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4125 strip FUHT - Dr. A\'s clinic (6 mth update)


#1

Patient particulars

Norwood 5.
Hair restoration, at patient’s preference, was to cover crown with a conservatively high hairline.

Patient nickname - Raj1.

The pictures are immediately pre HT, immediately post HT, 18 days after and 6 months after.

Raj1 is happy with the progress.

24 chest hair grafts were also transplanted in the right temple area.


#2


#3


#4

Picture taken by Raj1.


#5

Pictures taken by Raj1.

These pictures will help educate prospective patients on the hair transplant timeline.

We expect further increase in density in the next 6 months.


#6

wow, looks great after such a short period of time :slight_smile:


#7

» Patient particulars
»
» Norwood 5.
» Hair restoration, at patient’s preference, was to cover crown with a
» conservatively high hairline.
»
» Patient nickname - Raj1.
»
» The pictures are immediately pre HT, immediately post HT, 18 days after
» and 6 months after.
»
» Raj1 is happy with the progress.
»
» 24 chest hair grafts were also transplanted in the right temple area.

Excelent results as usual. If I could think of anything to do in Mumbai over the New year I might just take a flight over and double up with a consultation if your around! will there be a party in town?


#8

Marco if you go to Dr. A will you document the entire thing, front to back? You are such a strong poster and we need the info.


#9

» Marco if you go to Dr. A will you document the entire thing, front to back?
» You are such a strong poster and we need the info.

Of cause, I will also be looking at BHR who are quite local.


#10

V, would you be kind enough to detail your closure technique for strip. Thanks.


#11

» V, would you be kind enough to detail your closure technique for strip.
» Thanks.

Dear marco,
I will explain that one.

When making a strip incision and closure, we keep the following things in mind :

  1. The strip incision should be in the coronal plane. That minimizes chances of post HT stretching.

  2. The closure is in double layer with self dissolving 4 zero monocryl sutures.

  3. There should be no tension on the suture closure.

  4. Trichophytic closure is employed.

In points 3 and 4, if using the triclosure will put an increased tension on the suture wound, then we prefer that there be no tension.

  1. Pre HT scalp donor area stretching exercises must be performed to increase the donor area laxity.

  2. Post HT, scalp donor area pinching exercises - the forefinger and the thumb be placed on either side of the strip scar and then the intervening skin is pinched. This should be performed as soon after 15 days post HT when the patient can comfortably do so. This is aimed to take the stretch factor off the strip scar by transmitting it to the skin above and below the strip.

Regards,
Dr. A


#12

» 1. The strip incision should be in the coronal plane. That minimizes
» chances of post HT stretching.
»

Dr. A, I think that this is a very interesting and under discussed issue. I assume that you refer to the angle of the incision such that the plane is more vertical. I have always felt that this plane is important and is used in the trico closure. I believe the use of this plane by far out ways any other explanation for improved scar line when using trico closure. In fact, in terms of scar stretch, it is the only factor that has good rational when using trico. It seems to me that is any incision is strictly lateral to the forces that act on it then stretch is much more likely to occur than if there is a perpendicular aspect of the incision in relation to the forces on it. Not sure if that makes sense without a pic but I have thought about this and it also suggests a number of possible approaches to improving scar stretch. I would also suggest that if an incision is purely perpendicular to the forces acting on it then scar retraction may dominate but this would not be a usual scenario with HT.


#13

» » 1. The strip incision should be in the coronal plane. That minimizes
» » chances of post HT stretching.
» »
»
»
» Dr. A, I think that this is a very interesting and under discussed issue.
» I assume that you refer to the angle of the incision such that the plane
» is more vertical. I have always felt that this plane is important and is
» used in the trico closure. I believe the use of this plane by far out ways
» any other explanation for improved scar line when using trico closure. In
» fact, in terms of scar stretch, it is the only factor that has good
» rational when using trico. It seems to me that is any incision is strictly
» lateral to the forces that act on it then stretch is much more likely to
» occur than if there is a perpendicular aspect of the incision in relation
» to the forces on it. Not sure if that makes sense without a pic but I have
» thought about this and it also suggests a number of possible approaches to
» improving scar stretch. I would also suggest that if an incision is purely
» perpendicular to the forces acting on it then scar retraction may dominate
» but this would not be a usual scenario with HT.

Wait, what?


#14

»
» Wait, what?

In the diagramn, the arrows show a force on the incisions. A and B show the transaction plane of an incision (sagital if taken from the back of the head). In A the transaction is in the coronal plane in B the transaction is in the transverse plane. C shows a horizontal incision and D shows a vertical incision. On the basis that the major forces acting on the incision or resulting scar are as shown (and this is not always the case) then B and C have the highest probability of stretching. A horizontal incision shown in C but transacted with the incision shown in A have less chance of stretching.

All of this is an opinion and I have no experience of wound closure. I do have quite a bit of knowledge relating to the biochemistry of Elastin collagen and FXIII but that pales compared with the empirical experience of the surgeon.


#15

» »
» » Wait, what?

Thanks…
»
» In the diagramn, the arrows show a force on the incisions. A and B show
» the transaction plane of an incision (sagital if taken from the back of
» the head). In A the transaction is in the coronal plane in B the
» transaction is in the transverse plane. C shows a horizontal incision and
» D shows a vertical incision. On the basis that the major forces acting on
» the incision or resulting scar are as shown (and this is not always the
» case) then B and C have the highest probability of stretching. A
» horizontal incision shown in C but transacted with the incision shown in A
» have less chance of stretching.
»
» All of this is an opinion and I have no experience of wound closure. I do
» have quite a bit of knowledge relating to the biochemistry of Elastin
» collagen and FXIII but that pales compared with the empirical experience
» of the surgeon.
»


#16

» » »
» » » Wait, what?
»
» Thanks…
» »
» » In the diagramn, the arrows show a force on the incisions. A and B show
» » the transaction plane of an incision (sagital if taken from the back of
» » the head). In A the transaction is in the coronal plane in B the
» » transaction is in the transverse plane. C shows a horizontal incision
» and
» » D shows a vertical incision. On the basis that the major forces acting
» on
» » the incision or resulting scar are as shown (and this is not always the
» » case) then B and C have the highest probability of stretching. A
» » horizontal incision shown in C but transacted with the incision shown in
» A
» » have less chance of stretching.
» »
» » All of this is an opinion and I have no experience of wound closure. I
» do
» » have quite a bit of knowledge relating to the biochemistry of Elastin
» » collagen and FXIII but that pales compared with the empirical
» experience
» » of the surgeon.
» »

There is a definite improvement but with more light i can guarantee this will look see through.


#17

» » »


»
» There is a definite improvement but with more light i can guarantee this
» will look see through.

Looks great for the number of grafts used. Its not 10,000 grafts remember!


#18

» » » »
» » » » Wait, what?
» »
» » Thanks…
» » »
» » » In the diagramn, the arrows show a force on the incisions. A and B
» show
» » » the transaction plane of an incision (sagital if taken from the back
» of
» » » the head). In A the transaction is in the coronal plane in B the
» » » transaction is in the transverse plane. C shows a horizontal incision
» » and
» » » D shows a vertical incision. On the basis that the major forces
» acting
» » on
» » » the incision or resulting scar are as shown (and this is not always
» the
» » » case) then B and C have the highest probability of stretching. A
» » » horizontal incision shown in C but transacted with the incision shown
» in
» » A
» » » have less chance of stretching.
» » »
» » » All of this is an opinion and I have no experience of wound closure.
» I
» » do
» » » have quite a bit of knowledge relating to the biochemistry of Elastin
» » » collagen and FXIII but that pales compared with the empirical
» » experience
» » » of the surgeon.
» » »


»
» There is a definite improvement but with more light i can guarantee this
» will look see through.

Johhny, no one claims hair transplant can get you back all your hair. Get educated and quit posting these drive by comments… PLEASE.