Patient RGL was an early Norwood Class 6 with dark brown hair and average scalp laxity. His donor density was above average. In 1970 he had an old type of hair restoration procedure called a flap, where a strip of hair is removed from the donor area and sewn intact into the hairline. This is called a Vallis flap or free flap, because it is completely removed from the donor area rather than rotated from it. Following the Vallis flap he has two subsequent hair transplant procedures where large grafts were placed on the top of the scalp and at the hair line giving an unnatural pluggy look to the already geometric appearance of the flap.

To decrease the pluggy appearance and harshness of the flap, we removed 44 large grafts and re-implanted them as 142 individual follicular units and added an additional 3,686 grafts over three follicular unit hair transplant sessions.