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A case for DFU's - Paul Shapiro, MD

Paul Shapiro MD

Paul Shapiro MD

Valued member
There are some patients in which I think DFU €™s are extremely beneficial to the patient. The case I did 10 days ago is a good example.

This 34 year old man has fine caliber hair, and significant balding. He is on the way to having a Norwood type 6 pattern of balding and could easily become a Norwood type 7. He has a very large head which increases the surface area needed to cover when doing a transplant. The frontal 2/3 of this patient €™s scalp measures about 150 sq.cm while in most patients the frontal 2/3 scalp is usually 100 sq.cm. The area of his crown which is almost bald or has significant thinning is another 150 sq.cm. He has the potential for complete balding in 300 sq.cm. of scalp.

He is the breakdown of graft count and hair count on this patient:

In a case like this I will use DFU €™s in the central core area. I believe this gives a greater illusion of density using the exact same amount of hair per sq.cm compared to using only FU €™s. There is a chance that DFU €™s can look pluggy if not done correctly or when a patient has dark coarse hair and light skin. But done correctly in the appropriate candidates they should not look pluggy. To use DFU €™s correctly it is important to have technicians that are trained to cut and place them correctly. They need to be cut so they are the same size and so that the two Follicular Units line up one behind the other.

Here is a photo of the above patient 10 days after surgery. As you can see the central core

[http://i288.photobucket.com/al...pFront.jpg[/IMG]area[/url] looks
very dense but not pluggy.

Here is a close up of the central core with the area of the DFU's circled.

Here is a photo of the donor site:

Another patient of mine who is similar to the one above. He also has a large surface area of balding. I used 400 DFU €™s in his case and he was presented at the last ISHRS meeting. Most physicians could not tell that I used DFU €™s and were surprised at the results he got with only one surgery. This is an example of how using DFU €™s I can get the appearance of more coverage using the same amount of hair if I only used FU €™s.



The Coolest Member
I am certainly not opposed to DFU's when used in the right circumstances and done by a very skilled physician. I do believe that the cases that I have seen are much more dense looking as a result of DFU's. Now in the above case, possibly my eyes are "seeing" things because they are pointed out to us, but it does look like a person could see the DFU's as showing up a little darker?

I guess my questions are:

1. Does a person have to have their hair grown out to a certain length inorder for the DFU's to be fully camoflaged and provide the best natural look?

2. Are they not appropriate for FUE as a person still has option to shave down?



Invaluable Member

I saw this patient at 10 days post op and chatted with him for a bit while looking over the recipient and donor area. In fact, I helped with the pictures - that's my hand in the donor shot.......lol. If you look at this shot below, you can see dark hairs are in many areas of the head - not just in the dfu transplanted area. This shot isn't quite so zoomed in but can you spot the section that had dfu's? When I looked at the top of his head in person, I had forgotten that he had dfu's and when Dr. Paul mentioned about this write up with dfu's - I told him that he'd have to circle the area as there was no way to tell at least not in person with naked eyes. By all accounts, this patient will benefit when his grafts are grown out in 9 months from now with the central core area with a bit more density than if there were just fu's planted.

As for the fue question - if you extract a dfu via fue - it's no longer an fue but a dfue...lol. Anyway, the hole remaining in the donor would be too big to heal properly. That defeats the goal of fue of not having visible donor scars.



Staff member
When looking for the DFUs i am looking in the circled area and thinking /wantintg to see them which there seems to be darker hair groups .

When looking at the picture Janna posted,you cant see anything that looks un natural and what you would call a DFU.

Good post Dr Paul,it really does show that DFUs have a place in hair transplants providing the patient is the right candidate.

Thanks bm.


Excellent,clean and well thought out work IMHO once grown out this looks like it will yield an awesome result and quite a startling before and after transformation me thinks!
Top banana work again from the hair boffins at SMG!
Well done
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