VTZ is a Norwood Class 7, with salt and pepper, straight, fine hair and a donor density of 2.4. VTZ had two scalp reductions and an unsuccessful hair transplant with plugs many years ago of which most did not grow. VTZ also had significant sun damage with multiple keratosis on his scalp. These were treated prior the hair transplant. The treatment removed the keratosis and also improved the quality of his scalp. Because of the sun damage and scalp reduction scars, a conservative first session was performed using 1,668 grafts. A year later we performed a second hair transplant of 1520 grafts and three years later the patient had a final session of 1100 grafts. The results above are shown after three hair restoration sessions.