Coalition Surgeons

Janna · #1 **Top** 02-05-2010, 02:53 PM

CORRECTIVE FUE WORK ON YOUNG PATIENT (mid 20's)
A young patient went to another clinic for FUE work. His receding hairline bothered him a great deal so when he heard he could gain back all that he had lost, he was thrilled at the prospect. However, as we've seen so many times, young patients are vulnerable and can fall for unrealistic promises. The result is afterwards they are left with a lot less money and a head of hair that needs to be repaired. This is what has happened with this patient. After the hairs grew out, the patient realized it was unnatural with the hairline being too low, hairs growing in the wrong direction and the anterior edge being too harsh and straight. He noticed he was already starting to thin behind the transplanted hairs and worried about how this would appear if future loss continued. He did not want to end up with an unnatural ring of hairs in the front with little hair behind it.
He contacted Shapiro Medical when he realized his initial HT goals were not met. He sent SMG several pictures to be evaluated. While we could see why he was not happy with his end result from his pictures, it wasn't until Dr. Shapiro met him in person that he was able to thoroughly evaluate and assess what needed to be done to create a more natural look.
What needs to be corrected?
1) Hairline too low, especially with patient being so young with potential for future loss.
2) Hairline noticeably asymmetrical.
3) Number of 2 hair grafts at the hairline.
4) Hairs growing out in wrong directions.
5) 2400 grafts has already been used - depleting donor supply, therefore, care must be taken to use rest of donor supply efficiently as possible to not waste any donor.
As in many 'REPAIR' cases, it is necessary to conduct the repair cases over multiple sessions to get the best results. In this case, the first session was used to punch out as many grafts as possible that were transplanted too low, too big, or growing in unnatural directions. We recycled the punched out hairs further back where appropriate hairline should have been. At the end of our first session, total of 226 grafts were replanted. The plan for the next punch out session will be to repeat this process. The hope is that these two sessions will get rid of most of the grafts that were planted too low. Afterwards in a final and third session, a regular FUE session with predominantly 1 hair grafts to recreate a natural anterior boarder hairline will be performed. The number of grafts needed will be determined at that time. We've had good results with this approach in the past.
Typically, the tiny holes left by the punches heal well with minimal scarring or notice ability.

Janna · #2 **Top** 02-05-2010, 02:54 PM

Short clip of Punch outs:
http://www.youtube.com/watch?v=h1MI9z-XwVk

aaron1234 · #3 **Top** 02-05-2010, 04:56 PM

Very interesting case Janna. It's too bad this patient had poor work done on him. He appears to have a decent head of hair in the first place. I'm positive it will look natural in the end. Was strip not an option? Perhaps due to the prior FUE session?

Dr. Paul did around 2 dozen punch outs on me due to the multi-haired grafts in my hairline from my first HT. Punch outs may look somewhat gruesome and do take a bit longer to heal than normal recipient sites. In my experience they eventually healed and became unnoticeable between the third and fourth month. Just in case anyone was wondering.

Janna · #4 **Top** 02-06-2010, 08:28 AM

Quote:

Originally posted by aaron1234:
Was strip not an option? Perhaps due to the prior FUE session?

Punch outs may look somewhat gruesome and do take a bit longer to heal than normal recipient sites. In my experience they eventually healed and became unnoticeable between the third and fourth month.

That's correct Aaron as to why he'll be getting FUE instead of strip. Strip is certainly a viable option but he wanted FUE for his first session so he'd have the option to shave his head in the future so we'll continue on with this approach for his future HT work at SMG.

Thanks for the additional info on your healing timeline for the punch outs. I think it's really good for people to know this type of info. It never ceases to amaze me how quickly the body heals.

hdude46 · #5 **Top** 02-06-2010, 12:24 PM

Janna, typically how far back into existing hair does Dr. Shapiro usually go, especially on a younger patient who may lose more hair and also considering proscar doesn't seem to work as well in the frontal areas?

Thanks!

dakota3 · #6 **Top** 02-07-2010, 05:42 AM

I feel bad for this poor guy, but he's in great hands now and Im confident he'll achieve his goals with SMG. Good work Janna!

justincase · #7 **Top** 02-09-2010, 11:09 AM

Very interesting case. I imagine that there are going to be a lot of these cases out there like this in the next 10-15 years as guys in their 20's with low aggressive transplanted hairlines age. Janna I have a few questions because Im in a similar situation. What sort of scarring can be expected (if any) from the removal via FUE? Will there be white polka dot effect all over this region now? Also could laser hair removal be used to move the hairline back a cm or 2? Thanks!

Jotronic · #8 **Top** 02-11-2010, 01:21 PM

Janna,

These are some really good hi-res photos. Hopefully more clinics will follow suit. Do you have any photos without flash? It is always nice to compare apples to apples and oranges to oranges.

the B spot · #9 **Top** 02-11-2010, 06:08 PM

Quote:

Originally posted by Jotronic:
Janna,

These are some really good hi-res photos. Hopefully more clinics will follow suit. Do you have any photos without flash? It is always nice to compare apples to apples and oranges to oranges.

Joe,

What are we comparing exactly?

Janna · #10 **Top** 02-11-2010, 08:59 PM

Hi hdude,
They wouldn't go back very far into existing hairs if the native hairs are strong without any signs of miniaturized hairs.
Thanks Dakota.
Justincase,
As long as the skin surface is smooth before the removal of these grafts, the punched holes have been healing fine w/o signs of scarring. We have not come across any white dotting but we use very small size punches. The laser could remove these grafts too but I believe you need about 5-6 treatments to fully rid the hairs.
Hi Joe,
Glad you like our high res pictures, it's the same resolution we've been using for as long as I've been posting our results. You must not be looking, but that's okay, I know you're busy. I think many clinics have followed suit. Off the top of my head, clinics such as True&Dorin, Dr. DeVroye, Dr. Tychocinski, and Dr. Reed all post high res pics. I know there are more clinics but it's almost my bedtime and I'm tired.

Being consistent with our photos with use of same camera, lighting, multiple angles, etc. for BOTH before and after pics are important. We've found the shots from above (top-down shots) show through the hairs to the skin more when flash is used, making the density look less. We take pics with flash because it comes out the clearest at our clinic. We also consistently provide as much surgery detail as possible and I'm happy to see some clinics have followed suit. I hope more clinics follow suit in not only taking high res pics but providing all surgery details too.

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