Coalition Surgeons

balody · #21 **Top** 04-26-2008, 02:34 PM

cheers,good luck.

spex · #22 **Top** 04-28-2008, 01:20 AM

Hi bullitnut, as i mentioned on another forum, more than happy to help in anyway i can mate. What has happened to you previously is just despicable and I feel for you mate.

louierah · #23 **Top** 04-28-2008, 05:46 AM

how would the scars looked if you shaved to skin with Mach 3

bullitnut · #24 **Top** 04-28-2008, 09:59 AM

not sure mate never tried i cant afford mach3 ha ha i use pound shop razors. joking appart though mate i really dont know perhaps ill try

Dr. Alan Feller · #25 **Top** 04-29-2008, 06:53 PM

Much of hair transplantation is subjective and therefore open to wide interpretation and discussion by doctors and laymen alike. However, the proper location of donor incisions based on anatomical landmarks is NOT up for debate.

The bottom line is that the scar in Allan's photo is demonstrably and unequivocally in the WRONG position because it is located BELOW the occipital bump (also known as the "inion" or "nuchal bump").

The reason for this is simple. The area of scalp below the bump is thinner and contains three layers of skin that do not easily slide over each other. The result is greater tension and potential for a wider scar than excisions made above the bump. The area above the bump, in sharp contrast, contains FIVE layers that glide over each other much more easily.

THE textbook on the subject of hair transplantation: "Hair Transplantation, 4th Edition, Unger/Shapiro" clearly lays out the anatomy and physiology and demonstrates with diagrams and text why excision below the bump is plainly WRONG:

I have verified the anatomy and physiology put forward by Unger and Shapiro using Moore's textbook of anatomy and Gray's Textbook of anatomy and can confidently confirm the accuracy of their information and conclusions.

Above or on the bump- GOOD.
Below the bump- BAD.
Pretty simple.

If we apply what Unger/Shapiro, Moore, and Gray taught us, it is pretty obvious that Allan's scar is BELOW the nuchal bump in direct contradiction to the authoritive texts. While there are exceptions to this rule, they don't seem to be in evidence either in the report Allan gave or the photo he displayed. His surgeon has some explaining to do.

Besides the academia cited above, any experienced and astute surgeon knows that the area below the bump is usually tighter, more fibrous, and less conducive to stretching and sliding. The same goes for the donor area just above the ears.

Bill,
I would like to respond to your reference as to the appearance of the location of the scar in my patient Richie, Allan, and Balody.

Plainly stated my excision was made in exactly the right position with respect to the nuchal bump and within the safest area of hair bearing skin available in the donor area. It is NOT too high as you have perceived and the relative angle of the camera is inconsequencial. I would ask Richie to please post an immediate post op photo of the donor area that may show where his scar is with respect to the nuchal bump. I know it is on or above the bump because that is standard operating procedure with me.

As for Allan's scar, it is obviously BELOW the nuchal bump because you can plainly see the bump in the photo and the scar is clearly below it. Doesn't matter what angle the photo is taken at.

As for Balody's photo.

I can't tell where the bump is because his hair obscures the anatomy and I've never met the man. It appears to be below the nuchal bump but I couldn't say for sure. Either he would be kind enough to post an operative or immediately post operative photo, or perhaps you can dig one up as I believe he posted them after his second procedure. Balody, perhaps you can provide the photo for us.

This is a very very important post for doctors and patients alike. The position of the scar, with respect to the position of the nuchal bump, is a concrete and tangible way of sizing up the doctor you are thinking of using for YOUR hair transplant.

I'll also bet $10 that every doctor reading this post will (hopefully) read the textbook sections I cited here and will act accordingly for the good of their patients and their practice.

Dr. Alan Feller
Great Neck, NY

HairDew · #26 **Top** 04-29-2008, 07:16 PM

I swear to God Doc, you never cease to amaze me

I wish all doctors could be this upfront. I've read some posts of people calling you cocky (you are right and everyone is wrong) but you prove once again that any discussion/argument without evidence, which you DID provide, makes them look like amatures.

Great post Doc...

Bill - Managing Publisher · #27 **Top** 04-29-2008, 09:09 PM

Dr. Feller,

I agree that the ideal location of the scar is not up for debate. I also have the text book you are referring to and am enjoying it very much.

The point of my post was simply that appearances can be deceiving. Just as Balody's scar "appears" low in the referenced picture, Richie's "appears" high in one of his pictures posted in comparison on this thread. I have posted a few images below for your reference.

The first picture, seemingly based on the camera angle, the scar "appears" too high, but in looking at the scar from the side angle, it appears normal. In comparing it to other pictures on his blog, the scar looks normal.

Now if you compare the picture you referenced of Balody's scar to this one below, you will notice it looks much different. Whereas it "appears" low in the picture you referenced, this one appears perfectly normal.

I do appreciate however, you taking the time to post this detailed information.

Bill

richie48 · #28 **Top** 04-30-2008, 05:37 AM

Hey Dr Feller ,hope you and your staff are well

As requested , more photos of my scar and donor .

Bill , below I have posted 12 pics of my scar from all differing angles and different lighting , i have been as honest and as transparent as i can be .

You will see that in all the shots my scar looks to be in the exact position show by Dr Feller earlier in this thread , to be the most optimum for the best healing with mininum scar stretch , i have even put my scar next to the diamgram used from the teaching manual published by Unger and Shiparo using Moore's and Gray's text book of anatomy to show you .

My scar has also been scutinised in person by atleast 8 people at our Manchester show case less than two weeks ago , these people ranged from veterans to newbies but most had similar knowledge to yourself on were a scar should roughly be located and certainly showed knowledge of what would be concidered a low scar or a high scar , all these people commented at how neat and healthy and perfectly placed my scar was .

Balody was invited to this show case but unfortunitally couldn't make it ,which is a shame as many menbers of the ht "club" could have verified the hight of his scar and put this topic to bed once and for all .

Billorus have you ever met Balody to inspect his scar or are you only defending the hight from the photos from his blog ?

I only ask this due to the fact most of the pics on balody's blog show the scar looking very low , even the pic you have shown above has got bolody with a very tilted forward head with the scar looking very close to the nape of his neck , clearly out of the optimun zone shown demonstated by Dr feller in his above post .

here are my pictures ;

You can quiet clearly see from the photos above , what is a low area regards the medical infomation supplied by Dr Feller and which scar is right were it should be and within the lighter shaded area , as explain by Dr Feller in his above post .

You can also clearly see from the variety of my pics I have posted , that some do look a little higher then others ,however the most accurate are my side profile shots , were my scar can be seen clearly falling into the safe zone .

Perhaps Balody may be willing to supply more photos ,which would also help to clarify things ?

I hope that clears up any confusion
richie

Garageland · #29 **Top** 04-30-2008, 07:13 AM

My Norton scar is well below the hump....hence it has given me the right hump.They obviously haven't read any manuals on hair transplants.

Bill - Managing Publisher · #30 **Top** 04-30-2008, 08:02 AM

Richie,

I appreciate your post, but I'm not sure exactly why you felt the need to post all your scar pictures when I've already stated in plain black and white that your scar looks perfectly normal.

Once again, the purpose of my post is that LOOKS can be DECEIVING. And by this, I am referring to the APPEARANCE of your scar looking high and the APPEARANCE of Balody's scar looking low.

In ONE picture, your scar APPEARS high, but doesn't in your other pictures. Likewise, the picture you have selected of Balody's scar APPEARS low, while yhet other pictures show otherwise. Once again, see the below picture:

You can his 3 month scar pictures from the side view by clicking here.

Another 2 month picture is below and the scar also appears normal

In both of your pictures, it is quite difficult to see the Nuchal bump, and we must keep in mind that this bump is higher or lower in certain individuals.

Compare your scars to mine below:

According to some of the pictures displayed, mine is right in the middle between both of yours

. And I'm also sure if I tilt my head up or down, the scar will appear higher or lower than it really is.

I believe both you and Balody are in great shape!

Best wishes,

Bill

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