This asian patient had multiple sessions of plugs and minigrafts before visiting us. Unfortunately his donor area was quite depleted, but luckily his last surgeons neglected to harvest from the left occipital and temporal areas.

We were able to excise 2,100 grafts using strip technique and implanted them in such a way as to favor his left side as this is the side from which he combs his hair.

Here are his preoperative picutres, intra-operative pictures, and 10 days post op. We will be updating his photos as he visits us here in Reston, Virginia.

Work looks very refined to me. I also like the hairline design, and the "weighting" of the grafts to work in tandem with how he will be styling his hair -- I think he is going to be very pleased.

Looking forward to seeing the end-result, as I think it is going to be particularly impressive given his (prior) level of balding and the amount of grafts (strategically) used.

i am in agreement with thana,work looks good.he should be happy 12 months in.(much better pics this time doc)

Yeah have to agree this looks nice and refined and should produce a good frontal appearance.

Has he got any donor left now incase he needs a touch up as his donor in scar picture no 7 looks very depleted now due to his previous surgeries.

Dr. Lindsey,

I agree that the work looks nice and ultra refined.

I'm not sure however, that I understand the strategy.

Can you explain why you and/or this patient with very limited donor supply chose to densely back the hairline (and only one side) when is has very little native hair behind it?

It seems to me that this will produce an unnatural look.

I know that I have seen a strategy similar to this before, limiting the patient to a particular hair style simply because he doesn't have the donor supply for anything more.

Falc

that does look like very nice work dr lindsey:-) thank you for sharing them here and i am sure the patient who is a repair one will be very happy. it seems you have placed the hairs that way to copy his existing style ie the left to right comb across. i pressume you did it this way to concentrate on the problem areas where the old work was in order to hide it ... i am sure it will work well. was this the patients goal with his limited donor hairs left?

falceros, if only you gave other doctors such a grilling and made them answer questions that they leave and hope go away..

dr lindsay, you perfom fue i believe, how much do you charge per graft?

Frog,

quote:

falceros, if only you gave other doctors such a grilling and made them answer questions that they leave and hope go away..

First, I can't make a physician answer a question, I can only pose the questions just as other members can and do.

Secondly, if you have actually been around longer, you would know that this is common practice for me. Evidence can be found all over.

Please remember that I am a patient first above all else and have the patient's best interest at heart.

Cheers,

Falc

I have no problem answering as many questions as possible. I was told that when I started to post my patients online that I would be closely scrutinized and asked very detailed questions and I don't blame anyone for doing so.

I myself have seen such poor work from so many clinics in the past that it is reasonable to be suspicious of many HT doctors work. I believe the best policy is to be as transparent as possible.

As for this patient, we packed well more than the hairline. We ran well up his left side where his part will be.

The reason we wieghted the transplants heavily to one side was to maximize what he had to use. Since he has always combed his hair from left to right it just made sense to pack it more heavily on his left side. This way when he grows out he will have an appreciable mass of hair over his "part" area giving him a better illusion of hair and coverage. It will also best cover his old grafts and scarring this way.

You will notice that we went just past the midline of the scalp so that the final product won't look like a "combover". This is a very effective strategy for getting maximal results from minimal grafts. Lucky for him he has fairly thick caliber hair.

He still has some donor area left, but probably under a thousand, but I suspect he may not need any more work after this procedure.

Frog:
Yes, this style is exactly what he wanted as he he told us he always parted his hair from right to left. Also, his heaviest scarring was on his left side from the old transplants.

Yes, I perform FUE and charge $8 per graft.

thanks for answering dr lindsay, have you had much success with fue into scaring? i am very interested in getting as much fue into my large scar as possible.

falceros, you are a moderator first, not a patient first, in my opinion and are far too quick to jump to particular doc's defense over others especially when its nothing to do with you.Let doctors answer for themselves then you will be a patient first ..moderator second ;-)

quote:

falceros, you are a moderator first, not a patient first, in my opinion and are far too quick to jump to particular doc's defense over others especially when its nothing to do with you.Let doctors answer for themselves then you will be a patient first ..moderator second ;-)

I have defended physicians that YOU have unfairly maligned. I have told you on numerous posts that you are free to ask any questions you would like but you often jump too quickly to conclusions based on your experience.

You have stated loud and clear that your trust issues are because

quote:

I have been deceived before by this industry

I can understand why you have a hard time trusting this industry and I encourage a certain amount of skepticsm. This is the reason for asking questions and expressing opinions. But you often make absolute conclusions and condemn. This isn't fair.

After my response to you, you posed questions and I commended you for it. All of this information can be found on this thread.

Anyway, I believe you have a heart for patients. So do I. Despite what you think, that makes us on the same team.

Dr. Lindsey,

Thank you for your explanation. I look forward to seeing more of your work and these results when they grow in.

Falc

While this strategy is not what I would go for, we have to remember that this is the patients donor hair to use the way he feels best.

Since he had a limited supply, wants to hide the old work and cover as mauch as possible with a combover, we should respect what he decided to do.

The technical work looks refined and I would like to see the follow up pics when this grows out.

Thanks for the comment No Buzz. We did dense pack him with TRUE follicular units using a lateral slit custom blade technique. I think he will be very happy. For the last 10 years I have routinely right or left side loaded patients with limited loss or limited donor supply based on the patient's preferences and hair styles. I have had pretty uniform satisfaction by listening to the patient and working WITH them, not just dictating what I want to do.
http://www.lindseymedical.com/weimages/ek/after/5.jpg
http://www.lindseymedical.com/webimages/ek/after/3.jpg

Dr. Lindsey,

Definitely an ingenious solution...I'm sure that it's a challenge to get the most out of a limited donor supply, while dealing with a lot of balding area to cover, plus existing less-than-optimal HT work...well done, sir...!

Good growing to this dude!

Benjamin

Thanks for the positive comment Benjamin. This fellow ought to get a great result and I will post pics to show it this summer. Our extremely small 0.7mm slits allow for DENSE packing for both repair jobs and initial procedures.

William Lindsey, MD
Reston, VA

Dr. Lindsey

Welcome to HTN and the forums.

I think your planning on this patient was very creative for his specific situation. Clearly, as you stated, this was a repair case which requires a lot of grafts to adequately cover; but the donor was depleted so you had to really customize your strategy for this patient. At first look, it certainly looks unique, however, I'm sure there was a lot of dialogue between you and your patient to come up with this plan based on the way he parts his hair and his main concern to cover up the old plugs. it will be very interesting to see his results at one and two years when he grows out.

What is definitely evident is your technique with refined follicular units, small slit size for the frontal scalp, and high density graft placement. Dr. Feller has had a positive impact on your hair restoration technique!! I look forward to seeing more of your work.

It is important to remember that each case needs to be customized for the patient. That is where the doctor-patient relationship is so important so that the patient is educated in the pros and cons of various strategies to accomplish their goals; at some point, it is ultimately up to the patient to decide which direction to go. It is up to the physician to make sure that the planned strategy is of sound judgement to achieve the desires of the patient. Again, I look forward to seeing his results down the line.

Steven Gabel, M.D.
Northwest Surgical Hair Restoration
Portland, Oregon
503-693-1118

Thanks for the comments Dr. Gabel. You are correct on several issues. First, we did need a lot of grafts packed DENSE to cover in this repair procedure, and using our custom made 0.7-0.8mm blades, we can do just that with minimal surrounding trauma. Second, by having a good patient-physician relationship we maximized preop planning and informed consent. And finally, you are absolutely correct in that I have been highly influenced by Dr. Feller over the past 8 years. I look forward to sharing more cases with you all over the next few months.

Dr. Lindsey Reston, VA lindseymedical.com

Looks like job well done considering the depleted donor area.

Would be interesting to see more pictures in the future

It was a job well done primarily due to DENSE packing. From your experience with Dr. Feller, you know first hand about density of the hairline.

Thanks for the comment.

Dr. Lindsey Reston, VA lindseymedical.com

Excellent thread, a little late to this but am keenly interested in this patients ultimate result and will be watching to see how it turns out. Thanks a million for sharing all this information, it is incredibly informative for someone like me as I find myself in precisely the same situation as this patient

What was the length of his incision to remove these 2100 grafts, can that information be shared? I'm curious how far the incision is from photo number 7. It surely is not confined to such a small donor region, is it?

Happy growing to that guy.

Wylie,

Lots of patients are in the same situation as you and this fellow. Your question about the incision line lenght would vary depending on patient density and previous scars, but I think it was about 25 cm in this guy, and about 1.2cm of strip width.

I don't follow your question about distance from the scar in the second paragraph; but essentially his scar goes around his occiput to the opposite side and should heal well. The trichophytic closure obviously will help.

Thanks

William Lindsey MD RESTON VA