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Hair Dr Clinic - Dr Arshad

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  1. Hi all, Please see below comment from Dr Arshad. Regards The Hair Dr Clinic ___________________________________________________________ Dear forum readers, Melvin has kindly brought this thread to my attention and invited me to leave a comment. I have waited until now to do so as I wanted the patients prior consent. I can confirm this is my patient who underwent surgery with me in late May 2020. I think there are several issues here that might be worth elaborating on. Growth of transplanted grafts In relation to transplanted hair growth I completely agreed with the patient that the overall outcome is not what I would expect from the high standards we set ourselves. It is very disappointing for me personally to see that the outcome of surgery has not achieved the desired impact and importantly that the patient is not satisfied with the outcome. Despite following strict surgical protocols this is unfortunately a risk of surgery with any clinic/surgeon. The result is not guaranteed. However, it is important for us that the situation is addressed and action is taken by my clinic to try and improve the situation for the patient. Given this, after reviewing the result at 11.5 months (prior to this thread being updated) I did without reservation offer the patient a top up procedure, free of charge. I understand there is the inconvenience of undergoing a further FUE procedure, however, by waiving the fee we aim to make a gesture of good faith that we stand by all patients that we operate on. In relation to the pictures the patient has posted on this thread, when I saw the result in person at 11.5 months post op it did not look as ‘sparse’ as some of the pictures (especially when the hair is parted). It is well recognised that hair transplant is the illusion of creating density and if one is able to grow and style their hair to cover the scalp then that is success, in my opinion. No hair transplant can achieve and re-establish native (non DHT affected) hair density. Having said that as mentioned I agree the overall yield is not what I would have liked to have achieved and the reasons for this can be multifactorial including but not limited to unknown biological/physiological factors. In my hands, I have a top up rate of 3 to 5%. I feel this is acceptable, I am open and transparent about this. I council patients about this prior to surgery and it is written clearly in my pre-operative consent form which every patient signs before proceeding. Donor zone management Donor area management is an imperative aspect of this surgery. I take particular care to try and plan in case of future hair loss or if top up procedures are required in cases such as this. With this patient, I actually advised him not to proceed with the hair transplant given his expectations, family history of hair loss, donor zone characteristics and reluctance to take finasteride. However, I did not refuse him treatment as he signed to say he understood what I explained to him and accepted all the potential outcomes. He was keen to have a fuller frontal forelock in this phase in his life and accepts that later in life with more hair loss he may need to shave his head or look at other non-surgical options. There have been attempts to quantify the donor capacity and to calculate the extent the donor area can be maximised without it looking over harvested. In my experience, they are of very limited use in practice. The essence of hair transplant is moving hair from a region that is relatively DHT resistant to an area where there is hair thinning or loss. The hair follicles excised in the donor zone of course do not grow back, so in particularly larger hair transplant sessions I would advise all patients if the hair is cropped short in the donor zone they will MOST LIKELY HAVE EVIDENCE OF SCARRING AND THE APPEARANCE WILL BE LESS DENSE. When the hair is grown out in the donor zone it looks more uniform and any evidence of surgery is more likely to be concealed, but this is only after the donor zone hair reaches a certain length. There are many examples on this very platform where patients have been to experienced surgeons for large sessions and in the donor zone (when the hair is cropped shorter) the graft excision points are clearly visible – Melvin is a classic example of this from having previously seen his donor area. I understand that some people are strongly averse to their donor zone looking any different at all after hair transplant (even when the hair is cropped short) and to those people my advice is DO NOT HAVE A HAIR TRANSPLANT or at the very least keep the number of grafts transplanted to an absolute minimum. This in my opinion even applies to patients with above average donor density as the overall appearance of the donor zone does not always correlate with quantification methods especially when the donor zone is trimmed short. Factors such as hair to skin colour contrast, hair calibre/character, the angle of hair take-off from the scalp and the manner in which the donor hair is trimmed (scissors cut with layering Vs bad buzz cut) can all influence the appearance of the donor zone. Sometimes the issue is confounded when I have patients that undergo large mega sessions and are actually able to crop their hair very short in the donor zone (or even shave it into a ‘fade’) without noticeable evidence of surgery – but this is an exception NOT the norm. Everyone’s healing and scarring physiology is of course different. Whenever the dermis is breached there will be scarring and subdermal changes caused by the healing/repair process. Plan going forward I have advised this patient that I feel a top up procedure can achieve his goals and that he would need to wear his hair longer in the donor zone, I also informed him that SMP in the donor zone is possibly an option if he wants to crop the hair in the future. I hope he takes up this offer as I am keen to see him with a good result that is more reflective of the work that we consistently produce. Kindest regards Dr Arshad 12/05/21 ____________________________________________________
  2. Dear forum members/viewers, We present the case of a 52 year gentlemen who had 2 previous FUT surgeries performed in the UK. He was left with a rim of unnatural and coarse hair at the front of his hairline. He wanted a softer look to his hairline and density adding to the fronto-temporal region. Surgical details Surgeon: Dr Arshad FRCS Technique: Motorised FUE (0.8 sharp punch), incisions with 1.0 customised cold steel blade. Graft count Single hair follicular units = 506 (of which 178 = ultra refined soft singles) Double hair follicular units = 1007 Triple/+ hair follicular units = 271 Total = 1784 grafts Medical Therapy Minoxidil 5% + dermaroller, Biotin Not on Finasteride (patient choice)
  3. Hi @follically challenged Yes, he is on the finasteride to slow down any further androgenetic/MPB related hair loss. However, some patients in addition to maintenance do experience some re-growth/thickening (more so in the crown than the hairline). In our experience there is a spectrum of people in relation to the latter from non-responders to some patients who have an impressive improvement. I'll try and upload the video this week. Thanks Adam
  4. @follically challenged Many thanks for your feedback. I'm not sure if we have any pics of the donor before it grew out but I definitely have a video with comb through. Once we've uploaded the youtube video i'll post the link here shortly. Regards Adam
  5. Dear forum members/viewers, We present the case of a patient that came to see us about his receding hairline which he had noticed since his early 20's. He wanted to have a procedure which would achieve a natural hairline appearance and subtle so that it was appropriate as he ages into his late 30's and early 40's. Surgical details Dr Arshad performed an FUE hair transplant 18 months ago. 1841 grafts were excised from the donor zone at the back of the scalp and implanted into the hairline and frontal zone. The hair characteristics were thin calibre/fair hair. The graft breakdown is as follows: Refined soft single FU's = 78 Single FU's = 639 Double FU's = 744 Triple/+ FU's = 380 The patient is very happy with the outcome. If any questions, please feel free to ask. Regards Adam (from Dr Arshad's clinic)
  6. Thank you @JohnAC71 for your kind comment. The patient is very happy with the outcome. Donor area appearance with relatively short hair cut was a particular concern for this patient post procedure so he is delighted that it looks untouched. The grids that Dr Arshad has drawn onto the donor area for extraction/excision planning were marked out using Coles' safe donor area template. Regards Adam
  7. Dear forum members/viewers, We would like to present this case of a patient who had significant recession of the front-temporal regions and frontal tuft island formation. The patient was growing his hair from the mid scalp area to cover the front. He underwent FUE hair transplant by Dr Arshad. The post operative pictures are presented at 12 months. A close up of the hairline (with the hair lifted) is shown. The graft count was: Single FU's = 327 Double FU's = 1182 Triple FU's/+ = 1364 Total: 2873 On the next follow up we plan to capture a comb through with the hair wet and dry and I will post this in due course. Any questions please do let me know. Kind regards Adam (from Dr Arshad's clinic)
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