Frontotemporal hairline reconstruction using follicular unit extraction and direct hair implantation in a patient with Hamilton-Norwood stage II androgenetic alopecia

Introduction. Androgenetic alopecia may cause frontotemporal recession due to follicular miniaturization and changes in the anterior hairline. Assessment of the recipient area and occipital donor reserve is important for planning surgical reconstruction, particularly in early-stage disease. Case presentation. We report the case of a 25-year-old man with Hamilton–Norwood stage II androgenetic alopecia who underwent frontotemporal hairline reconstruction in March 2025. Clinical examination and trichoscopy revealed a frontotemporal hair density of 82-94 hairs/cm², with miniaturized hairs accounting for up to 31%, and an occipital donor hair density of 168-184 hairs/cm². A total of 2000 follicular-unit grafts were harvested from the occipital scalp using follicular unit extraction (FUE), classified according to hair count, and implanted into the frontotemporal region using direct hair implantation (DHI) with implanter pens. Single-hair grafts were placed along the anterior hairline, while two- and three-hair grafts were implanted posteriorly. The intended local placement density was 30-40 grafts/cm²; however, the recipient surface area and achieved mean density were not measured. Early postoperative examination and photographic documentation showed the reconstructed anterior contour, moderate erythema, and fine crusting. No suppuration, necrosis, hematoma, active bleeding, or graft displacement was observed during the reported early follow-up period. Conclusions. This case describes the surgical planning and early postoperative appearance of frontotemporal hairline reconstruction using FUE harvesting and DHI implantation. As graft survival, sustained hair regrowth, and patient satisfaction were not assessed, the long-term efficacy of the procedure cannot be determined from this case.