For over a year I have been working on a method to minimize the donor scar. The technique involves removing the epidermal edge of the donor incision and leaving the growing portions of the hair follicle intact.This would be termed a "tricophytic closure". The wound is then closed and the subsequently the hairs that have been trimmed of epidemis grow through the scar. I have named the closure technique the "ledge closure" technique because essentially a ledge is created in the tissue prior to closing.
I have found that the resultant scars are very difficult to discern and the results are extremely encouraging. I plan to present the technique at the upcoming meeting of the European Society of hair Restoration in Bussels in June.
I will be posting some pictures as well.

Paul T Rose, MD
612 965 4247
813 259 9889

Dr. Rose,

Having had surgery with you this past November, I can say with confidence that my "donor scar" is almost impossible to detect even under close examination. It also healed very rapidly. I was very impressed with the care you took in excising a very long narrow strip from my donor area and the time you took to suture it.

It has healed beautifully and my crown is now thickening up. Thanks for the outstanding results.

Pat

Dr. Rose:

Thank you for sharing this with us. Is the "ledge closure" technique an option for patients who have had previous strip surgeries (and who are hoping to shrink their scar a bit)?

Marc

Marc:
The ledge technique can be used as part of a scar revision. A key facor is being able to ensure that the wound closes with little or no tension.
Paul T Rose, MD
612 965 4247
813 259 9889 office
getfithairs.com

It should prove very interesting on the outcome of each case including the scar revision cases mentioned.

That would certainly save an extra step of having to add hair into a linear scar later.

Dr. Paul Rose emailed me the below photo and asked me to add it to this thread. This photo shows a donor area closed using his "ledge" technique.

ledge_photo_from_Dr_Rose.jpg (237 Kb, 1821 downloads) image of "ledge" donor closure

I believe Dr. Rose has establish the closure technique of the future--not only limiting the scar but saving FU's in the process-- Great contribution to the HT surgeon community and patients.

Below is another photo supplied by Dr. Rose which he asked me to post on his behalf. I had posted it earlier and it had not worked due to our forum being temporarily over its storage limits (sorry to all who were inconvenienced).

We have expanded our limits and there is now plenty of room for everyone's photo so post away.

Thanks, Pat

fit_dots_by_Dr_Rose_jpeg.jpg (197 Kb, 569 downloads)

The pics are not loading. Can you try again?

Any updates on this "ledge closure"? Anymore pics? What happened at the conference in Europe? Are you using this technique on all your patients?

This closing technique is nothing new...

It has been around for awhile as I know one doctor in Australia by the name Of Dr. Marzola who told me about using this technique a while back if I chose to do a scar revision with him...

At the time I didn't know too much about the technique and thought it was too good to be true... So I contacted another prominent doctor that Doctor Rose has worked with and He told me that is wasn't too good a technique to use...

Whether it is a good technique (I certainly hope so) as it would help many (not having to graft scars)...
Please fill us in Doctor as to why it offers us more benefit that the normal 'double suture' closure techniques that are widely in use now..

Thank you for your interest in the ledge closure technique.
I recently returned from Brussels where I presented this technique.It is similar to a technique that Dr Frechet in Paris has been developing and it is significantly different from Dr Marzola's approach.

In my technique the inferior or lower portion of the wound is the edge that is de-epithelialized.The trimming is done as one continuous strip that is about 1mm in depth and 1 follicular unit wide. Dr Marzola trims the superior edge and I believe he uses a scissor at intermittent points. I believe that it is crucial to use inferior edge as this allows the hairs to grown through in the proper direction.

Additionally my technique involves some limited undermining in the fat. This also seems to limit tension and is similar to the way Dr Frechet performs his closure.

The wound is closed with minimal or no tension and a single layer closure is performed. I think that it more and more physician are going to a single layer closure and a two layer closure is not "the norm". A single layer closure causes less trauma to the tissue and I feel that there is less scar tissue produced. At times a two layer closure may be necessary to attempt to take off tension from a wound.

In response to my colleague's opinion that the technique is not good,I question how this person would know. How many patients has he or she seen that have had this closure? Has he or she tried it? I would also what motive the physician could have in criticizing the technique.I have been using this closure technique for over a year on many but not all patients.The results have been very encouraging and I think the photos that I have posted support such a view.

There may be things that we can do to further refine and improve results but I think we are on the right track.

Paul T Rose, MD
612 965 4247 cell
813 259 9889 office
813 924 4247 office
getfithairs.com

Thank you Dr. Rose for your points of clarification.

Hi Dr. Rose,
I am very interested in this Legde closure technique since I plan on having a scar revsion this fall. Do you know what the percentages are of having less of a scar against those whom the scar became even wider? Also, is shock loss and the usual post effects of the HT involved in this scar revision? After my first HT I had a wide scar. When I went in for the 2nd HT the doc told me he would cut out the old scar and it would be thinner this time, unfortunately he was wrong and it is even worse (much wider and longer and not smooth). This would be great news if this technique of yours really works.

Just to point out my experience to back up Dr. Roses's theory on single closure being better than double, my first HT I had single closure and resulted in a minimal scar, my 2nd HT I had double closure and resulted in a 5mm scar. Not sure if that was the reason for the scaring. I plan on going to Dr. Rose in the fall to have my scar corrected.