The following are some photo and diagrams that may be useful to refer to when reading the recent post I sent called "Informaiton on the Trichphytici Incision" I hope they are educational and helpful in understanding this technique

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Thank you Dr. Shapiro. That is excellent information. How long will it be before all of the top surgeons are using this technique or some variation thereof?

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2700 Total Grafts w/ Keene 9/28/05
663 one's = 663
1116 two's = 2232
721 three's = 2163
200 four's = 800
Hair Count = 5858

1000 Total Grafts w/Keene 2/08/07
Mostly combined FU's for 2600+ hairs

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See me at Dr. Keene's Gallery

Thanks for the post Dr. Shaprio. Though I had heard the method described, the visual helps provide a more thorough understanding of what actually takes place.

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Hairbank

1st HT 1-18-05 - 1200 FUT's
2nd HT 2-15-06 - 3886 FUT's Dr. Wong
3rd HT 4-24-08 - 2415 FUT's Dr. Wong

GRAND TOTAL: 7501 GRAFTS

current regimen: 1.25mg finasteride every other day

My Hair Loss Weblog

Disclaimer: I'm not a Doctor (and have never played one on TV ) and have no medical training. Any information I share here is in an effort to help those who don't like hair loss.

Dear Dr. Shapiro (and others),

Question is:

If I have had a previous strip procedure, can you simply have the second procedure excise the first scar and close with this new procedure (assuming you can excise the first scar).

Thank you.

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Dec. 2004 - 1938 Grafts via Strip
Feb. 2009 - 1002 Grafts via FUE

I'm not a Doc but can answer your question as I just had it done. Unless there's a specific reason not to do it, they should automatically remove the old donor scar with the new harvest for the HT. Downside is you probably lose 400-500 grafts but you get the thin, clean results of Tricho.

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Hairbank

1st HT 1-18-05 - 1200 FUT's
2nd HT 2-15-06 - 3886 FUT's Dr. Wong
3rd HT 4-24-08 - 2415 FUT's Dr. Wong

GRAND TOTAL: 7501 GRAFTS

current regimen: 1.25mg finasteride every other day

My Hair Loss Weblog

Disclaimer: I'm not a Doctor (and have never played one on TV ) and have no medical training. Any information I share here is in an effort to help those who don't like hair loss.

The answer is a "qualified" yes.
If the scar from the first donor procedure is thin and the laxity is adequate then you can excise the first strip entirely. As Hairhope says the downside is that since part of the strip now contains scar tissue with less hair the amount of grafts will decrease. Sometimes that is not an issue as the laxity is so good that you can go wide enough to get the desired grafts and exise the scar. Also sometimes the scar is so thin that the decrease amount of hair in the scar is minimal.
At other times when the scar is wider or if the laxity has decreased you have a decison as to wether to leave the scar and just go right next to it to improve your yield and then do a scar revision later ...that only adresses the scar

Now if you are trying to repair a scar that is "very" wide sometimes you simply cant exise the entire scar and have to use other approaches for scar repair.(multiple small excisions, FUE into the scar, douple layer closures, and sometimes even expaners have been used for very wide scars)

I think I will write a brief informational piece on the donor scarring and the approach do scar repair over the next couple of days like I did for the trichophytic closure

Take care
ron shapiro

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Dear Dr. Shapiro (and Hairbank),

Thanks for your comprehensive reply, it gives hope to those who previously have had a strip procedure prior to the availibility of the trichphytic technique to have a better (and almost unsightly scar) after a second HT.

Regards,
HH

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Dec. 2004 - 1938 Grafts via Strip
Feb. 2009 - 1002 Grafts via FUE

Dr Shapiro

When you provide this overview of scar revision techqniues can youl also give some commentary on revising/improving appearance of donor scars from the old circular plug surgery. I guess there are quite a few middle-aged men that still suffer from the 80's eraly 90's from this type of surgery and while the scars are mostly hidden by hair it leaves one neverthelesswith a psychological reminder of what they had done and potentially fear for the future as they age and the hair inevitably gets thinner

Hi everybody who is interested in the Trichophytic closure. Doctor Williams utilizes this technique on all of his patients, so I asked him to comment on the posts made on the Forum about it. This is what Dr. Williams had to say:
"I wish to thank Dr. Shapiro for his excellent explanation to the Forum explaining the Trichophytic closure technique of the donor skin after removing the donor strip. We have been utilizing this closure on all of our patients and I am very impressed at how well this works to encourage hair to grow into the incision line providing a greatly improved to invisible scar. Those patients who have concern about an obvious scar, after undergoing hair restoration, may wish to have this technique utilized. I certainly will continue to use this technique on all my patients."

We welcome all questions inregards to the technique.

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I am employed as the patient consultant for the Advanced Medical Hair Institute, Dr. Williams office in Las Vegas, NV.