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The importance of proper training in HT


#1

Dear forum readers,

At present modern Hair transplant is not taught in any medical college or hospital.
I wish all leading hair transplant doctors take up teaching the future generation of doctors in a dedicated way. Not a 2 week or 1 month course.

Otherwise, time will ensure that the untrained doctors entering the field will keep damaging patients and giving hair transplant a bad name.


I request readers to spread the awareness that hair transplant (whether strip FUHT or FUSE/fue or BHT or facial hair-to-scalp transplants), requires proper and dedicated training on part of the physicians offering them BEFORE they do offer them.


I present a few instances where physicians have used, technically, follicular units. However, lack of rigorous indoctrination ensured that the patient got disfigured.
In each of the instances proper training would have ensured much better and natural results.

I hope such case illustrations builds up public opinion and pressure that ensures doctors undergo proper training before they start offering hair transplants.

Regards,
Dr. A

P.S. - None of these cases have been presented before this time, and all of these have been performed by physicians that are “certified” members of various hair restoration organizations. These are not the accepted level of care and the cases have been performed in recent years (not a decade ago).


#2

Dr. Arvind, out of curiosity, what kind of HT training did you have?


#3

» Dr. Arvind, out of curiosity, what kind of HT training did you have?

Dear Readyfreddy,
If I say, little, if any formal training under another senior doctor performing hair transplants, that would not be far from the truth.

After completion of my medical studies (1990), I was commisioned in the Indian Army Medical Corps as medical officer (1990 to 1996).

My tenure in Army gave me chance to work with senior dermatologists and exposure to dermatologic surgery in form of skin grafting and related procedures in burn victims and vitiligo cases etc.
There, I also had my exposure to hair transplants victims. I had earlier seen a senior professor who had recieved plug grafts.
I saw more cases performed by various doctors (not any of them being of the Army).
That was the start point of my curiosity about hair restoration.

Perusal of all the available literature led me to the conclusion that better technologies were evolving. I am talking of mid 1990s.

When I wanted to undergo training in modern hair restoration, I found that there was no detailed training programs.

What disturbs me is that 15 years ago, there were no training programs and very few rigorous ones exist today.
Hair transplant is like a step child of modern medicine that no field wanted to adopt in its infancy. Now when it has evolved, many wish to claim it as their own without giving it due respect.

I do not want the talented new generation of doctors to suffer due to the same lack of educational/training resources that existed a decade earlier.

Regards,
Dr. A


#4

Vikram had a procedure elsewhere. The procedure was claimed to be fue and follicular units were used.

The scar tissue in the centre of the scalp was not present before the HT. Grafts were transplanted there too.


#5

12_file27.wmv


#6

How many grafts did he have?


#7

Dr. Arvind, do you know what cause the scar tissue to develop? Isn’t it uncommon to have scar tissue like this in the recipient site?


#8

» Dr. Arvind, do you know what cause the scar tissue to develop? Isn’t it
» uncommon to have scar tissue like this in the recipient site?

Dear therapy,
Yes, it is highly unusual to get scar tissue in the recipient area the like of which Vikram did.

But an untrained doctor trying desperately to put the grafts in, can lead to a lot of trauma. Not that it necessarily happened in Vikram’s case. But that is one of the first things that come to mind.

What troubled me more was that Vikram got that HT less than 2 years ago.

A depleted donor area and a scarred recipient area, with unnatural growth in the surviving grafts, however, is least of his misfortunes.

Theres more… and I feel bad that anyone is allowed to perform HT just because they decide to.


#9

Dr. Arvind do you have a pic showing what his hair looked like before this?


#10

» Dr. Arvind do you have a pic showing what his hair looked like before this?

Dear Ixan,
No we do not have pictures of the patient prior to his first surgery.
Regards,
Dr. A


#11

So often, I see repair cases that convince me that doctors underestimate the requirement of proper training.

Vikram is another instance of greedy physicians undertaking FUE, thinking its just about holding a punch and coring away.

This is the third such patient I have seen. But I suspect there are more out there in similar unfortunate situation.

We performed a strip FUHT - both in an attempt to repair some of the frontal areas and to excise many of the cysts the patient could feel in his donor area.

At the time of taking out the strip, my fears were confirmed.
Entire full thickness grafts had been buried and the scalp skin had healed over them - trapping them underneath.

I suspect the cause was overtumescence and random high speed “coring”.

We have sent the cysts for Histopathological examination and plan to present these cases as case report for the medical journals. Hopefully, this will dissuade doctors from undertaking such cowboyish approach.

The following are some pictures taken at the time of Vikram’s repair HT at our clinic.

The donor area with the hair buzz cut to 1mm

The initial strip incision reveals one of the cyst (pointed with the yellow arrow) lying close to the edge of the strip.

Another

and another

and another

Some of the cysts that were dissected out and later sent to the lab.


#12

There should be a warning for these pictures, that s gross!


#13

» There should be a warning for these pictures, that s gross!
I think you are correct.
Therefore, I have added the “viewer discretion” in the subject line.


#14

» There should be a warning for these pictures, that s gross!

My stomach just turned. That is the last thing I want to see on a Monday morning.


#15

OMG ! What’s the reason for sending it to the lab? What can the lab tell you?


#16

Geezz, does it hurt if someone has those cysts under the scar? I had strip done. How can I tell whether I have it or not? I kind of regret opening this thread, now you got me worried


#17

I have seen this before, I think it was also posted by Dr. Arvind. I guess this is more common than we thought? What is the worse that could happen if they were left under the skin?


#18

Dr. Arvind, what would happen if you leave the cysts there?


#19

» Geezz, does it hurt if someone has those cysts under the scar? I had strip
» done. How can I tell whether I have it or not? I kind of regret opening
» this thread, now you got me worried

Dear stitchmeup,
My intention was not to cause undue worry to anyone.

As for a strip surgery patient, I highly doubt that such a situation can occur. That is because the nature of the surgery is totally different.

Regards,
Dr. A


#20

» OMG ! What’s the reason for sending it to the lab? What can the lab tell
» you?

Dear reiner,
The histopathological examination at the lab is to rule out any atypia or signs of malignant changes or those of chronic inflammation + eosinophilia in the excised cyst.

The patient was advised to regularly examine the remaining cysts. They may be removed at a future date with the patient’s permission.
Meantime, Vikram has been advised that if he notices any sudden increase in size of the cysts/nodular swellings, he is to contact the nearest hospital and seek advise.

Regards,
Dr. A