This case study follows a 34-year-old Norwood 4 patient through every phase of a 3,000-graft FUE hair transplant, from initial assessment through 18-month final results. The data, decisions, and outcomes illustrate what separates a great result from an average one.
Patient Profile
| Detail | Value |
|---|---|
| Age | 34 |
| Norwood stage | 4 |
| Hair type | Straight, medium caliber |
| Ethnicity | Caucasian |
| Donor density | 195 FU/cm2 (average for Caucasian: 170-230) |
| Family history | Father Norwood 6 by age 55 |
| Prior treatments | Minoxidil 5% for 2 years (minimal results) |
| Goal | Restore hairline and fill midscalp, maintain natural density |
Phase 1: Pre-Consultation Assessment
Before contacting any clinic, the patient used the free AI analysis at myhairline.ai/analyze to establish a baseline.
AI assessment results:
- Norwood stage: 4
- Estimated total grafts: 2,500-3,500
- Zone distribution: Hairline 35%, Midscalp 35%, Crown 30%
This baseline gave the patient concrete numbers to compare against clinic proposals.
Phase 2: Clinic Consultations
The patient consulted three clinics before making a decision.
| Factor | Clinic A (Turkey) | Clinic B (USA) | Clinic C (USA) |
|---|---|---|---|
| Norwood classification | 4 | 4 | 3-4 |
| Graft estimate | 3,500 | 3,000 | 2,800 |
| Technique | FUE (sapphire) | FUE (motorized) | FUE (manual) |
| Price per graft | $1.50 | $5.00 | $4.50 |
| Total cost | $5,250 | $15,000 | $12,600 |
| Aftercare program | Video follow-ups | 5 in-person appointments | 3 in-person appointments |
| Surgeon credentials | ISHRS member, 8 years experience | ABHRS board certified, 15 years | ISHRS member, 10 years |
Decision factors:
- Clinic B's graft estimate (3,000) aligned closest with the AI assessment range
- Clinic B offered the most comprehensive aftercare with 5 scheduled follow-ups
- The surgeon at Clinic B had the strongest credentials and longest track record
- The patient prioritized surgeon quality over cost savings
Selected: Clinic B, 3,000-graft FUE at $5.00/graft ($15,000 total)
Phase 3: Pre-Surgery Preparation
The clinic provided a 4-week pre-surgery protocol.
| Timeline | Action | Reason |
|---|---|---|
| Week 4 before | Started finasteride 1mg daily | Stabilize existing hair (80-90% halt further loss) |
| Week 4 before | Blood work panel | Check for clotting disorders, thyroid function |
| Week 2 before | Stopped alcohol | Reduce bleeding risk during surgery |
| Week 1 before | Stopped ibuprofen and aspirin | Prevent excessive bleeding |
| Week 1 before | Stopped minoxidil | Reduce scalp vascularity for cleaner extraction |
| Day before | Washed hair with antimicrobial shampoo | Reduce infection risk |
Phase 4: Procedure Day
The procedure lasted 7.5 hours with the following specifications.
Extraction phase (3 hours):
- Motorized FUE punch: 0.8mm diameter
- Total grafts extracted: 3,012
- Transection rate: 3.2% (97 grafts damaged during extraction)
- Viable grafts: 2,915
- Storage: HypoThermosol at 4 degrees Celsius
Graft distribution:
| Zone | Grafts Placed | Density Target | Graft Types |
|---|---|---|---|
| Hairline (Zone 1) | 950 (33%) | 45 FU/cm2 | Primarily single-hair grafts |
| Midscalp (Zone 2) | 1,050 (36%) | 30 FU/cm2 | Mix of 2-3 hair grafts |
| Crown (Zone 3) | 915 (31%) | 28 FU/cm2 | Primarily 2-3 hair grafts |
Implantation phase (4.5 hours):
- Sapphire blade recipient sites
- Surgeon personally created all channels
- Two trained technicians placed grafts under stereomicroscope guidance
- Average out-of-body time per graft: 3.2 hours (well within the 6-hour viability window)
Phase 5: Recovery Timeline
Week 1 (Days 1-7)
- Days 1-3: Moderate swelling in forehead area, managed with cold compress protocol
- Day 3: First gentle wash with clinic-provided shampoo
- Day 5: Swelling resolved completely
- Day 7: First follow-up appointment, healing assessed as normal, no signs of infection
- Donor area: Small dot scars visible but already healing
Month 1 (Weeks 2-4)
- Week 2: Scabs fell off naturally during washing
- Week 3: Transplanted hairs began shedding (expected and normal)
- Week 4: Nearly all transplanted hairs had shed, recipient area appeared similar to pre-surgery
- Second follow-up appointment confirmed normal shedding pattern
- Continued finasteride 1mg daily
Month 3
- First signs of new growth visible in the hairline zone
- Fine, thin hairs emerging (initially wispy and light-colored)
- Third follow-up with trichoscopy confirmed active follicle growth
- Resumed minoxidil 5% as directed by surgeon
- Donor area fully healed with minimal visible scarring
Month 6
- Noticeable density improvement in hairline and midscalp
- Crown growth lagging behind (normal for crown transplants)
- Hair caliber increasing as follicles mature
- Fourth follow-up with comparison photos showed clear progress
- Patient satisfaction at this point: 7/10 (still waiting for full density)
Month 12
- Strong density across all three zones
- Hairline appeared natural with proper angulation and density gradient
- Midscalp coverage provided seamless connection between hairline and crown
- Crown showed good coverage with natural whorl pattern preserved
- Fifth follow-up with densitometer measurements confirmed results
Month 18 (Final Assessment)
| Metric | Pre-Surgery | 18-Month Result |
|---|---|---|
| Norwood appearance | Stage 4 | Stage 2 appearance |
| Hairline density | Receded 3cm+ | Natural-looking density at 42 FU/cm2 |
| Midscalp density | Visible thinning | Full coverage at 28 FU/cm2 |
| Crown density | Expanding bald spot | Good coverage at 25 FU/cm2 |
| Estimated graft survival | N/A | 93% (approximately 2,710 of 2,915 viable grafts) |
| Patient satisfaction | N/A | 9/10 |
What Made This a Great Result
Several factors contributed to the outcome quality, each aligning with the criteria for great hair transplant results:
- Accurate pre-surgery data: The AI assessment and in-person densitometer readings together produced a precise surgical plan
- Appropriate graft count: 3,000 grafts for Norwood 4 sits in the middle of the expected 2,500-3,500 range, neither under-grafting nor wasting donor supply
- Proper zone distribution: Roughly equal allocation across three zones produced balanced density rather than a heavy front with thin back
- Surgeon skill: 3.2% transection rate is well within the acceptable range (under 5% for FUE)
- Equipment quality: 0.8mm motorized punch, sapphire blades, and HypoThermosol storage
- Aftercare compliance: Patient followed all post-op instructions and attended all 5 follow-up appointments
- Medication protocol: Finasteride prevented further native hair loss during the 18-month growth period
What Could Have Gone Better
No case is perfect. The patient noted:
- Crown density at 25 FU/cm2 is adequate but not thick. A touch-up of 500-800 grafts could improve it.
- The 7.5-hour procedure was physically and mentally exhausting. Breaking it into two shorter sessions would have reduced fatigue.
- Cost of $15,000 plus ongoing medication ($30-60/month for finasteride) represents a significant investment.
Key Takeaways for Your Decision
Use this case study as a reference point, not a guarantee. Your results depend on your specific Norwood stage, donor density, hair characteristics, and surgeon choice. Watch for how to spot clinic red flags during your own research process.
Start by getting your own baseline assessment at myhairline.ai/analyze, then follow the same structured approach: multiple consultations, data comparison, credential verification, and aftercare evaluation.
Medical disclaimer: This case study is for illustrative purposes only and does not constitute medical advice. Individual results vary based on patient characteristics, surgeon skill, and aftercare compliance. Consult a board-certified hair restoration surgeon for personalized treatment recommendations.
FAQ
How do I find a reputable hair transplant clinic?
Follow the same research process shown in this case study. Get an independent Norwood assessment first, consult 3+ clinics, compare their graft estimates against AI data, verify surgeon credentials (ISHRS/ABHRS), and read 20+ patient reviews on independent platforms before making your decision.
What credentials should a hair transplant surgeon have?
As demonstrated in this case, the operating surgeon should hold board certification in dermatology or plastic surgery, have ISHRS membership, and have performed 500+ procedures using their primary technique. The surgeon should personally review your case and be present throughout the extraction and implantation phases.
How do I know if before/after photos are real?
Real case studies like this one include full timelines showing every phase, including the unflattering shedding period at weeks 3-4 and the slow growth phase at months 3-6. If a clinic only shows pre-op and final results without the intermediate stages, the timeline may not be from the same patient.