History: This 54-year-old otherwise healthy Caucasian male had 5 prior hair transplants to his scalp as well as 3 scalp reductions in his crown. His last procedure was 18 years ago. His concerns are that his hairline and transplanted hairs appear unnatural, that he lacks overall density for any hairstyling option, and that the scar from scalp reduction in his crown is visible. He is compelled to cut his hair short in order to make his unnatural hair look less obvious. Of note, he has been taking finasteride 5 mg for the past 3 years for an enlarged prostate but has not observed any significant hair regrowth during that time.
Physical Examination: This patient exhibits a Norwood 5A pattern with grafts placed into his hairline, central midscalp, and the scar in his crown. Due to his hair loss progression, his native (non-transplanted) hairs gradually were lost to expose only his remaining transplanted grafts. He now exhibits hair loss in the fronto-temporal region, upper portion of the lateral humps, in the midscalp, and with extension into the vertex/crown region. He shows large plug grafts placed densely and at a perpendicular angle to the scalp in an unnatural U-shaped hairline.