An interesting case

[Dr_Arvind]

Dear forum readers,
I think the following case is one that will be of interest to readers and physicians alike.

He is a NW 6, who underwent strip, FUE and BHT at some other clinic before coming to us.

The patient had a 3000 strip grafts, followed by an indeterminate number of FUE and BH grafts by the previous practitioners. The patient doesnt accurately remember the number of grafts taken by FUE and BHT but he feels his scalp resources have been exhausted already.

He has currently decided to go for BHT with our clinic.
At present he wishes to utilise the most robust 2000 grafts to fill up the frontal areas and to close the temple angles.

Some pictures before start of HT with us.

Regards,
Dr. A

[Dr_Arvind]

[marco]

I am sorry to detract from the intended theme of the post but this patient raises the most important question for us. He has had 3000 strip graft and probably 1500-2000FUE and almost no growth. The strip and FUE were done in the last 5 years (or less I think) judging from the type of insertion in the recipient. Regardless of when it was done there is virtually no growth, a load of white dot scars a strip scar and an exhausted donor region. How do we protect against this happening to us when ALL surgeons detail their successes but no one highlights the percentage that and up like this. How can we believe any surgeon when they do not let us know what the risk is of this happening. This comment is NOT directed at Dr. A clinic or any other individually. It is directed at all clinics. Dr.Avind, Dr. Umar, Dr. cole and Dr.Woods have all had a share of failures from my investigation but these are only discussed if the patient highlights them or if the Dr. shows a failure that came from another clinic. All surgeons do this and not only hair transplant surgeons. It is a disgrace but especially in the HT industry since there are only a few shots for the patient before it is difficult to correct! Again this is not directed at Dr. A’s clinic any more than any other.

[Dr_Arvind]

» I am sorry to detract from the intended theme of the post but this patient
» raises the most important question for us.

Dear Marco,
I shall reply to your concerns on the other thread that you have started. I agree that they are valid concerns for all prospective patients as well as all ethical HT physicians.
Regards,
Dr. A

[Dr_Arvind]

Dear forum readers,

In course of 2 days, a total of 2352 grafts were transplanted in the front half of the patient’s scalp.

The donor grafts included
450 Scalp,
430 pubic,
464 beard,
327 armpit, and
568 chest cum abdomen hair grafts.

113 grafts were also extracted from the thigh.

The front hairline and the temple angle closure was performed using a mix of the scalp and the finer calibre thigh hair.
The more robust hair from remaining donor areas were used to add bulk to the other areas.

Following are some pictures.
Before

Immediately post op.

[Dr_Arvind]

Dear forum readers,
Following is the picture of some grafts derived from the facial/beard area.

Following are comparative pictures of the grafts derived from the various donor areas. Due to their differing characteristics, we have mixed them while transplanting for naturalness.

Regards,
Dr. A

[Dr_Arvind]

[Dr_Arvind]

Dear forum readers,
The approach followed for this patient has been to use various more robust hair and mixing them to account for their different hair cyles.

Only the front hairline area was transplanted utilizing the fine calibre thigh hair alongwith the scalp hair.

The patient has promised to send pictures of his progress.
Regards,
Dr. A

[system]

I wonder why people that have got to this stage of baldness even bother with transplants, i mean he’s never going to have a full head of hair again, unless of course the plan is just to frame the face with a new hairline etc

[system]

» Dear forum readers,
» The approach followed for this patient has been to use various more
» robust hair and mixing them to account for their different hair cyles.
»
» Only the front hairline area was transplanted utilizing the fine calibre
» thigh hair alongwith the scalp hair.
»
» The patient has promised to send pictures of his progress.
» Regards,
» Dr. A

Interesting case, keep us posted. Do you know who performed his other 2 procedures.

[Jessica]

Dr. A,

Very nice job; I appreciate your approach and the simple way you have explained it both verbally and visually. I look forward to his results.

Do you have any guess as to why the first transplants did not grow? Could this patient have troubles with his physiology? Can you tell if poor technique was used?

Thanks

[damon]

I agree,very well presented,I will be even more interested to see the end result.

[Dr_Arvind]

» Dr. A,
»
» Very nice job; I appreciate your approach and the simple way you have
» explained it both verbally and visually. I look forward to his results.
»
» Do you have any guess as to why the first transplants did not grow? Could
» this patient have troubles with his physiology? Can you tell if poor
» technique was used?
»
» Thanks

Dear Jessica,
I can not comment on the merits of the technique used for his previous HTs as I am not privy to the techniques used by his previous doctors - strip as well as fue.

It would be difficult to pin point the reasons. Only the doctor who performed the procedure can explain.
Regards,
Dr. A

[drmwamba]

Very interesting case.I really like your approach.
I am little bit concern of what’s going on in the back ground.Unless if i am convinced that previous surgeons or surgeries did a bad work (and i understand Dr A doesn’t want to pin point it),I will be tempted to go for a biopsy to exclude any underlying process that could interfere with hairs growth.Or I may transplant at very low density to increase the chance of maximum yield.studies showed that the yield tend to decrease when we increase grafting density.
What do you think about this approach ?
» » Dr. A,
» »
» » Very nice job; I appreciate your approach and the simple way you have
» » explained it both verbally and visually. I look forward to his
» results.
» »
» » Do you have any guess as to why the first transplants did not grow?
» Could
» » this patient have troubles with his physiology? Can you tell if poor
» » technique was used?
» »
» » Thanks
»
» Dear Jessica,
» I can not comment on the merits of the technique used for his previous HTs
» as I am not privy to the techniques used by his previous doctors - strip as
» well as fue.
»
» It would be difficult to pin point the reasons. Only the doctor who
» performed the procedure can explain.
» Regards,
» Dr. A

[Jessica]

Dr. Mwamba,

It seems easier to approach repair with confidence for patients who went to poor surgeons. But the size of this patient’s strip scar is thin and properly closed. The existing trasnplanted hair seems to be placed in proper directions and without plugginess. It stands to reason that there might be underlying reasons for the transplant to fail.

How could you screen a patient for poor physiology? Blood tests? Biopsy? What could you look for?

It is an interesting case, indeed.