Informaton on Tichophytic Closure

[Dr. Ron Shapiro]

I was recently asked if I perform the "Trichophytic Closure". The answer is yes. I have been using it routinely since I saw it presented at the annual European Conference in Brussels last summer (6/05).

 

I??ve noticed that the level of knowledge and degree of interest in this closure is fairly high on this forum. So some of you may find it interesting to know more about the history, details, uses and benefits of this technique. If this type of information is useful and appears desired I will continue to do it about other subjects as time goes on. It may be helpful to open up the album I created with photo and diagrams and refer to it as you read.

 

Photo For Trichophytic Incison Information

 

TRICHOPHYTIC DONOR CLOSURE

 

At that annual European Society of Hair Restoration Conference (ESHRS) that took place on 6/05, two physicians (Dr Paul Rose from the USA and Dr Patrick Frechet from France) presented two slightly different variations of trichophytic closure technique. They also referenced and gave credit to a third physician (Dr Mario Marzola from Australia) as having developed a third variation of the technique at around the same time. Dr. Marzola was not present at the European Conference. However, Dr. Marzola did present his variation of the trichophytic technique one year before at the Annual International Society of Hair Restoration Meeting (ISHRS) in Vancouver, Canada. These three physicians are each given credit for introducing the technique of the trichophytic closure to the field of Hair Restoration Surgery.

 

Although relatively new to hair restoration a trichophytic incision is not new to the field of plastic surgery. The idea was actually used in brow lift and other cosmetic surgeries where skin bordered hair in the past. In order to hide a scar created from an incision at the border of the hairline in a brow lift, the initial incision was not made parallel to the hair, but instead, angled the opposite direction (against the grain). This direction of the incision angle transected the follicles and the hope was that these follicles would grow back through and hide the scar. This technique was probably first described by Dr Juri from South America around 1979.

 

It worked well for brow lifts and flaps and one may wonder why it was not thought of to use during donor harvesting in hair transplantation sooner. If you think about it the answer becomes fairly obvious. One of our primary goals when harvesting donor tissue is to NOT TRANSECT HAIRS. If you transect hairs follicles too far down on the shaft a significant percentage won't grow or may be lost during the rest of the graft preparation process. The bottom line is that significant transection during donor harvesting can diminishes the patient's precious and limited supply of donor hair and thereby limits the ultimate amount of coverage and density he can obtain. A lot of practice goes into developing the skill to make the initial donor incisions parallel to the hair in order not to transect them. A skilled practitioner using proper technique can keep his transection rate down to 1-3 percent.

 

Let's get back to the trichophytic closure in donor harvesting. As you can see, we cannot make the initial incision when harvesting donor tissue a trichophytic incision that goes against the grain. Too much transection would occur at too deep a level and potentially ruin the donor supply.

 

However the idea came to a few people in the field (Dr Rose, Dr Frechet, and Dr Marzola) to make the initial incisions parallel to the hair follicles, and then, on one side of the resulting wound, make a second "trichophytic" incision in a very controlled fashion , that trims off a thin strip of epithelium and with it the tips of the hair follicles below. This trimming right below the epithelium is still very high on the hair shaft and does not create any transection that can lead to decreased hair growth. It is controlled transaction very high up on the hair shaft. Then of course the edges are pulled together with the untrimmed side covering the trimmed hairs so the hairs will grow up through and scar and hide it.

 

 

DIFFERENCES BETWEEN

FRECHET, ROSE AND MARZOLA

TRICHOPHYTIC CLOSURES

(Figures 1, 2, amd 3 in album)

 

Photo For Trichophytic Incison Information

 

 

There are slight difference between how the above three physicians perform there closure. At this time we do not know whose technique is best ....but all three make an improvement in the appearance of the scar. One of the major differences is that Dr Marzola trims the upper edge of the incision while Dr Frechet and Dr Rose trim the lower edge of the incision.

 

Although both Dr Rose and Dr Frechet trim the lower edge of the incisions, their respective techniques vary slightly with respect to method that they use to trim away the tissue from the lower edge of the incision. Dr Rose uses a scalpel and first scores the entire length of the incision about 1mm back from the edge. He then uses the scalpel to trims away this 1mm wide piece of tissue just below the epithelium (~1mm deep) so as to only cut off the tip of the hair follicle. It actually looks like he created a ledge or step off with exposed hair shafts hence his name "The ledge technique"

 

On the other hand Dr Frechet uses a surgical scissor rather than a scalpel to simply trim away the edge of the epithelium from the lower edge. Another difference unique to Dr Frechet is that he also does some minor undermining at the level of the epidermis just below the roots. He feels this further loosen up the skin for a non -tension closure. Dr Rose and Dr Marzola do not feel this undermining is necessary.

 

The differences between the three trichophytic techniques are minor and all three have helped improve the appearance of donor scars.

 

 

ADDITIONAL POINTS RELATED TO

THE TRICHOPHTIC CLOSURE

 

"?? The primary method a trichophytic closure limits the visibility of a scar is by the camouflage that occurs when hairs grow through the scar. (Figure 4 and 5 in album)

 

Photo For Trichophytic Incison Information

 

 

"?? A second hypothetical method in which this closure may work is by a postulated "anchoring effect" that may occur. It is theorized that if all the tiny little hairs start growing through the wound edge early they may act as multiple tiny little anchors or "micro sutures" and give extra support to the closure that lasts even after the sutures are removed.

 

"?? For scar revisions the use of the trichophytic closure is more variable. It may be effective if the pre-existing scar is thin, there is sufficient laxity remaining, and the entire scar can be excised with limited tension, than it may work well. However if the pre-existing scar is wide and there is decreased laxity than the technique may be less affective for the following reasons. The decreased laxity may make it impossible to remove the entire scar at once. The decreased laxity will increase wound tension and the potential for the new scar to stretch out again. Finally, \the edge of wounds in a scar may have less hair present to grow through which limits the effectiveness of the trichophytic closure.

 

"?? The Trichophytic closure is not a magic technique that will automatically create a less visible scar if these other rules are not followed. All three innovators of the technique still emphasize that it is still necessary to use all the rules and methods usually employed to create fine scars. (i.e. limit wound tension, create good skin approximation, properly space sutures or staples, etc). As stated above the trichophytic closure does not limit the width of a scar but instead, primarily masks a scar by letting hair grow through it. Since only a 1 to 2 mm wide zone of epithelium is trimmed away, and this creates only a 1-2 mm width of exposed follicles, the trichophytic incision works best when the scar resulting from the donor incision is 1-2 mm or less. When this occurs the results can be amazing and with the scar being nearly undetectable even with the hair cut short. However if the underlying scar resulting from the donor incision is wider than 1-2 mm, for whatever reason, the benefit is less dramatic. There are a number of reasons why a scar may occasionally end up being wider than expected. This is true no matter what technique is used and no matter who the surgeon is.

 

Figures 6 and 7, in the album show examples of trichophytic closures.

Figures 8 and 9 in the album shows examples of non-trichophytic closures.

 

Photo For Trichophytic Incison Information

 

 

"?? By far the most common cause of a wider than expected scar is misjudging donor laxity and taking out a strip that causes excess tension on a wound. One reason why the old dogma exists about limiting donor strip size to 1 cm is because it is safe. It is known that nearly 100 percent of patients will not have increased tension if you limit your strip width to 1 cm or less. As you go wider the potential for increased tension and therefore a wider scar goes up. This does not mean you cannot take wider strips, as is obvious by the number of cases being done with wider strips, without significant scaring. But it does mean that you have to use good clinical judgment when deciding who can have wider strips and how wide of a strip is safe. One of the difficulties with trying to predict safe maximum strip widths is the exponential change in tension that begins to occur with very minor increases in width at a certain point (or threshold). To visualize this concept think of a rubber band being stretched. At first you can stretch it quite far very easily but after a certain amount of stretch the tension suddenly increases and goes up dramatically when stretched just a little bit more. Another analogy that may help visualize this concept is that of packing a suitcase. One can put quite a bit of clothes into the suitcase and it will close easily. But then at a certain point (or threshold) even adding one more shirt may prevent it from closing without a struggle.

 

With harvesting donor tissue it is the same thing ....the donor may close easily at a certain width but at a certain point, when you take out just 1 -2 mm more it may suddenly create a dramatic increase in tension and become hard to close. Dr. Mel Mayer has attempted to develop a testing method for predicting laxity and safe donor widths that he has presented at conferences for the last 3 years. He makes two dots on the donor area about 1 cm apart and pushes the dots together to measures how much they move. Depending on how much the dots move he developed a formula that suggest safe widths ranging from 1-2 cm. So far aside from clinical experience and judgment this is the best we have.

 

"?? The ability to predict safe maximum strip widths has become particularly important over the last few years because in order to get the larger sessions that are becoming more popular, a donor strip often has to be greater than 1 cm. It think the old dogma of keeping strip length to 1cm or less in everyone was too conservative For example last week I did two cases that were both 4000 + grafts each. I had to make an incision 1.6 cm wide on one and 1.75 cm on the other. But both patients fit my criteria for taking wider strips as they both had tremendous laxity and good donor density. In addition they were both aware of the relative risk (or potential) for a slightly wider scar and they were willing to accept this risk. On the other hand if they had not satisfied my criteria (i.e. - poorer laxity, poor donor density, an increased concern of even a small scar in the donor area, the desire to wear a crew cut, young age with the risk of significant donor hair loss in the future, etc) then I would have suggested a more conservative approach.

 

Many patients may be candidates for wider donor strips. How wide will vary in different patients. For some it may be too risky to take wider strips while for others it is not. It is important for you as patients to understand the thought process and the criteria physicians use to make these decisions.

 

The same is true when it comes to other currently controversial aspects of the procedure such as doing larger sessions and higher densities. Larger sessions and higher densities can be done and are powerful tools for us to use in the right candidates. However everyone is not the same and everyone is not a candidate. The criteria we use to decide what to do on different patients needs to be shared and understood.

 

I know I am beginning to touch on some controversial issues here. I have a lot of thoughts on them and if it is desired I will continue to share them in future posts. For the record I want to state that I am not dogmatic and look at different techniques as tools tool to be added to a physicians armamentarium to be used in the right situations. I think it is important for patients to begin to develop a feel for how different physicians make these types of decisions.

 

For now when my patient post I will encourage them to give the details of the procedure as well as any criteria I may have used to choose a specific approach. With respect to the donor area I will give them my estimate of donor laxity, donor density, total donor supply as well as the length and width of the strip used. . With respect to the recipient area I will give them the total number of grafts, the total number of hairs, the total breakdown of grafts (1's, 2's, and 3's), the total area transplanted. When referring to densities I will try and be specific about the different densities produced in different areas of the recipient area as the density is not consistent throughout.

 

 

Take care

Ron Shapiro

[troy]

Thanks for your post I learned a lot from it and look forward to your up coming post. I think the new people will greatly bennifit from this type of information. Thanks.

[Guest]

Stunning post

 

Great overview of the closure technques and really important point that pateints should post their breakdown of 1s,2s,3s,4s grafts.

 

Does it matter whether this is the breakdown before or after potential graft splitting, i.e. harvested breakdown or inplanted breakdown ?

[Pat - Community Publisher]

Dr. Shapiro,

 

Thanks for providing such a thoughtful and well presented post on such an important topic.

 

I think it is important that patients understand the considerations and trade offs when committing to the size of their surgical session.

 

I would like to encourage all patients who post on this forum to provide more detailed information about their surgery such as -

 

Donor Information -

 

Their donor laxity, density and supply

Length and width of their donor strip

 

Recipient Area Information -

 

Total number of grafts

Breakdown of grafts (1's, 2's, and 3's)

Total number of hairs transplanted

Total area transplanted

 

I think such detailed information will enable people to compare sessions much more accurately (apples to apples).

 

I encourage Dr. Shapiro and his colleagues to continue to post such excellent information on this forum.

[Dr. Ron Shapiro]

It was just pointed out to me that I made a slight historical mistake in my original post about the time line of who presented the procedure first and would like to correct this for historicalaccuracy. I would like to thank Dr Cooley for pointing it out to me

 

Dr Cooley went back to his program books from the 2004 ISHRS meeting in Vancouver in Aug 2004 and saw that Mario Marzola had indeed given a talk on this trichophytic closure at that time. Dr Marzola also gave credit to Simon Rosenbaum who had presented this idea at a previous 1999 ISHRS meeting in San Francisco. So in reality these two were the first to present the idea . Frechet and Rose on the other hand were the first to present the 'lower' edge variation of the technique.

 

This type of historical mistake may happen from time to time as many ideas have been around for a while and often have been worked on by more than one person at around the same time.

 

I am going to edit the original post to reflect this information.

 

Take care

Ron Shapiro

[M&M]

Dr. Shapiro,

 

Great post on explaining Trichophytic Closure and some of the relevant information that you weigh before making a decision. I am scheduled for an appointment with you in May, so I am excited at the prospects! Which of the three techniques do you use, if you don't mind me asking?

[troy]

Funny you ask that m&m, I was wondering the same thing, also which one is the most effective for hiding the scar and why?

[UGLY MAN 4 LIFE]

Dr Shapiro,

 

Do you feel the trichophytic closure is advisable for patients who will almost certainly come back for more work? Does it increase the potential of transecting hair follicles when the same scar is re-opened for a second procedure?

 

Cheers

[Dr. Ron Shapiro]

Originally posted by M&M:

Dr. Shapiro,

 

Great post on explaining Trichophytic Closure and some of the relevant information that you weigh before making a decision. I am scheduled for an appointment with you in May, so I am excited at the prospects! Which of the three techniques do you use, if you don't mind me asking?

 

At this point in time know one can say which technique is the best. All three physicians who have lectured on the technique have shown a range of results that are similar. Some of the scars are near invisible while others can still be seen slightly on when the hair is combed up.

 

All three are based on the same principle and all three have been shown to work.

If you poll the physicians using it it seems to be split between using the upper edge like marzola or using the lowe edge like Frechet and Rose.

I have used both techniques but currently I use Dr Roses ledge tecnique the most. Since the strip is taken at an angle the uppe edge has a lip and this lip fits perfectly into the ledge created by this technique.

 

I will on occasion trim the upper edge and usually that is if there is a pre-existing scar that has decreased the number of hairs in the lower edge. If there is less hair in the lower edge the technique is less effectiver so in this case I use the upper edge.

 

As you can see all techniques are tools and the key is to know when to use each one.

 

As time goes on and we get 1-2 years behind doing this tecnique and alot more patients that have had the ability to heal for 1 year than we will be better able to evaluate if there is a true difference between the techniques

take care ron

[Pat - Community Publisher]

Attached is a photo of the donor area of a patient of Dr. Paul Rose's. Notice how the hair growing in and around the donor scar due to the use of the Trichophytic Closure tecnique disguises the scar even when the hair is combed up to reveal the donor scar.

 

[Pat - Community Publisher]

Another view of the donor area Dr. Rose's patient.

 

[hrthr]

I am curious, how this appears when patients buzz their hair to a 1 or 2 (or less). I think that is the real test of this new process.

[troy]

I am a former patient of DR Rose and am now almost 4 and a half months post op and will be going down to a number before summer. I did a number 3 at 4 months and it was not noticable.

[Waiting4hair]

I am also a patient of Dr Rose and had HT on 2/20. Other than still being pink, the scar looks great. I can see the hairs growing through it. I would say that it is already undetectable.

[MrJobi]

Hi

I'm at 3 months with the T closure and I am the same. Low detectability but it is still a little pink. I'm sure this will fade by 6months or so.. Looking forward to seeing the final result of the scar or lack there of). Dr. True did both of my surgeries

 

1417 1st

1476 2nd with T closure

[DrBauman]

Many thanks to Dr. Ron Shapiro on a beautifully written, detailed summary of the Trichophytic Closure! Excellent quality photos as well.

I wanted to add that I was equally impressed by the talks given and papers published by Drs. Rose, Frechet and Marzola last year. Under normal circumstances, I think that most patients have the ability to heal a traditional non-trichophytic donor harvest with a 0-2mm scar. However, in order to camouflage the donor harvests even better for my patients, I have also incorporated the trichophytic donor closure technique with increasing frequency over the recent months. I have to say that I am very enthusiastic about the results I've observed thus far. I have found it particularly useful for those patients with short hair who want the virtually undetectable scarring of an FUE procedure, but also want the 'efficiency' of a large session of strip harvesting. I agree with Dr. Ron Shapiro on the fact that a lower edge modification of the donor harvest seems to be better both intuitively and in practice. The lower edge trichophytic closure is what we demonstrated on several of the cases performed at Live Surgery Workshop this past March. As an observation, I have noticed that some of my patients with a trichophytic closure experience more ingrown hairs in the donor area within the first few weeks after the procedure than those who have had non-trichophytic closures. Also, I've seen that trichophytic closures have slightly more inflammation during the healing process within the first few weeks. In some cases, I have found it necessary to mechanically release trapped or 'ingrown' hairs from within the trichophytic closure during the first few weeks post-operatively. I believe that helping those hairs 'find their way' to the skin so the inflammation can subside is important for the healing process. Regardless of the type of closure, I have observed that many patients seem to heal faster in the the donor (and recipient areas, for that matter) when they use healing treatments such as copper-peptide, low level laser therapy and hyperbaric oxygen treatments in the immediate post-op period. Thanks again to my colleague, Dr. Ron Shapiro, for an excellent summary of the trichophytic closure. Hopefully, we'll have some more improved guidelines from doctors observing their results from this technique as the months go on and more doctors incorporate this technique routinely into their practices.

Sincerely,

Alan J. Bauman, MD

Medical Director

Bauman Medical Group -- Boca Raton, Florida

[Jeffrey Epstein MD, FACS]

Not sure why my prior post did not come through- perhaps because I attached some photos. I'll have Pat add my photos to the post.

 

The trichophytic closure technique has been used by plastic surgeons for years in browlift surgery. During my plastic surgery training, we learned the importance of choosing the proper edge to deepithelialize- thus my choice of the lower edge. This is a technique I have been using for 6 months, and last month I presented my technique and experience at the Live Surgery Workshop held in Orlando.

Overall, the best candidates for the procedure are those with fine hair, while not as good candidates are those with thick curly dark hair, due to the higher incidence of cyst formation. Also, second surgery patients are not as well treated as first timers.

 

Jeffrey Epstein, MD, FACS

Miami and NYC

www.foundhair.com

[Alps007]

Hey Ron,

 

I have really heard some great stuff about you on this site and really wish I had known about this site before having my surgery over 2 weeks ago with Dr. Melvin Mayer of MHR. I have seen alot off crap about MHR on this site and hope I haven't made a bad decision with Dr. Mayer. I am unable to find much info about that Dr. but realise that you have done some studies with him and was wondering if you have personally come across any off his work and what would your thoughts be. I am 26/m and have a thick head off hair but receding hairline and had 1000 grafts in the frontal area. Look forward to your response.

[the B spot]

Wow, I had forgeotten what a great thread this was back then!!!

 

Thanks for bringing it back Alps007!!!!

 

Anyway, I would send Dr. Shapiro a PM, just to make sure he gets your question.

 

Many Docs find it hard to get on the boards everyday, so many times it takes them forever to respond.

 

Hope this helps you out!

[Guest Paul M Straub MD FACS]

It has been almost nine months since Dr. Shapiro gave his excellent report on trichophytic closures. Dr. Bauman and Dr. Jeffery Epstein also reported. I thought you might be interested in my experience.

 

I also attended the European Society of Hair Restoration Surgery meeting in Brussels in June of 2005. I left the meeting intensely inspired by idea of the trichophytic closures.

 

After returning I immediately began to test trichophytic closures.

 

Before that, for about three years, I had been closing using a continuous absorbable Maxon suture in the intracutaneous region and a fine Prolene suture to the skin. This produced finer scars than many clinics but had the disadvantage that frequently Maxon sutures would be spit out.

 

It is my personal opinion that Dr. Frechet's technique of excising the lower margin is the best. After a strip is excised from the donor region parallel to the hair shafts, the upper edge forms an acute angle and the lower edge is an obtuse angle. (figure 2) The upper edge with the acute angle comes easily to meet the epithelium of the lower edge. (figure 4) If the strip is excised from the upper edge, the bottom must rotate 135 degrees to meet the upper edge. As a result the trichophytic hairs exit the skin at a different angle. Even Dr. Marazola said on the podium. "Maybe I'll switch to excising the lower edge." Dr. Rose's technique, while it works quite well, is technically more difficult and more time consuming. It requires two long scalpel incisions carefully done one to two millimeters from the edge. A slight variation from these precise cuts can cause an inclusion cyst.

 

 

 

 

 

Dr Frechet's trichophytic closure has three steps.

1) A strip is removed from the edge of the lower margin. It is triangular in cross-section and 1 to 2 mm wide on the external surface and on cut surface. The third side, which is the hypotenuse, is naturally greater. This strip cuts 2 or 3 hairs (one follicular unit) just below the surface and above the bulb. These hairs will not go into telegen, but will continue to grow. I leave my sutures in 14 days. By that time these hairs have grown ?? of an inch and act as "nails" to prevent further widening of the incision.

 

2) Undermining is carried out in the fatty layer. This is not the location of most undermining. Most undermining is done under the galea. The width of the undermining is the same as the width of the excised strip. For example, a donor strip of 1 cm. width would be undermined 1 cm. This undermining can be done ?? cm. on the lower side and ?? cm. on the upper side or 1 cm. on the lower side or 1 cm. on the upper side.

 

3) The epithelium is closed using a very fine nylon continuous suture one to two mm. apart and one to two mm. deep.

 

 

 

The results

The last time I counted I had used this technique 274 times but I have been adding to my experience regularly.

When used in the first session, in general, the results have been spectacular. The overwhelming majority have resulted in donor scars which could not be located by a third party who was not a hair transplant surgeon or an assistant when given a comb. It is also extremely difficult for a trained person using magnification to locate the scar. If you are taught to search for hairs which exit the scalp at a slightly different angle you might be able to identify it. However the patient probable could identify the scar line because there may be a slight tenderness or elevation of the line up to a year after surgery even though this cannot be seen with the naked eye.

 

Complications

In the early cases we had a good many occlusion cysts. These would occur because the excised strip was irregular. Later I developed special trichophytic scissors and the occlusion cysts became very rare or even non-existent. Using these scissors any surgeon can excise a uniform strip which produces no occlusion cysts with very little practice.

One case became very red and inflamed. It looked like an allergic reaction, possibly to the suture material. After the sutures were removed the redness and swelling went away. The case eventually healed normally.

In all cases the redness lasts longer than a non-trichophytic closure. Also there usually is a microscopic elevation of the line for 6 months to a year.

The undermining of the lower edge is easy as the follicles and bulbs can easily be seen. Undermining the upper edge can cause result in hair loss if you don't do it properly. There is a tendency to turn the edge upward so you can see the follicles then undermine in the fatty layer. This will result in cutting the follicles. It is necessary to turn up the upper edge, place the blade in place, then pull the upper edge downward and make the cut blindly. Otherwise you will excise the bulbs and create an area of thinning above the incision line.

 

Trichophytic closures after the first session

Later sessions do not have the same nearly 100% undetectability of the first session. It is surprising how a very lax scalp can seem much tighter by the time the second session is done. In addition to the fact that some of the scalp was excised, there appears to be a second factor in that the pull causes a scarring of the subcutaneous region. I would not consider excising the old scar line as it is essentially not to be found. With each succeeding session the percent of totally undetectable closures becomes less but, especially in loose scalps, the majority are not to be found.

 

How can you minimize the chance of wide scar after multiple sessions?

Use wide undermining under the galea and deep permanent buried sutures in the galea. I used to use absorbable sutures (Maxon) but now mostly use nylon and leave it in. I am not aware of any of my patients spitting out one of my deep nylon sutures.

 

What kind of skin is more likely to scar?

Very tight skin and very loose skin produce the worst scars. You all know that if you have to close under tension is difficult to get a fine scar line. You may not be aware that extremely loose skin also produces large scars because it doesn't have or produce the collagen needed to hold the wound shut. In pigmented skin I always inquire about a past history of keloids.

 

Trichophytic studies

In Orlando in the spring of 2006, Dr. Frechet carried out a study which is still going on. A first time patient was selected with average flexibility. The donor site was designed to bisect the midline. Dr. Frechet closed the left half using his technique and I closed the right side using Dr. Marazola's technique. One year later, this spring, we will see the patient again and compare the scars.

 

Thank you for listening.

 

Dr.Straub

 

 

 

figure 1, the direction of hair in the donor region

 

 

 

acute angle

 

 

 

obtuse angle

 

 

 

figure 2, the donor strip excised

 

 

 

 

 

 

 

figure 3, the triangular strip excised; the hairs cut at the surface will grow

through the scar

 

 

 

figure 4, the donor area closed

[NervousNelly]

Thanks for taking the time for the post. It is a very interesting read and I think that you'll find that many of us are eager to learn and truly appreciate your source of knowledge.

[Bill - Seemiller]

Dr. Straub,

 

Great post...thanks for sharing your research and direct experience with Trichophytic scars. Your figure examples, however, are not showing...would love to see them.

 

Bill

[Guest Paul M Straub MD FACS]

I don't know why my the four drawings that I made to illustrate the post did not come through. I will try to send them as ab enclosure or ask Pat to add them to my post.

Straub

[Bill - Seemiller]

I'll occasionally check back on this post then to see if the figures are present. Not there as of 12/18/2006

 

Bill

[Guest Paul M Straub MD FACS]

I've attached figures 1 + 2 of my previous post to this message.

Thanks