Medical hair restorations, Denver, CO.

[Bayer]

Hey Andrew,

 

I can't speak to the potential graft loss, but I would definitely not use any comb. I had a bunch of scabs caught in existing hair and gently eased them out by hand. This was a bit labor intensive but seemed worth it.

 

Bayer

[Bill - Seemiller]

Andrew,

 

You may or may not have lost a graft...but at 5 days post op, it is definitely possible. I wouldn't sweat it though, honestly...I know many, including myself, that lost a graft or two by doing something they shouldn't have or by accidently bumping their head, etc. Ultimately one graft in the scheme of things won't be that critical.

 

BUT...do NOT use a comb on the grafts until at least day 10. Even then, I see no reason why you should use a comb on such short hairs. Just use your comb overtop of the grafts (still...not until day 10) to come the hair around it.

 

Using a comb over the scabs is like picking them with your nail. And if you've read some of my other posts...you should NEVVVVVVVVVVVVVVVVVVVVERRRRRRRRRRRRRRRRRRRRRRRRR do this

 

Bill

[AndrewYoung]

Bill,

 

Thanks for taking it easy on me. It was stupid to even try and I was more mad at myself than anything for the rest of the day. For the record, I wasn't actually combing on the grafts. I was simply trying to comb the existing hairs over the top and accidentally stuck the dang comb down there. It only took a flash for it to happen.

 

Of course you are right, it's just one graft. I am over it moreso now. Took another shower this evening and the scab residue has definitely improved in the past 24 hours. They are actually starting to feel like little hairs now instead of stubby prickly little dots. It just made me so mad that I was that careless.

 

What I guess I was really asking is that since I am actually at day 8 is it still possible that I pulled the whole thing out.

[hairbank]

AY-

 

I cracked up when I read about your frustration with Crown shots..............man their tough, aren't they??? I remember stretching my arms out.....reaching back, trying to get the "good" shot .......it's tough. I ended up finding a surface that's about as tall as I and just setting the camera on it and using the timer, then crouching slightly and tilting my head back til I got a good shot. An immobile camera takes better pics .

 

I will point out that I do think you received a quality HT as far as the overall look of incisions.........very small and have healed nicely.

 

As for actually having pulled a graft out..........with that much blood, yes, I'd guess it's a strong possibility . On the bright side , you've got more than 3,500 of them to pick up the slack . Usually, the grafts are seated more like around day 10, not 5.

Happy healin',

[AndrewYoung]

HB,

 

Yea, I went in for suture removal today and confirmed that, sure enough, I did pull that darn thing right out. She said, yep, sounds exactly like a lost graft when you see that much blood. She said the same thing as you.

 

My suture removal wasn't too bad. About brought tears to my eyes a couple times right near the centers and the ends where they were tied. But I manned up and got thru it. Doc said she was real happy with how I had taken care of the incision - very clean and scarring shouldn't be too bad at all. She also said that I probably could have had them removed on Day 8 - which was a Friday rather than waiting until Day 11 - today (Monday). Guess I had healed up so well that a few of them didn't really want to come out that easily.

 

Bonus was that the hairdresser was in and she helped me cover up a bit with some Toppik and trimmed the back and around the ears up a bit as it was looking kinda shaggy. She helped me comb forward and applied some Toppik so I could feel a little better about covering up my new. lower hairline. Seemed to work.

 

Had one co-worker compliment me on my nice haircut and another might have known something was up when she asked what I did on vacation. For now, I think my secret is safe. Not sure why, perhaps it is the stigma, but I really don't want to tell anyone. I'd rather leave them guessing at this point.

[AndrewYoung]

Oh, I almost forgot, B Spot asked a couple of pointed questions about my strip and my hair count. I received that information today when I went in.

 

First, let me say, I am not sure what is normal or how you measure but I will try my best to describe the diagram Doc Pauls wrote for me. At the center of the strip, there is a 4 cm length that, at it's widest point, is 20 mm. On each side of that it is 4.5 cm wide and at the center of each, at what I presume would be 2.25 cm, it is 15 mm. The side that leads to the ends is 5 cm on each side and at the center point of that it is 10 mm. So, what I do understand is that the total length is 23 cm and it is 20 mm at it's widest part. What is the average width? Beats me, but perhaps those with advanced engineering degrees can figure it out. Hope that make sense.

 

Now the other measure I was asked for....the hair count:

 

463 singles

 

1510 doubles

 

1453 triples

 

92 quads and yes,

 

6 completely rare quintuplets!

 

Total hairs = 9166

 

Finally, the time on job of the techs that did my graft placement. 5 yrs, 3 1/2 yrs and 3 yrs. Oh, and all three weren't bad looking either ;-)

[Gorpy]

Dude, you had a ton of triples! That should give you some nice density.

[Janna]

Hi Andrew,

 

Thanks for posting your graft and hair count info. I don't have an engineering degree of any kind, so I'm not able to help you in deciphering your strip widths. From my experience, the length is just short of the "average" size we take out. I take it that your doctor must of free handed the strip with a single scalpel to get such varying widths.

 

I must say your donor yielded extreme density as I have not yet come across a patient with so many three's when you take your total grafts into account. I've seen some five hair fu's, so that wasn't a surprise. You'll be looking pretty hairy in about a year.

[AndrewYoung]

Gorp,

 

I only wish the hairs I had were of thicker substance. I guess I made up for being fine-haired with the hair counts. Kinda a reverse correlation to me but quite a pleasant surprise.

 

Janna,

 

Hopefully just on my head. I was wondering about your comment on the free hand, what method do other docs use? I just assumed there wasn't some machine that punched out a strip. Also, what is the typical shape of the strip? I didn't actually see mine so I have no idea what a strip even looks like. Doesn't it come to some spot where the two edges would meet to allow the re-suture skin to come together? My guess is had I seen it, I might have fainted anyway. Not much for blood and gore.

 

If I understand what she decribed it sounds as if it was largest at the center back of my head and, consistent with the other side, reduced down from there. Does the shape of the head have anything to do with the strip width varying? I would assume the size of the head affects the length they can take and to get 3000 grafts, which is what was originally planned, they had to take a wider strip. Correct?

[Janna]

Andrew,

 

Many doctors use free hand while others may use a multi bladed knife. The doctors I work for use a multi, which can be adjusted to the width they prefer for each patient. They actually have two ready for each patient. One may be set for 1cm width for the sides while another can be ready for 1.3cm width in the middle. Our "average" strip width is 1.2cm to 1.5cm width. The length can be anywhere up to 31 to 31cm long (depending on the size of the patient's head). Our "average" strip length is probably 26cm long. The width and length depends on the patient's laxity, elasticity, fu per cm2 to get the number of grafts desired for that particular case.

 

There are some clinics where they have more than two blades (the # depends on the number of strips they plan to take out (2-4). This is a thechnique a doctor may use to not rely on a tech for slivering. Transection rates can be very high in these cases if the doctor is not trained well.

 

Tension at the sides of the head typically is tigher than the center (the reason why your doctor was able to take a wider strip in the middle). It's fortunate for all that the center is more lax as it's also more dense in that region.

 

You doctor may not have had to take a wider strip than planned. Your density may have just been more dense than they had anticipated. Or, the other reason may have been she did go wider to get more grafts than you both planned. It's a question for your doctor. There's some guess work involved when determining the strip size to extract.

[Aquarius]

Janna, You stated that the doctors you work for use multi. Is that multi adjustable or multi-bladed? As the latter has been proven to be detremental to the patient.

I bow to your experience but would like a clear explanation.

As I would prefere a single bladed carefully removed elipse.

[Bill - Seemiller]

Though this wasn't asked for, I thought this might help some people:

 

The formula for measuring the number of grafts you've received is:

 

(Density in FU/cm2) X (strip width in cm) X (length of strip removed in cm) = Projected number of grafts

 

To measure the average number of hairs, multiple the whole formula above by 2.2 since the average number of hairs is 2.2 hairs per FU.

 

The formula would then be

 

((Density in FU/cm2) X (strip width in cm) X (length of strip removed in cm) X 2)= Projected number of HAIRS

 

As long as you have all but one component, you can come pretty close to figuring out any of the other measurements including your donor density.

 

Let's say you know your graft count (3500), your strip width (2.0cm) and your strip length (20cm) (after you've received these from your doctor) but want to determine your donor density. Simply plug these numbers into the formula

 

(Density in FU/cm2) X (2.0cm) X (20cm) = 3500

 

Simplify it by using simple algebra where A = Density in FU/cm2

 

A X 2 X 20 =3500 (multiply 2 X 20 and you get)

A X 40 = 3500 (divide 40 on each side of the equation)

A = 87.5 FU/cm2

 

Just some random but useful information.

 

Bill

[Janna]

Aquarius,

 

Most of the time Dr. Shapiro uses the multi-bladed instrument. The formal name for it is called the Vari-blade. You can adjust the width size as well as the angle of the blades. We put just two blades on the instrument to get one strip. Dr. Shapiro has 9-10 years experience using this very instrument. He'll use a single bladed scalpel if the occassion calls for it. The strip he extracts has very minimal transections. Because he uses highest magnification loupes during excision, he is able to adjust with each patient.

 

Dr. Shapiro has never been one to sit back thinking he's got everything mastered. It's always been about improving every aspect of this procedure. Strip harvesting is very critical and in some hands, or inexperienced hands, detrimental. I've been to many surgery workshops with Dr. Shapiro, the top doctors share and compare their work with each other. Our doctors wouldn't be using the Vari-blade technique if it did not extract the best strip possible.

[Janna]

There's couple things I'd like to add to my yesterday's post:

1) I'd like to make it clear about the "multi-bladed" knife as it can be misconstrued to mean multi-strip harvesting. Dr. Shapiro was mentioning to me today that he was part of group who studied multi-strip harvesting of 2-5 strips using 3 to 6 blades. Those multi-strips did result in too many strips with too many transections. This is not the case anymore when loupes, adjustable angles and a single strip is harvested.

 

2) Dr. Shapiro is currently perfecting the use of scoring the donor strip with a single blade or two blades before using the "Haber spreader" to gently spread apart the donor incision to eliminate any transections. The spreader is optimal only for the first time patients as the scar tissue is too strong to just pull apart.

In anycase, whatever method is used for donor harvesting, skill and experience play a major part.

[Bill - Seemiller]

Janna,

 

I'm sure that helps clarify things for people. Obviously one of the major challenges (that has improved significantly) is minimizing transection of hair follicles during the donor strip removal. I'm glad to know that Dr. Shapiro (along with many other top physicians) continually work hard to improve this method.

 

Bill