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Waterloo

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  1. I don't believe Dr. Feller does excision removal repair work..only additional grafting to hide the plugs. Dr. Bernstein does do this type of repair and describes his technique at length in his website. He has pictures of repair patients who have had plugs removed with suturing. You can zoom in on the photos and decide for yourself what looks better, your existing plugs or the surgical excision end result. Others noted for this type of repair are: Dr. Beehner, Saratoga, NY and Dr. Vogel, Baltimore, MD. Check out their websites as well.
  2. For what it is worth....I grew up in a working class neighborhood with milkmen, garbagemen etc. Garbage men carry the weight of a garbage loaded tub on their shoulder, either right or left, while walking from the customers house to the truck. Every one of those men had a large thatch of hair on the prominent shoulder used daily to carry the weight and bare the friction of the load. This struck me as a child into possibly a link to growing hair on bald pates.
  3. I believe that 2 sessions of 2,000 graphs per patient for a doctor like Dr. Bernstein is not uncommon. At $11 per graph, minus the $1 per graph, ARTAS fee, that's 40 grand per case, do 5 cases like that and it's paid for. Seems like a winner for a doctor with even minimal FUE interested patients at $11 per graph.
  4. Good luck Bill...please keep us updated on your progress. Waterloo
  5. Dr. Pawlinga, in evaluating this case, was there ever an option considered by you and the patient to just remove or cut out his old plugs? It seems that the result of the 22 or so cut outs you made left minimal scarring. Esthetically, in your hands, it would seem that this fellow had the option of being just another normal bald guy, if he choose that route. Given his degree of hair loss, and paucity of donor hair, he went for the sparse transplant look instead. Did he have a choice? I would appreciate your feedback, since I have seen similar situations with other repair patients using other surgeons. Thank you for your time in this matter. Waterloo
  6. Bachstrad: Thank you very much for sharing your experience with members of this forum. As you pointed out, there are few examples of this excision only work in evidence. I did notice that several excision sites were not sutured. I may be mistaken, but Dr. Beehner may not have been able to suture all the sites closed due to the numerous sites, and in respect for scalp tension. If this is so, and, during your healing process, have you been able to discern a cosmetic difference between the sutured and open sites? From your pictures, you are vastly improved in all areas. How long did it take for the redness to subside to a cosmetically acceptable level? Did you need a hat or concealers to be comfortable in public for awhile? In my opinion, trying to camouflage a large balding area of man who is now a NW6-7, who had old school plugs long ago is futile. Your end result, of a bald man with acceptable, common sun spot skin discoloration on his scalp, is much more of a normal look than the alternative of using too little hair on too large of a plug scarred scalp. So, IMHO, even if you had enough donor for 2-3000 grafts, the result you achieved is far superior. I believe that doctors in the hair transplant business should consider this excision only option more than they have indicated in forum posts or on their websites. I recognize that this type of procecure may not be as much of a revenue generator as a hair transplant, but, obviously, it has a benefit for certain patients. Heal well my friend, and thanks again for sharing. Waterloo
  7. I have read good things about Matristem and wound healing, with an emphasis on diminished scarring. Many past and present forum posters received hair transplants using older methods, including 3-4mm plugs. For any number of reasons, many of those men have expressed a desire to remove those plugs and not proceed with further hair transplantation. Considering the recipient area only, the risk for this excison only procedure was scarring from the punch outs and a 20-25% regrowth of hair at the excision site, despite the removal of the plugs. The reason for the regrowth, according to Dr. Vogel, et al, was that a 3mm punch is used to remove an original 4mm plug, because of contraction, so the round scarring is removed, for cosmetic reasons, but 20% of the follicle remains because a 4mm punch, to get it all, would create a greater scar. Additionally, punch outs over 2mm require suturing, for cosmetic reasons, which creates scalp tension, so a limited number of plugs are excised in a staged manner, often requiring 3 or more procedures, 2 months apart. This is a drawn out proceedure with a lengthy down time. With the use of Matristem (ACell) would it be possible to now excise original 4mm plugs, with 4mm punches to get the entire follicle, and leave the wounds to heal openly (With Matristem powder or sheets) with a better than expected cosmetic and complete result than the old staged method using sutures? With open (Secondary Healing) many of these excisions could be done in one procedure since scalp tension would no longer be an issue. I believe that Dr. Cooley may have suggested that suturing may neutralize the benefits of Matristem in wound healing, so open healing may be the preferred technique anyway. I would like comments from both forum members and doctors on this topic. Thanks for your time Waterloo
  8. new2thissite: Did you go for an additional HT because as your native hair thinned over the years, the scars from the excision sites were obvious, or were you adverse to being bald? Would you be so kind as to provide the number of plugs you had removed and who did the removel? Were they mini's or 4mm old school plugs? Thank you for your time. Waterloo
  9. I do not...perhaps others can offer information about Van Gundy's surgeon. There is a guy who posted on this forum, ccexxp1, who had many plugs removed by Dr. Bernstein. He posted no pictures and had a subsequent transplant. He sounded very credible and was very positive with his results during the excision process, which would lead me to believe that removing his plugs was a marked improvement in his condition. The process involves a 2-3mm biopsy punch. The plug is removed and the skin sutured together with 1 or 2 sutures. The key is space between the plugs, healling characteristic's and scalp laxity. Usually the older you are the more relaxed your scalp is. With the newer procedures involving thousand's of graphs, removel probably would be more problematic, if not impossible. It would be great if other's opined here, including doctors, since there are many like Bill grappling with what alternatives are possible.
  10. With excision in skilled hands, the removel and suturing should eliminate the existing scar and pitting. Discoloration can be addressed using V-Beam laser, if it is an issue after a reasonable passage of time. There are not many examples of excision only posted by physicians on this site. However, Jeff Van Gundy, former Knick basketball coach had a bad plug job for years and had them removed. Just put Van Gundy in a Google search. Zoom in on his picture with plugs and now bald, without plugs, both pictures are available....you decide which looks better.
  11. Bill: As another option, I would investigate the possibility of removing all the plugs without further transplanting. You have a very large area to cover for a natural look, and failing to do this, you would have spent lots of money, devoted lots of time, and may perhaps expose yourself to a large ear to ear scar which couldn't be hidden with your fringe hair shorter. Since your plugs are spread out, it would make excision easier and more cosmetically acceptable because normal skin can be sutured to close the holes. When done correctly, small linear scars result, which in time, fade to a degree commensurate with your healing qualities. No more worry of wind, water, concealers etc. Doctors who seem to have credible results and experience in this type of repair include Bernstein, Beehner and Vogel. Dr. Bernstein is mentioned most prominently on this board and would most likely suggest 3 staged sessions, 8 weeks apart. This is to allow for relaxation of the scalp so a closure can be made with less tension, and, theoretically, a less obvious scar. If you devote a few thousand grafts to fill between the plugs and you are still not happy with your look, the above option would probably be off the table. This is just one man's opinion.
  12. I am a bit of a newbie in this forum, gathering information about surgical hair restoration options. In this example, Dr. Charles has definately improved this fellows look with more hair. However, there appears visable scarring where the hairline work was done. Is it true, that even with the smaller incisions of modern transplanting, that the end result, depending on patient physiology, can result in visable scarring? For example, if this fellow is outside and the wind blow the front of his hair up...will his scarring be more visable?
  13. Stamos, Surgeon's do excise or alter old plugs. They can either sliver them, with something called The Lucas technique, which reduces the plugginess and spread the field, so to speak. they can also excise them and try to suture healthy scalp tissue together. This would also reduce pitting and cobblestoning. Factors which need to be considered are: Scarring from past procedure(s), Space between plugs/grafts, Scalp laxity, Location etc. You would be best served by consulting with any number of the competent surgeons listed at this site.
  14. If Bachstrad has 150 plugs, and assuming they did have hair, say 15 hairs per plug. Given the vast expanse of baldness in this NW 7 patient, would 2250 individual hairs really make a difference? This dividing and reimplanting of FU's would lengthen the repair process to assure proper blood supply and growth of the re implanted FU's. Wouldn't this gentleman best be served by cosmetically improving his look in the fastest, safest time frame, have a fairly normal bald look instead of looking like a peeled chicken?
  15. Sorry then...my mistake, thought I saw tiny dark dash like marks on the scalp, between the hair.....I'd better get my lenses checked!!
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