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Dr. Mwamba - WHTC - Class 7 Restoration - 12 mo. Result


#1

This patient had his surgery 12 months ago. He was a class 7 with broad head, and his donor density was average. With advanced hair loss and very limited donor reserved, he was classified as “not an ideal candidate”. There is no way to cover his entire scalp without a combo of BHT and scalp.

So we began by treating his frontal zone and midscalp with only scalp hairs: 3500 grafts. Then we placed 1200 grafts BHT in the crown as a test to see how he will respond to it. The main goal was to cover the front and top, matching the density of the sides. This has been accomplished.

Great care must be taken when creating sites and placing grafts in areas of diffuse thinning. Any damage to surrounding hairs can cause shock loss in the area.



Preservation of the donor is of great importance especially for patients with advanced loss. The patient had only average density in the donor to begin with and also prefers to wear his hair short in the back.

Now that the 12 month results have grown in, the goal is to treat the crown. Recently we transplanted the crown with scalp, and used body hairs to reinforce the middle scalp. If we want to harvest more, FIT Farming will be required. We used only leg hairs because this is the patient’s only BHT with good caliber. Below is the result of the 1200 BHT test session in the crown.


#2

Class 7? What are you smoking? Does anyone agree that this guy is anywhere near a class 7?

» This patient had his surgery 12 months ago. He was a class 7 with broad
» head, and his donor density was average.


#3

» Class 7? What are you smoking? Does anyone agree that this guy is
» anywhere near a class 7?
»
»
» » This patient had his surgery 12 months ago. He was a class 7 with broad
» » head, and his donor density was average.

I thought the scale only goes up to class 6.


#4

» » Class 7? What are you smoking? Does anyone agree that this guy is
» » anywhere near a class 7?
» »
» »
» » » This patient had his surgery 12 months ago. He was a class 7 with
» broad
» » » head, and his donor density was average.
»
» I thought the scale only goes up to class 6.

The scale goes until class7.In this class,you are loosing the lateral hump and your back line in the crown drop closer to your occipital protuberance.(I will say within 5cm from the protuberance.
This patient looks like a class 6 but when I looked closer with magnification he had miniaturized hairs or baby hairs in the lateral humps and within 5 cm from the occipital protuberance .And when I drew a line to follow those baby hairs ,I noticed his pattern was closer to a class7 and I treat him as a class 7.I didn’t harvest the lateral humps as usual and I didn’t go up to the 5cm above the occipital protuberance as usually.I explained to the patient his status(not good candidate) but the goal was to even the density in the side and on top to frame his face.And the test of BHT was in order to use them in the future when his loss will be noticeable in the hump,etc…
In conclusion,I will just say this patient had an extensive thinning that required a strategic planning to bring his life back.


#5

So you are saying is that you believe that he will EVENTUALLY be a 7, even though he is nowhere near that now. That is NOT the same as being a Norwood 7 before transplants…


#6

» So you are saying is that you believe that he will EVENTUALLY be a 7, even
» though he is nowhere near that now. That is NOT the same as being a
» Norwood 7 before transplants…
You are missing a point.This patient ,before the surgery had thinning (miniaturised hairs) in his lateral humps and within 5cm from his occipital protuberance.Those area should be considered as bald and treated such as.Therefore ,this patient is a class 7,eventhough he looks like a class 6.


#7

Do you have pics showing where the grafts were taken from, like an immediately post op pics ?


#8

The patient previously had no significant hair coverage over the male pattern baldness area. The fact that he is a 7, rather than a 6, may not be crystal clear upon immediate review of the photos for two reasons: 1) there were some isolated areas of wispy hair growth and 2) his hair is very short in the photos. The fact remains, however, that the patient had no real scalp coverage in the norwood class 7 zone. Not only is he “somewhere near” a class 7, he effectively is a 7 and was therefore treated accordingly.


#9

» » So you are saying is that you believe that he will EVENTUALLY be a 7,
» even
» » though he is nowhere near that now. That is NOT the same as being a
» » Norwood 7 before transplants…
» You are missing a point.This patient ,before the surgery had thinning
» (miniaturised hairs) in his lateral humps and within 5cm from his occipital
» protuberance.Those area should be considered as bald and treated such
» as.Therefore ,this patient is a class 7,eventhough he looks like a class 6.

dr mwamba, if his donor is so small what can you get from him, is this it, is he on meds?


#10

» » So you are saying is that you believe that he will EVENTUALLY be a 7,
» even
» » though he is nowhere near that now. That is NOT the same as being a
» » Norwood 7 before transplants…
» You are missing a point.This patient ,before the surgery had thinning
» (miniaturised hairs) in his lateral humps and within 5cm from his occipital
» protuberance.Those area should be considered as bald and treated such
» as.Therefore ,this patient is a class 7,eventhough he looks like a class 6.

The fact is that you are both right. At this time, he isn’t even a severe class 6. He is staring a NW7 straight in the face eventually.

So you are treating a current NW6 that is destined for NW7 unless meds prevent further loss. The treatment looks good, but wouldn’t look nearly that good if he was already at a NW7. If meds don’t work, it won’t look that good in the future either.


#11

» The patient previously had no significant hair coverage over the male
» pattern baldness area. The fact that he is a 7, rather than a 6, may not be
» crystal clear upon immediate review of the photos for two reasons: 1) there
» were some isolated areas of wispy hair growth and 2) his hair is very short
» in the photos. The fact remains, however, that the patient had no real
» scalp coverage in the norwood class 7 zone. Not only is he “somewhere near”
» a class 7, he effectively is a 7 and was therefore treated accordingly.

I don’t know what’s all the fuss is about. I think it’s irrelevant whether he is a class 6 or class 7. He only has so much donor that you can work with. My questions is same as Craig, I want to know where you obtained the 3500 scalp hairs from. Can you post some pics ?


#12

»
» I don’t know what’s all the fuss is about. I think it’s irrelevant whether
» he is a class 6 or class 7. He only has so much donor that you can work
» with. My questions is same as Craig, I want to know where you obtained the
» 3500 scalp hairs from. Can you post some pics ?

No problem.

Here is the donor at the begining of day 2


#13

Here is the donor at the end of day 2

A closer pic at end of day 2

Right side of the donor area at end of day 2

Notice how Dr. Mwamba skips around a bit when he harvests the grafts. If he sees an area of a little less density, he respects that as he harvests. Every hair is crucial with this extent of loss - be it Class 6 or Class 7. :slight_smile:


#14

Close up shot of the healing after 24 hours


#15

Here is the donor after day 3

A closer pic at end of day 3


#16

Immediate post op photo of graft placement


#17

I am amazed how natural he looks, I bet he can buzz it down and nobody could tell he had hair transplant, that’s the ultimate security: nobody knows you had wk done.


#18

» I am amazed how natural he looks, I bet he can buzz it down and nobody
» could tell he had hair transplant, that’s the ultimate security: nobody
» knows you had wk done.

Thanks, John. He had a difficult case - not an ideal candidate - but Dr. Mwamba came through for him and delivered a great result.


#19

The result is always imho based on improvement. Yes he looks better! So congrats.

» The patient previously had no significant hair coverage over the male
» pattern baldness area. The fact that he is a 7, rather than a 6, may not be
» crystal clear upon immediate review of the photos for two reasons: 1) there
» were some isolated areas of wispy hair growth and 2) his hair is very short
» in the photos. The fact remains, however, that the patient had no real
» scalp coverage in the norwood class 7 zone. Not only is he “somewhere near”
» a class 7, he effectively is a 7 and was therefore treated accordingly.