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Hair Restoration Research Forum Hair Restoration Questions and Answers SlowlyThinning@59 Photos from Limmer (Personal Album)|
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| Below is a link to John’s (SlowlyThinning@59) photo file. Included in the series are preop, immediate post-op and donor site / closure photos. He had just over 3100 grafts with 2/3 + up front and a little less than a 1/3 of the procedure in the crown. Photos 1, 2, and 3 are his pre ops. One thing to note is his good cosmetic density in the bridge region and lack of miniaturization along the periphery of the crown. He was placed on finesteride / Rogaine / nizoral to minimize risk of loss / need for grafting in these areas. Photos 4, 5, and 6 are his immediate post op photos. His hair is wet in these photos as we wash the scalp post op with an airbrush that sprays sterile saline. This minimizes the amount of blood/crusts on the grafts so patients heal quickly and usually feel comfortable going out in public within 7-10 days (or less) without having having to hide their scalp. Also, we did not plant the bridge region. Although when wet you can see through it, when dry, as noted in his pre op photos (and in person) has very good cosmetic density. Planting through this area would not have yielded any significant cosmetic change, but could have risk unnecessary trauma. Some might have planted through this area. But as has been noticed in prior posts John is not 30 years old and in all situations, but when his hair is wet, looks like normal full cosmetic density. If he desires, it can always be addressed at a later date. Waiting also gives us time to see if these areas respond to medical therapy. Also, because of his remaining hair and the patterned planted John understands the importance medical therapy plays in keeping it and minimizing the need to chase after additional loss with more grafting. This is true in most cases but still sometimes hard to get patients to understand, medical therapy and transplant surgery go hand in hand. One compliments the other to help achieve your best overall result. Photo 7, 8, and 9 show first the medial aspect of the closure from day one with the shaved area for day two. Next is the planned (outlined) 20 sq. cm. harvest for day two (16 cm long and 1.3 cm wide). Last is the posterior center of the scalp showing the closed and connected donor excision sites from his two day procedure. Photos 10 and 11 show the lateral aspect of the two donor excisions. As seen, you could not harvest any longer of an excision to yield more grafts. The length was at maximum. The only way to have obtained more grafts would have been to widen the excision. Going up in width by ~0.2mm (1.5 cm total) could have yielded ~ another 500 grafts, but at least above his mastoids it would have been snug. This is also the area that people most commonly point to regarding pain or have slight widening of scar. Thus if you are going to increase the width, it would be best to do it at the lateral aspect of each excision as well as the area that the two meet. But not the area above the mastoids. Please let me know if you have any questions, need additional descriptions or information. Brad Limmer, MD/jac |
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Hair Restoration Research Forum Hair Restoration Questions and Answers SlowlyThinning@59 Photos from Limmer (Personal Album)