PGP, I guess, in a sense, you're right. However, given the area of the bald skin, my scheduled procedure won't be as simple as normal strip surgery. Dr Ron will have to go about 1/2 inch below the bottom of my two scars in two separate areas and remove the troubled skin.

While combining the two scars, the grafts from between will be used instead of being discarded-can't have that. If I simply went for a scar revision, I'd still be left with two scars and only the follicle dead tissue would be removed. Hope that eliminates your confusion but that's how it was explained to me.

dmoor
I had a hair transplant with Dr. Paul Shapiro a little over two months ago. And I would recommend him highly to anyone who is thinking of a hair transplant. The Hair Transplant from beginning to end was a great experience. Dr. Paul spent ample time explaining to me the procedure and the risk and benefits.
I am a type 6 and had a large area to cover. See my previous post for photos.
I decided to go for a large procedure of 4,000 FU. I am 63 and my donor site is a bit tight which Dr. Paul said he often sees in older patients. I do remember Dr. Paul letting me know that the risk of a larger scar was possible with large donor strip removal. So at least with me he was clear about the risk involved in the surgery. I still opeted for the larger session because I have such a large head and wanted as much hair as possible. I know my situation is very different from Tom R and I am not sure if it comparable.

I left town the day after surgery for a week long meeting. And when I returned from my trip (7 days post op) no one noticed I had a transplant. The scabbing had all cleared up and the transplanted hair looked completely natural. As warned my little transplanted hair did fall out but I can feel it growing back in.
As for my donor site, it is healing fine. I have to look hard to see that it is even there. When I go for my 6 month follow up I will post more photos.
This is just my experience and I know it is one of many, but I did want you to know about my positive experience with Dr. Paul and I would highly recommend him to anyone considering hair transplant surgery.

I would like to thank all the patients who gave me positive comments and I am glad that Dmoor is still confident that he will have excellent results with my surgery. Dmoor is correct in saying that I do strive for perfection and that any time my results are less then this, such as in TomR's case, I do review the case and try to see if there was anything I could do better.

One thing I know I could do better in TomR's case is communicate better. It is very important to me that all my patients go into surgery fully understanding the surgery, my approach to their specific case, and that the patient fully understands the risk and benefits of the surgery.

From TomR's comments I can tell he understands that a scar like his can occur in hair transplant surgery and that even the most skilled surgeons can not bat 100% of the time. But I could have done a better job describing his specific risk and letting him know about his tight closure.

In many hair transplants, the removing of the strip is a very straight forward process. In a case like TomR's the strip removal is not straight forward and some decisions need to be made. Usually I review this carefully with my patient, explain the pros and cons of different approaches to the strip removal, and together, we come up with the best plan for a strip removal. Some how this was not done in TomR's case and I am take full responsibility for that.

In TomR's case he had already had two previous surgeries. The first surgery was in 2000 at a different clinic then SMG, and the second was at SMG in 2006. His donor laxity was not great, but not terrible. Usually in a case like this I discuss different options with the patient. I discuss that if we try for the maximum number of FU I can get, the closure may be tight which increases the risk of a larger scar. I always assure the patient that if they do end up with an unacceptable scar I will do a scar revision at no cost. As a side comment I have had many tight closures in which there was no unusual scarring.
I also usually discuss that if I go along the old scar line, the yield will be less. It is just common sense that there is no living hair in scar tissue and often the tissue around the scar has fewer hair follicles.

TomR is correct in saying that I made a judgment call when I decided how wide a strip of donor tissue I should remove for his surgery. I take out a piece of tissue that I think will close with no tension. In his case I judged that a 1cm wide strip would close easily. Unfortunately it was a bit tight, resulting in tension. All hair transplant surgeons end up in this situation at one time. In patients with a tight donor area, the difference of only 1mm, or .045 inches can make the difference between an easy or tight closure. I like to use the analogy of packing a suitcase. Many of us have had the experience in which we pack a suitcase to the max and it closes. Then we add just one more shirt and it is difficult to close.

In summary, when a patient has had previous surgeries and/or a tight donor area, there are some difficult decisions to be made. If we want to maximize FU yield then we may chose to not go along the old scar and this results in two scar lines. I we choose to maximize yield then I need to take out a donor strip with a width that has a chance of resulting in a tight closure. I am always thinking of what is best for the patient and in these difficult cases try for the best yield with the least risk for additional scarring.

http://en.wikipedia.org/wiki/Ischemia

Does this mean that there was necrosis on your scalp Tom? I am unclear on this.

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-Steve

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I don't work for a doctor.
Got 2700 fu from Ron Shapiro, 11-30-7

Dr. Paul,

Thank you for providing your feedback into this situation.

Clearly there are always risks that go along with surgery. There is seemingly a delicate balance that must be found between excising as much donor hair as possible while being sure not to over-tax the donor. In this case, it appears that taking a bit less donor may have avoided the complication of a "tight closure" which led to healing complications. But as you said - decisions often have to be made on the fly.

I admire your willingness to accept responsiblility for the lack of communication in this matter and I apppreciate your explanation of the situation. A world class hair restoration physician does not always bat a 1000, but they do take care of their patients. I'm glad to see that Shapiro Medical is taking care of Tom free of charge for the repair.

Best wishes,

Bill

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To learn about how I restored my hair, view my my hair loss website.

Remember, true beauty radiates from within, not from the skin.

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

EmuSteve, I was somewhat unclear myself until Dr Paul responded. As it was eplained to me, I simply suffered from scar stretching when too much tissue was excised. There is no dead or black skin. It is white and smooth.

I'd like to add and I mentioned this to Dr Paul, that I used ice for extended periods of time post-op. If the blood supply to my donor area was already compromised due to previous scarring, this could have contributed to the problem.

And Dr Paul was a bit incorrect about my prior surgeries. My last two of 2000 and 1500 were done at SMG. The first (2000) was done by Dr Rose while he was employed with the SMG.

Are Ron and Paul brothers that both work in the same office?

Never mind I read the OP over again and answered my question, sorry...