Despite being only a Norwood class 3 at the time of his surgery, this patient decided that he wanted to put his hairline back where it used to be when he was younger, before it got any worse. After 4 procedures totaling 3790 grafts in all, he is very pleased with his results.

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The information below was provided by Dr. Rassman upon request due to information typed incorrectly on the initial post.

The patient actually received 3790 grafts (sorry for the typo), 1350 in the first procedure and 1025 in the second. The patient lost some hair behind the original transplant. After the second procedure, the patient had a stretched scar measuring 1cm in width in its widest portion. The third and forth procedures were combination of two hair transplant procedures with scar revisions. The grafts were placed to thicken the work previously done. The entire scar was removed and closure tensions were low at both procedures and although some scar returned, the scar was improved.

All strip procedures produce scars. In some patients, the scars widen. I believe that the scars that stretch are more tied to the patient’s healing characteristics than the surgical technique or the size of the strip. In this patient, there was no wound tension at the wound closure on any of his procedures, but scar revisions are less than a perfect process. I have not seen any patients where the scar revisions made the scars worse (although I heard of one patient who had a genetic collagen defect and had his scar widen when an attempt at repair was done). Most patients get some improvement from a scar repair, possibly because the strip is limited in width. Amongst physicians who perform strip surgery, there is no general agreement as to the proper scar repair technique. Many surgeons close the wounds with a single running skin suture, while others close the wound with a two layer closure to guarantee a lower wound tension. In the two layer closure, the deep layer can be closed with interrupted absorbable sutures, or they can be running sutures. I have been using a running quill suture for my scar repairs and the sutures are anchored in the occipitalis fascis (deep layer) which is imbricated to take up the tension at the closure. With these closures, the skin tension is often very low, yet the scar may still return despite the logical value of the deep layer.

Comments were made by some of the posters of my classification of this patient’s balding pattern as a Norwood Class 3. I would rather consider it a 3A evolving into a 4A pattern. The nubbin of hair in the center on the original pictures was highly miniaturized. There was critical comment about the shape of this patient's hairline. I recommend on most of my Caucasian patients is what I discuss as the normal mature hairline as shown in: http://www.baldingblog.com/200...-mature-with-photos/ . The midline is measured one fingerbreadth above the highest crease of the wrinkled brow and the shape is convex. In many Asians, some people from the middle east and many Africans, the hairline is flat. The child’s hairline is lower, located at the highest crease of the wrinkled brow and is concave in shape (look at your children if you do not believe me) as are women’s hairlines.

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Don't get me wrong, the work itself is very good, but 7400 grafts!! It seems like overkill for such a small area and poor planning for the future. I can't help but feel a good result could have been achieved with 3000-3500 grafts.

very poor result and looks kinda strange.

there's that headband thingie again.

I would have said it looks good, but was the outlined area(so frontal third) the only area where these 7390 grafts were addressed to?
Now lets guess he had an area of about 60cm2 to be filled in which would be lik 123 grafts per cm2 ? even when It would be 80cm2(highly doubtful) that would mean 92 grafts/cm2 and still somewhat a see through hairline with what looks likes some folliculitis? I really thought this amount of grafts should have made it extremely dense looking like some of the hairlines we see on here in same situations as this patient with fewer grafts. The only thing which matters if the patient is happy about the result and will be happy with it many years from now on.
the result itself; looks good.

this poor guy likely made a big mistake.. he had better pray hes the first person to ever STOP the balding process, cause it looks to me like an outrageous amount of grafts used to foolishly lower a hairline and its STILL not very thick... if that is what Rassman does with 7000+ grafts its easy for me to see why that poor young guy who THOUGHT he was winning a life changing free transplant on that tv show got such a terribly thin outcome also....

terrible future planning, i dont care if its what the patient wanted.OBV patients dont always know whats in their best interest. the doc should have declined... instead he just kept taking his money 4, count em, 4 different times..your a saint doc, bravo.........

to top it off we get that deceptive band that pulls the hair straight back again.... MY HT hair looks like that when i pull it back and my HT sucks....

how was this guy ever highly regarded in this industry?? anyone??

no way 7390 grafts, also looks like an HT.

I agree with LMS!

i think it's time for rassman to stop performing hts. 7k grafts to achieve that? ridiculous....

Maybe he meant 7390 hairs?

Or maybe some of those grafts went into the crown? Either way, not the greatest documentation.

Guys,

I sent an email to Dr. Rassman encouraging him to reply to your comments and concerns. Frankly, I hope grafts were also placed to add density in other areas of the scalp not represented in these photos. Otherwise, hopefully the're some explanation as to why 7300 grafts were used in the frontal third of a patient's scalp and why it appears sparse. Perhaps the surgical details are incorrect?

I encourage Dr. Rassman to offer his input on this result.

Best wishes,

Bill (Falc)

quote:

Frankly, I hope grafts were also placed to add density in other areas of the scalp not represented in these photos.

I totally agree. If there were some top down shots (crown included), we'd have a better idea of how all of the 7400 grafts were used. Like I said, better documentation (ala H&W, SMG) would be helpful.

I'm speechless...

7400 grafts would be a complete restoration front to back using H&W cases on a NW5-6.

If just the front third was covered and that central core wasn't touched, the graft calculator shows it would take 1484 grafts to reach 50FU/CM2 around the area marked. If 7400 grafts were truely placed just in that frontal area(1&2), that would be a density of 250 FU/CM2 which is impossible. The area shown looks to be more in the 40 FU/CM2, if that.

Someone's got some 'splainin to do.

I know I've commented on this before, but it never ceases to amaze me why clinics would post such minimal before and after photos & details and then likely get upset at us drawing conclusions that are (certainly in this case) not favourable. 7390 grafts? On a Class III patient? Most others get by with 3-4,000.

http://www.hairtransplantnetwo...-byClass.asp?Class=3

I must admit that I also dislike the wording chosen by the New Hair Institute. As only a Norwood 3, he would certainly not need 7390 grafts. It's also unrealistic to put a patient's hairline back "where it used to be when he was younger", as this uses up valuable donor despite potential further thinning in the future. In fact, the original poster identifies this by saying he wanted his hairline back "before it got any worse" meaning that his hair loss hadn't even stabilized yet.

So all that I see is a lot of grafts used, for not a lot of coverage, at 'average' density on a patient still thinning and trying to play 'catch-up' to his hair loss after four surgeries.

I know we've talked about this before, but it should be required for clinics to show top-down photos, immediate post-op, how far along from the surgeries the patient is, and any other details (such as explaining the "scabbing" visible just behind the thin hairline).

M&M

It's either a major screwup on the presentation or a major screwup on the planning and result. Either way, it's scary this is a coalition clinic. That confirms my feelings that there are probably only two, maybe three doctors out of the entire coalition that I would dare let touch my head. And I'm still a little nervous about those.

quote:

That confirms my feelings that there are probably only two, maybe three doctors out of the entire coalition that I would dare let touch my head

Severn,

I think this statement is highly unfair.

Frankly, it's sad that you would use this example to condemn the majority of the Coalition while most are diligent in presenting impressive examples of their high quality work on our forum. You are entitled to your opinion and preferences, but to condemn the majority of an elite group of surgeons when there's numerous examples to support their work is first-class is insulting. Frankly, I take personal offense to this statement, especially since Pat and I work extremely hard to make sure those surgeons we recommend are among the best in the world.

quote:

And I'm still a little nervous about those.

Frankly, this last statement says it all. Your reluctance to proceed with a hair transplant has nothing to do with the quality of work physicians recommended by this community regularly perform. Physicians aren't magicians. Even the elite have to work within the natural limitations and an individual's characteristics.

Bill (Falc)

Falc:

I think my post came out a bit different than I intended. It was poor wording on my part and could be interpreted that I thought the majority of Coaltion doctors were not good. And this isn't true. Most Coalition docs here have presented a ton of great results.

As my procedure draws closer, I am just getting more paranoid. Not in the sense that I am having second thoughts but after being burned by Bosely I don't want that to happen again, even if it's unintentional.

And my comment about being nervous about the 2 or 3 I would let work on me wasn't meant that I don't have confidence in them. It's more like going into open heart surgery. You can end up with the best heart surgeon in the world but you are still going to be nervous before going under the knife.

I will be a repair patient so my surgery won't be about trying to look younger so much as repair the scarring done from the scalp reductions years ago.

My appologies for the paranoid post!

(And many thanks to you and Pat for all the hard work you guys have done to bring transparency to the field!)

In my most honest and blunt opinion, this is disgraceful. This clinic has shown blatent disregard for presenting their work in a dignified, honest manner to best serve patients -- and, frankly, what is seen of their work doesn't leave the imagination panting in delight.

And I couldn't help but laugh that after kindly yet firmly calling them out for presenting their work in *such* a disingenuous and laughable way...that there next case isn't just one as incredibly dubious as this, but it is presented in *identical* (atrocious) form.

I can barely even assess just how severely dubious this case is, as I can't help but simply laugh after seeing pictures -- yet again.