This Vancouver area patient in his mid-50’s had a noticeably receded hairline and area of weakness in the crown. In addition, the entire top of his scalp was thinning. Visually there was no one particular area significantly worse than the other. The pre-op photos may not reveal the extent of the thinning but you can see the difference in the hairline and crown. These types of DPA (diffuse pattern alopecia) cases can pose challenges. Especially when combined with fine hair. For the mid-scalp and crown, there is coverage but the density is not up to the desired levels. The challenge is to safely transplant into existing hair without causing damage. This is where shaving of the recipient area, the lateral slit technique and a skilled surgeon become even more critical. It is also important to preserve the native hair over time with medication. Should the patient not take medication, the end result will still be coverage and a cosmetic benefit. However, losing the non-transplanted hair may result in a similar situation of a thinning look much like the pre-op state. In some cases, maybe worse than the pre-op state. In a case without medication if donor hair permits, a second procedure would be required to restore the previous density. When donor reserves are limited, the medication plays a more important role. Individual cases may vary and a plan for both medication and surgery would be tailored to each specific case. For this patient, Dr. Wong and team planted 4287 grafts of which 790 were singles, 2,369 were doubles and 1128 were 3-4 hair grafts. This patient also takes the medication Finasteride to prevent further hair loss. These photos were taken 10 months post-op.