Dr. Carlos Wesley
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Everything posted by Dr. Carlos Wesley
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Our office would like to wish you a happy holiday season and a healthy 2016. We would also like to reflect on a wonderful year. I have posted an in-depth montage of the various patient transformations that took place in our office during this time period. Male and female patients benefited from surgical approaches (FUT and FUE) as well as non-surgical procedures (PRP and SMP) throughout the year. In addition to the standard before/after pictures, various patients also volunteered to include video footage of themselves for prospective patients to also view. On a personal note, I have grown to appreciate the candid dialogue on sites such as this more this year than ever before. Just like in a "healthy democracy," reason and level-headedness truly seems to prevail when patients' personal experiences with the various procedures and medical therapies shape each debate. Happy New Year! -
I have attached magnified images of this patient’s donor and recipient areas that were taken during our initial consultation together. As you can see, the prior transplant (performed at a different surgical clinic) left grafts in the recipient area that were originally spaced at a density that resulted in an unnatural-appearing pattern. The healthy caliber (thickness) of the transplanted hairs was inconsistent with the wide spacing (10-15 grafts/cm2) between them. Different types of grafts should be distributed in different densities according to their number of hairs and the caliber of each hair shaft. In this example, transplanting at an average density of 35-40 grafts/cm2 throughout much of the frontal half resulted in a more natural-appearing fullness (as seen in the global before & after paired images).
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Here is this patient's donor scar in which a trichophytic closure was used.
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Much is still being discovered regarding the effect of platelet-rich plasma (PRP) on human hair follicles. In our practice, we have observed that, when used as a holding solution, PRP can help increase the survival rate and caliber of transplanted grafts. We've also seen trends towards earlier transplanted hair growth when PRP is used as a graft holding solution. An additional finding that has also been observed by other practices throughout the world is that PRP can help return some of the original hair color to follicles. PRP appears to stimulate melanocytes in hair follicles which, in turn, may help bring back some of the color to hairs that have become almost transparent over time. Below, an example of a patient who underwent PRP mesotherapy in our office and a few of the hairs in this image are colorless prior to his treatments and then have more of their original brown coloration about 6 months later.
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I appreciate your comments and I certainly agree that it's not a good idea to be packing too many grafts into the crown. This patient's pattern addressed (but was not limited to) his crown. It actually focused more on his mid scalp region. The first image in the original post of this thread shows the general idea with the back border drawn with a black wax pencil - the concave arc that bends around in keeping with the eventual crown border extending beneath it. The last image pair in the original post also shows the general pattern borders planned as drawn with a wax pencil. The back border touches the vertex transition point - where the scalp begins a downward slope. To better illustrate this idea, I have attached an intra-operative image of this patient. You can see that the surgical pattern extends well beyond his pre-existing hair into areas of future loss. This ensures that the transplanted hair pattern holds stable, even when the pre-existing hair is lost over the years. Another patient in whom the mid scalp (not the crown) was treated with his future crown hair loss in mind can be seen below.
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Ha! Yes, grateful, it most definitely is you! Your comments (and those of the others on this thread) are very much appreciated. You had a positive outlook all throughout and your results reflect that! Enjoy the holiday season!
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ESPN weighs in...
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This 33-year-old patient simply wanted to preserve his current hair pattern, but add to its fullness. Preferring to wear a short hairstyle and having a limited donor hair reserve, he elected to have a follicular unit extraction (FUE) procedure with our team. A 0.8mm FUE punch was used to perform the harvest and platelet-rich plasma (PRP) and ACell Matristem was used as a holding solutions for the grafts while they were out of the body. The patient returned about one year after his FUE session for a follow-up.
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Piloscopy vs mFUE
Dr. Carlos Wesley replied to Davis91's topic in Hair Restoration Questions and Answers
Here is a video summary of the lecture I delivered at last week's ISHRS Scientific Meeting in Chicago. It provides an update on the status of piloscopic hair surgery as well as a few live surgical clips. The password for viewing is "piloscopy" -
Here is a video summary of the lecture I delivered at last week's ISHRS Scientific Meeting in Chicago. It provides an update on the status of piloscopic hair surgery as well as a few live surgical clips. The password for viewing is "piloscopy"
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Thanks for your comment, David! Stig, great observation. For both my FUT AND FUE cases, patients are not required to shave their recipient areas. I've presented a few video examples of this in a previous thread. Now, every physician is different, but in my hand it is certainly just as safe to not shave it down and let patients keep their recipeint hair at its normal length. It may be a bit faster to make the recipient sites as quickly as possible when the hair is shaven, but - aside from the slight ease of site making in the short term - I simply don't see a long-term benefit to the patient. Much has to do with the physician's comfort zone and during my days of surgical training, all of my patients came in with their normal length recipient hair. They appreciated being able to return to work and social activities within 10 days (or even sooner). It does take a little longer to meticulously part the normal-length hair in order to create recipient sites within the pre-existing hairs, but it is well worth it for patient recovery. In addition, if the hair is wet preoperatively, it's very easy to see the areas of future loss and plan your recipient area accordingly.
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Got it. Thank you!
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Thank you all for letting me know! We've updated the privacy of the video (seen above in this thread) so that it is now public and able to be viewed by all.
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Thanks, all, for the comments. I do use a hand-held motorized punch for all of my FUE cases. Rather than outsourcing the labor, I perform all of my own FUE harvests along with my staff (hence, the blisters on my fingers!). Here is the patient's donor area on postoperative day #1 as well as a few months after his FUE session with me. @David: Is there a way to move this thread into the FUE section (where it should more appropriately be located)? Thanks!
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This patient lives in the area. We could certainly reach out to him to see whether or not he is willing to communicate with other prospective patients. Please email info@drcarloswesley.com
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Agreed, Bill. We will certainly take and present more overhead images if and when this patient comes back to address his thinning crown. In general, patients who have ample coverage of the frontal portion of their scalp all the way posteriorly (backwards) to the "vertex transition point" they are left with a natural appearance that looks full from both the front and the side. The vertex transition point is the region towards the back of the head where the scalp begins to slope downwards. Coverage back to this point with a feathered, concave arc of a border allows the transplanted pattern to match the border of any naturally-occuring thinning in the crown. That way, patients are never obligated to return for another transplant simply to make it look natural. Instead, they have the choice of filling in the crown or leaving it thin with a natural-appearing border.
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Thanks for your comments, everyone. Below, please find intra-operative images that demonstrate the surgical pattern that I used on this patient. For each procedure, our practice uses a combination of platelet-rich plasma (PRP) and ACell as a graft storage solution.
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The piloscope is now ready for limited clinical use in a select group of patients. Development and testing of the device that enables select harvesting of the stem-cell containing portion of hair follicles without traumatizing the overlying skin surface has led us to this point. The company (Pilofocus) overview can be seen here. Beginning at the end of July 2015, a handful of patients will be able to undergo very limited surgical hair restoration with this method. The cases will initially involve transplantation of approximately 100-200 follicular units. Although this "scarless surgical" method will eventually be made available to all hair types, patients most suitable for the initial piloscopic procedures are those who have previously undergone follicular unit transplantation (FUT) as the instrument will harvest donor hair adjacent to their donor scar. There is no charge for patients selected to take part in these initial, small pilosocpic procedures. Please email, Barbara, our office manager at info@drcarloswesley.com or call 844-PILOFOCUS (1-844-745-6362) for more information.
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We appreciate your comments. I'm especially glad to hear that so many of you are able to understand the benefit of not only addressing the "now" (the 30s, in this patient's case), but also planning for later in life when more severe hair loss surrounding an isolated transplanted region would start to look unnatural and draw attention to itself. Often times, as demonstrated in this patient scenario, increasing hair fullness within a hairline gives the illusion of lowering a hairline without actually lowering it. The patient loves this in the short term because the fuller hairline provides a healthier facial framing. It's equally important as well that the patient is appreciative down the road when they maintain an age-appropriate hairline that still looks natural.
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Thanks, all, for your kind words. Although I cannot speak for every hair restoration specialist, it is standard operating procedure in our practice to use a combination of PRP and ACell as a storage solution for follicular units when they are out of the body in both our FUE and FUT cases. The upside: It has been demonstrated to generate a statistically significant improvement in survival and caliber (thickness) of transplanted hair follicles. I've also found the hair growth to occur earlier and the redness to be minimized. The downside: It demands a large, dedicated staff as the process requires a staff member to focus on the isolation and creation of the PRP as the surgical procedure is taking place.
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Thanks for your comments. The donor scar extended along half of this patient's donor area (occiput, parietal, & temporal regions). It's just nice for patients to know that this option exists as knowing that it can be well camouflaged often allays concerns regarding long-term donor scaring from FUT.
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Thanks, hair there! Another nice aspect of the PRP/ACell augmentation of density is that it can be re-administered years after the procedure as desired. Our office was glad to see that this treatment for hair loss in women was highlighted in a recent NYTimes article (below) http://nyti.ms/1ILTdC6
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Many patients have inquired about the current status of development for the piloscopic surgical technique. Therefore, I wanted to share a link from my recent presentation delivered at the 2015 American Academy of Cosmetic Surgery Meeting that provides both an overview and an update. I hope that you find this helpful.
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This patient desired more fullness in his eyebrows. Using a 0.8mm FUE punch, a combination of body hair (leg) and scalp hair from the temporal region was used to treat both eyebrows. The patient returned to our NYC surgical clinic 11 months after his session to display his results. Grafts were incubated in PRP and ACell throughout the procedure.
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Thanks for your comments (and unanticipated controversy!). Yes. I can attest that this is the same patient in all images. As our office couples before and after images together, we occasionally use the same "before" pic with a different "after" pic to achieve a different pairing for comparison. I think this helps give a better sense of the result. The "blonde" look of the hair was simply due to the reflection from the OR light above. If it helps, our office will post a video of this patient shortly. Meanwhile, I have attached intra-operative pics of my pattern and density of FUE transplantation.
