Before and after four procedures totaling 3790 grafts by Dr William Rassman of the New Hair Institute

[skunky]

This case just needs some clarification which I hope will be next Tuesday because I believe it may be a misleading post for those new people seeking to restore their hairline and seeing this case (so many grafts= so sparse density?).

4 Surgeries is just ridiculous or maybe the post op pics are from the first surgery?

Will keep my eyes on this one.

[Dr. William Rassman1530037930]

The patient actually received 3790 grafts (sorry for the typo), 1350 in the first procedure and 1025 in the second. The patient lost some hair behind the original transplant. After the second procedure, the patient had a stretched scar measuring 1cm in width in its widest portion. The third and forth procedures were combination of two hair transplant procedures with scar revisions. The grafts were placed to thicken the work previously done. The entire scar was removed and closure tensions were low at both procedures and although some scar returned, the scar was improved.

 

All strip procedures produce scars. In some patients, the scars widen. I believe that the scars that stretch are more tied to the patient's healing characteristics than the surgical technique or the size of the strip. In this patient, there was no wound tension at the wound closure on any of his procedures, but scar revisions are less than a perfect process. I have not seen any patients where the scar revisions made the scars worse (although I heard of one patient who had a genetic collagen defect and had his scar widen when an attempt at repair was done). Most patients get some improvement from a scar repair, possibly because the strip is limited in width. Amongst physicians who perform strip surgery, there is no general agreement as to the proper scar repair technique. Many surgeons close the wounds with a single running skin suture, while others close the wound with a two layer closure to guarantee a lower wound tension. In the two layer closure, the deep layer can be closed with interrupted absorbable sutures, or they can be running sutures. I have been using a running quill suture for my scar repairs and the sutures are anchored in the occipitalis fascis (deep layer) which is imbricated to take up the tension at the closure. With these closures, the skin tension is often very low, yet the scar may still return despite the logical value of the deep layer.

 

Comments were made by some of the posters of my classification of this patient's balding pattern as a Norwood Class 3. I would rather consider it a 3A evolving into a 4A pattern. The nubbin of hair in the center on the original pictures was highly miniaturized. There was critical comment about the shape of this patient's hairline. I recommend on most of my Caucasian patients is what I discuss as the normal mature hairline as shown in: http://www.baldingblog.com/200...-mature-with-photos/ . The midline is measured one fingerbreadth above the highest crease of the wrinkled brow and the shape is convex. In many Asians, some people from the middle east and many Africans, the hairline is flat. The child's hairline is lower, located at the highest crease of the wrinkled brow and is concave in shape (look at your children if you do not believe me) as are women's hairlines.

[hairthere]

thanks for clarifying dr. rassman. makes much more sense now...

[aaron1234]

Yes, that explanation certainly clarifies things. It would be great if you could continue to include that kind of detail in the initial post.

[Bill - Seemiller]

Dr. Rassman,

 

Thanks for taking the time to reply to this thread. I've taken the liberty of modifying the original post with the corrected number of grafts. I also included your reply in the initial post so that those who view these photos in the future will have the correct information without having to read all the way through the thread.

 

I do agree with others that this kind of detail would be very helpful in the initial post moving forward. I also encourage you to post top down before and after photos and surgical pictures in the future.

 

Best wishes,

 

Bill