions that also work well:

1. Follicular unit extraction (FUE) into the wound will put hair into the scar, or
2. A trichophytic closure could wipe out much of the wound if the laxity is good enough

The telogen count is about 10% of hairs, but as these telogen hairs grow back, others fall out so I would not expect more than 100%. I have read such studies and they are clearly flawed in their methodology. You can’t believe everything you hear or read. Nonetheless, thank you for contributing your photos and allowing me to publish them! The results after the Couvre look great. The photos are below; click to enlarge.

This patient has had three procedures with a total number of 4761 grafts. The last procedure he had was a little over a year and a half ago, and the after photo was taken this week. He’s grown his hair long for the “rock and roll” look, and the results speak for themselves.

I realize that the quality of the before photos isn’t all that great, but they should still be clear enough to see what the transplants did for his hairline and the hair behind the hairline. The transplants were placed almost to mid-head and when he combs it in almost any direction, he has a full head of hair. The photos were taken previous to his first surgery 8 years ago and our digital camera back then was hit and miss, so I do apologize if the quality of those photos is lackluster. Click the photos to enlarge.

Before:

After:

Hi Doc,
I’m a 32 year old male of Korean (dad) and French (mom) descent and have been obsessed with my hair loss for years. I got my dad’s hair, including his balding. It looks like I’m a Norwood category III or IV. I have light skin and dark straight hair so I think that would be difficult to make a successful transplant and haven’t seen many photos of Asians with hair transplants. Anything you can provide? Thanks so much.

Well timed! I just had a Japanese patient in my office this week that stopped by for a follow-up, so I’m glad I could promptly oblige your request quickly. He had a Norwood Class 4 hair loss pattern and we transplanted 1836 grafts in a single procedure about 3 1/2 years ago.

Click the photos to enlarge.

Before:

After:

For the record, it’s not that we avoid posting results photos of patients from certain ethnicities, but I can only show the results of patients that sign a photo release, and not everyone wants to do that (which is completely within their right, of course). I always appreciate when patients allow me to show their results, though!

Update — June 16, 2008: More photos added from the top view.

You have mentioned several times the success you have seen in your patients from propecia. In view of this and considering the limited photographic evidence availiable on the web I was wondering of you had any photos you could make availiable showing various results of patients on propecia. I know you insist that those who are pleased with a product are those who are less inclined to comment on it, but I am quite surprised at the scant photographic evidence availiable anywhere of propecia effects. The reason I ask this question is because despite the details saying x number of hairs come back on average, it is hard to gauge the actual effect.

These are some patients that take Propecia that I’ve posted here previously. I’m sure there are others that I’ve posted on this site over the years, but these were the first ones I found in a search.

• Are Minoxidil and Propecia Worth Using? (with Photos)
• Response from Propecia in 49 Year Old Man (with Photos)
• Anyone Taking Propecia for a Decade? (with Photos)
• Propecia Results - Crown Photos
• Propecia Patient Results (with Photos)

You should keep in mind that I take photos of my patients for their personal file and I NEVER show these pictures to anyone unless I have a photo release. I do not get photo releases as a routine with my private practice. In addition to these pictures, my experience should tell a great deal, unless you do not trust my truthfulness, but my experience parallels the experience of most doctors in the field.

i have been having a problem with my hair falling off at the sides for a very long time. im 27 years old so that should not be a problem of age and i have not given birth. the problem is that it grows but keep falling off. i’m short of tricks to do and the worst thing is that its really hard to style my hair. i never had tight pig tails and i have always had this thought that its hereditary as my mom has also that problem and i experienced it early im teenage. and i have tried some creams but they have not worked and been to the doctor. help

The photo appears to show traction alopecia, but it could be an autoimmune process as well. There is a condition called triangular alopecia, where the hair at the temples may be lost on both sides, but I am unaware of reports of it being this extensive. Perhaps a biopsy would help make the diagnosis. You need to see a good dermatologist who should be able to let you know what you have. Thank you for permission to post your photo.

Please click the photo to enlarge.

So I think I am finally ready to have a procedure, on average, how long does it take for the scabbing to go away? I do not want to go back to work before it does.

The last two patients done this past week had no scabs when they left surgery or on the days following surgery. This is what we expect in over 90% of patients and most can go out into the real world without a hat on. Some people keep the scabs longer. The length of time relates to the:

1. size of the wound (the smaller the wound the shorter the scab period)
2. washing skills
3. patient variables

Two of these are in control of the doctor and the patient, while the third is not controlled be addressing #1 and #2 alone.

Update: Here are 2 photos of a patient — the photo on the left was taken under an hour after the surgery of 1500 grafts was complete; the photo on the right was taken 11 days after surgery. This is the typical post-operative appearance of our patient surgeries. Click to enlarge.