L0ke

First of all, I would like to mention that I feel very sad about the patient’s situation. 

At my clinic and towards our patients, we always do our utmost from the preoperative planning/consultation onwards until the day of surgery. We also appreciate to stay in touch for any specific questions concerning the aftercare and monthly updates.
 

Here’s a brief summary from the initial contact until the follow-up after his 2^nd  surgery:

- Online consultation (July 2012) – pictures hair situation patient
*attached picture Results1-jpg

Since I hadn’t met the patient in person, I wasn’t able to perform any measurements concerning his donor density and scalp flexibility. Therefore, the initial treatment plan, after inspecting the pictures of his online request, (pic 5 & 6) was either a FUE 3000 – 3500 FU or FUT with 3500 - 4000 FU. I also advised him to consider the extraction of the previous transplanted FU’s on his right temporal area (pic 2), as in my opinion, the hairline design (ex-domo) was too low.

- Preoperative consultation (1^st surgery - October 2012, Hasselt, Belgium)
Anamnesis:
29-year-old patient who suffers from hair loss since 2004 and underwent a FUT operation in 2008 ( ex-domo). At the current age of 29, the patient believed his hair loss was relatively stable and he didn’t use any medication such as Finasteride or Minoxidil.

Family anamnesis:
Hair loss father: all zones
Hair loss mother: /
Hair loss brother: 1, 3
Hair loss grandfather on mother’s side: /
Hair loss grandfather on father’s side : 5, 5v, 6
Hair loss uncle on mother’s side: unknown
Hair loss uncle on father’s side: unknown

- The genetic hair loss is inherited from the male side of his family
- According to the patient, approx. 1000 - 1500 FU were transplanted for the reconstruction of his hairline and temporal recessions during his previous surgery in 2008.
 

Diagnosis:
Hair loss pattern classification: MPB Type NW III – IV, vertex, Class T
Donor area: good skin condition and optimal scalp laxity occipital and parietal area
Hair structure: slightly wavy
Measured density occipital: 76 FU/cm² of which 25 % – 30 % were singles FU
Miniaturization occipital: 10 %
Hair density: 158 hairs/cm²

Linear scar in the lower occipital and parietal area with a length of approx. 14 cm and a variating width of 3 to 8 mm.
Recipient area: multiple incorrectly placed FU’s (incorrect angulation and direction) in his right + left temporal recession

Advised treatment plan after personal examination: 

1. FUT in order to reconstruct frontal third (zone 2, 3 and the transition towards zone 4) in a medium density
2. Extraction of several incorrectly placed FU from previous surgery out of his right temporal recession

- OR-Report October 2012 – 1^st surgery (Dr. B. Feriduni)

Breakdown:
1684 Singles (!)
1965 Doubles/Triples 
Total: 3649 FU

Aftercare:
Postoperative aftercare performed at my clinic between 1 and 14 days postoperative without any complications
*attached picture Result2-a.jpg

Evaluation after 11 months postoperative:
As it wasn’t possible - due to the high percentage of single FU’s - to achieve the necessary HGI during the 1^st operation, we agreed on performing a touch-up surgery (April 2015) through FUE with the strategy to “cherry-pick” the double and triple FU in order to obtain a higher HGI (Hair per Graft Index).

- OR-Report April 2015 - 2^nd surgery touch-up FUE  (Dr. B. Feriduni)

Breakdown:
FUE in cherry-picking technique with a total amount of 1299 FU (HGI: 2.3 Hairs/FU) to increase the density in the central core and bridge  (zone 3 and 4).

Internal rating of surgery quality (1 = very bad; 10 = excellent):
Extraction: 8/10
Implantation: 8/10
Graft quality: 7/10

Aftercare:
Apart from a slight seroma wound on the 1^st and 2^nd day postoperative, no further inconspicuous findings were visible. 

After the 2^nd procedure, I haven’t heard back from my patient until the 18^th day postoperative when he sent some pictures which showed a normal healing situation. And as I didn’t receive any further updates I presumed that the result turned out fine because most patients tend to forget to keep us posted as the growth continues to mature. 

>> So why did we get this result?
In general, following points are important for a good result:                

1. The operation (long term strategy, meticulous preoperative planning)
2. The healing process during the first 14 days postoperative
3. Patient related factors like the PGI (Personal Growing Index), general diseases, smoking or other non-MPB related reasons
4. BUPA (Bald Unpatterned Alopecia with a high degree of miniaturization in the donor area)

I’ve sent a personal message to the concerned patient to invite him for a check-up at my clinic. I will examine the result and have a closer look at his donor area to exclude BUPA (recently revealed), other patient-related factors and to discuss possible further medical therapy, surgical as well as non-surgical options such as Tricopigmentation in order to help him correct the unexpected result.

Dr. B. Feriduni

5 hours ago, Payam said:

Pretty appalled by how this guy was being treated.. it is completely understandable why he wouldn't want to share his contract information. Also where is the response from the clinic? 

Dear Payam,

Due to legal restrictions we are waiting for the written consent of the patient. 
We're very sorry that we can't respond with a proper medically substantiated explanation until then.


Kind regards,
 

Hi Melvin, thank you! I've changed it, had no idea, sorry for the wrong impression

FUE performed on a 50-year old Caucasian male with

• NW III vertex, Class N

• Donor density of 80 FU/cm? temporal and 92 FU/cm? parietal / occipital

• Hair diameter of ~54-56 microns

• FUT ex domo 2012

Treatment plan

• Follicular Unit Extraction Transplantation to attain an aesthetic reconstruction of the hairline.

Performed procedure

Procedure (May 29th, 2017)

Follicular Unit Extraction Transplantation with 3107 FU

* 400 single hair FU

* 565 double hair FU

* 2142 tripple hair FU

Parallel incisions in custom-sized blades technique (Cutting Edge blades of 0.7-0.85mm).

Extraction performed with a 0.8mm FUE punch with WAW-system. No microscopic preparation of the follicular unit grafts.

No microscopic preparation of the follicular unit grafts.

Case posted by L0ke, representative for Dr. Feriduni

FUE performed on 36-year old Caucasian male with

• Type Norwood II

• Donor density of 80 occipital and 76 temporal FU/cm?

• Hair diameter of ~64-72 microns

Treatment plan

• Follicular Unit Extraction Transplantation to attain an aesthetic reconstruction of the hairline and add more density.

Performed procedure (January 16th, 2017)

Follicular Unit Extraction Transplantation with 2035 FU

* 489 single hair FU

* 528 double hair FU

* 1018 triple hair FU

Parallel incisions in custom-sized blades technique (~Cutting Edge blades of 0.7-0.9 mm).

Dr. Bijan Feriduni

Dear Gasthoerer,

Thank you for your compliment.

Considering your question: nowadays, a latest state-of-the-art hair transplant without magnification is impossible. There are different types of magnification on the market, but in our clinic we choose to work with Zeiss loupes with a 3x , 4x, 5x and 8x times magnification ability.

There are some misunderstandings concerning the terms microscopical preparation and microscopical control. Please allow me to explain the difference:

1. Microscopical preparation

What is meant by preparation of the FU’s is basically “trimming” the FU’s with a surgical blade in order to reduce their connective tissue. This is mostly not necessary, especially when the dissection is done with a small punch size, e.g. CIT Punches 0,8 or 0,85 mm. That?s why we add this information always to our case reports. In general, it is possible to create the necessary amount of single FU’s by simply splitting a FU. Having a close look at the different donor areas - occipital, parietal and temporal - we see nearly in every case a difference in density, caliber and different types of FU groups.

Attached an example of the 3 different donor areas: occipital, parietal, temporal

There are much more and finer single follicles at the temporal area. Dividing the singles in “normal” and “fine” follicles helps, together with some more important points to create a natural hairline.

2. Microscopical dissection:

In my opinion, stereo-microscopical inspection is a must to evade “double” FU’s in the first frontal line. There is however no guarantee which excludes these at all times as there are also obviously some of them, who find themselves in the dormant - or telogen- phase, and which cannot be perceived under any type of magnification. After being extracted and dissected, we prefer to cool the FU’s temperature down to 4° Celsius whilst classifying them into groups of single, fine and normal ones.

Attached two images of pre-sorting the FU's after extraction

Double and triple FU’s are mostly divided together under loupe magnification. They are generally not classified in separate groups, as - in my opinion- the mixture of double, triple and sometimes also quadripple FU’s gives the most natural effect. That is also exactly what the nature is doing.

Attached an example of the donor area with a mixture of different groups (photo DermaLite)

Shortly before implantation we perform a final microscopical check of the single, fine and normal FU’s with our Mantis 5,0 microscope and store them per 50 FU in small platters. Also the double, triple and quadripple FU’s get prepared on small platters with 50 FU per compress.

Attached an image of the FU's being prepared on small platters and an close-up of the FU's

My apologies for the belated answer. I hope you are satisfied with my personal reply.

Kind regards,

Dr. Feriduni

FUE performed on 36-year old Caucasian male with

• Type Norwood II

• Donor density of 80 occipital and 76 temporal FU/cm?

• Hair diameter of ~64-72 microns

Treatment plan

• Follicular Unit Extraction Transplantation to attain an aesthetic reconstruction of the hairline and add more density.

Performed procedure (January 16th, 2017)

Follicular Unit Extraction Transplantation with 2035 FU

* 489 single hair FU

* 528 double hair FU

* 1018 triple hair FU

Parallel incisions in custom-sized blades technique (~Cutting Edge blades of 0.7-0.9 mm).

Dr. Bijan Feriduni

Dear Gasthoerer,

First of all our apologies for the late response. Our clinic was closed last week (Easter).

I will get back to you with an appropriate answer from Dr. Feriduni himself as soon as the surgeries today are done.

Thank you for understanding and the nice compliment you gave us.

Case performed by Dr. Feriduni – 2171 FU in 1 procedure

FUT performed on 57-year old Caucasian female with

• Type Ludwig I

• Donor density of 80 FU/cm?

• Hair diameter of ~64-72 microns

Treatment plan

• Follicular Unit Strip to add more density to the hairline and restore the midhead section.

Performed procedure (August 13th, 2012)

Follicular Unit Strip Transplantation with 2171 FU

* 478 single hair FU

* 1293 double hair FU

* 400 triple hair FU

Parallel incisions in custom-sized blades technique (~Cutting Edge blades of 0.7-0.9 mm).

Case performed by Dr. Feriduni – 4374 FU in 2 procedures

FUE performed on a 47-year old Caucasian male with

• NW III vertex,Clas T

• Donor density of 80 FU/cm?

• Hair diameter of ~58-62 microns

Treatment plan

• 1st Follicular Unit Extraction Transplantation to restore the crown area.

• 2nd Follicular Unit Extraction Transplantation to attain an aesthetic reconstruction of the hairline and add more density.

Performed procedures

1st procedure (November 11th, 2015)

Follicular Unit Extraction Transplantation with 2354 FU

* 300 single hair FU

* 850 double hair FU

* 1204 triple hair FU

Parallel incisions in custom-sized blades technique (Cutting Edge blades of 0.8-0.9mm).

Extraction performed with a 0.8mm FUE punch with CIT Manual Punch Handle. No microscopic preparation of the follicular unit grafts.

2nd procedure (June 6th, 2016)

Follicular Unit Extraction Transplantation with 2020 FU

* 479 single hair FU

* 400 double hair FU

* 1141 triple hair FU

Parallel incisions in custom-sized blades technique (Cutting Edge blades of 0.8-0.9 mm).

Extraction performed with a 0.8mm FUE punch with CIT Manual Punch Handle.

No microscopic preparation of the follicular unit grafts.