Diagnosis: Frontal Rebuild After Prior Surgery

This patient, with classic frontal thinning, presented after having surgery elsewhere. Unlike modern surgery, where only true refined follicular units are used for transplantation, this patient underwent a procedure where larger, “pluggy,” mini-grafts were used. Instead of containing naturally occurring individual follicular units, mini-grafts – or possibly mini-“plugs” – contain small clusters of multiple follicular units. These grafts are bulky, must be placed far apart, and look like small “islands” of hair when they grow out. This typically results in a sparse and unnatural appearance. Unfortunately, this is what happened after this patient’s first surgery. He came to our clinic for surgery and instead of using bulkier grafts placed further apart, we used tiny, true follicular units placed very close together. At the end of the 2,000 graft case, the patient was amazed at how different the post-operative appearance looked in comparison to his first surgery. He returned 12 months later, and clearly the approach worked. Instead of an unnatural, sparse appearance, the patient now had a full, thick appearance throughout the frontal scalp.

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