This patient came to us to soften his hairline by removing some of the larger unnatural grafts from the hairline. He did not want to do a large session of plug redistribution at any one sitting. Softening hairlines may be done by three methods. One is lowering the hairline with many more natural appearing smaller grafts. The second is done by removing larger grafts and leaving the more natural grafts in place. The third is to remove larger grafts and in a second procedure to add more natural grafts to the hairline.
If the hairline is already too low, it is impossible to lower it further. Also, lowering a hairline requires more grafts, which may not be possible in a depleted donor area or when there is an anticipation of more hair loss later on. Building a new lower hairline that was more natural in appearance was not an option in this case.
If a hairline is composed of natural looking single hair grafts and some multiple hair grafts, one can selectively remove the larger grafts and leave the smaller grafts. This can work as a stand-alone procedure.
Finally, one can remove the larger grafts in one procedure and then build a new hairline properly in a second procedure. This method always results in less hair immediately so it is not a viable option for some people. This method is preferred when the patient simply cannot live with his ugly appearing hairline.
This patient did not want an immediate transformation that removed all the larger grafts. He wanted to proceed slowly by removing a smaller number in each case and redistributing them.
We began by removing a total 36 larger grafts from the hairline on both side in 2007. This is a small procedure of plug removal. We then redistributed these into 137 smaller grafts into the top and crown area to improve coverage. We followed this up by removing 133 larger grafts and split them into 270 smaller grafts that we placed on the left side of the scalp to improve coverage here in 2011.
Following this procedure the patient wanted to focus on improving coverage with Acell and PRP. In the first session we used the Angel system, to produce a 5x platelet increase with a low WBC count in 2012. We also used 15 mg of Acell. The patient noted his best improvement 8 months after this treatment. The patient returned 9 1Ž2 months later for a second PRP treatment at the same settings on the Angel system along with 60 mg of Acell.
We noted his cross sectional trichometry (CST) before the first session. We measure the CST at a distance of 8 cm, 12 cm, 18 cm, and 33 cm from the glabella. The CST readings were 31, 21, 12, 28, and 53 at these respective distances. On follow-up 9 1Ž2 months later the readings were 62, 32, 38, 43, and 64 respectively at these distances. This corresponds to the following improvements in surface areas: 8 cm (100%), 12 cm (52%), 18 cm (217%), 33 cm (21%). This is objective data supporting the rationale for a PRP and Acell treatment to improve coverage. It will be interesting to see if there is any change positive or negative on his next follow-up visit.