Donor Scar photos at Clipper #4

[Sean]

Was this a Trichophytic Closure technique?

Hopefully it turns out well for you. I plan on having a transplant but debating on what to do, fue or strip. I was shifting more towards fue due to a possible showing scar. Please keep up posted with your progress. So, if you decide to have strip the lowest clip you are able to use is a clip 4? Correct me if I am wrong. Thanks.

[azn_guy]

pvtpoint, no ACELL was not used

 

Sean, I already had FUT, and due to certain circumstances I cannot use a clipper #4 right now

that is why I am going in for scar revision. After the scar revision, I expect I will be able to buzz down to a clipper #4

[azn_guy]

Here is an update because I reread my post and a lot of it is inaccurate.

 

So here is the story with my situation.

 

I decided to get 3000 grafts and had a successful HT. During the procedure ACELL was used

 

When sutures are used during an HT, they are soaked in a solution. I think during this period, Dr. Cooley was trying a new method which included different Sutures, Different Solution, and ACELL

 

With that said, the combination of Sutures, Solution and ACELL were used on the Main strip. I believe the type of suture and the solution caused the widening of the scar. ACELL was used too but according to the clinic, ACELL's benefits were offset by the solution and the sutures, so there was no benefit of ACELL.

 

With the secondary strip, Dr. Cooley used his tried and proven combination of sutures, solution, and ACELL was used.

 

This second strip turned out pretty good while the Main strip stretched.

 

When I go back to Dr. Cooley, he is going to use his tried and proven combination of sutures and solution, unfortunately ACELL is now an additional cost since it's no longer funded by the company who provided it to Dr. Cooley in the first place

 

There will be extra grafts because the stretched scar needs to be removed. I will ask Dr. Cooley to place the grafts in two places.

 

- Secondary Strip Scar, because it is noticeable with my Asian Characteristic Hair

- Temple Regions as they should be thickened up

Edited November 22, 2010 by azn_guy

[hair_me_out]

The fact that they didn't ask you whether you wanted have the experimental stuff done, seems a little disturbing. Did the Dr. talk to you about this at all?

[Sparky]

He experimented with you? That seems absolutely crazy, i'd go ape.

[Bill - Seemiller]

Azn_guy,

 

I find your most recent post a little concerning given that it contradicts previous posts and then you claimed that much of what you wrote previously was inaccurate. If you claimed ACell wasn't used previously, how did you come to the conclusion that it was? Can we assume you had a discussion with Dr. Cooley recently where he went over the details of your procedure?

 

What's most concerning is that your last post leads us to the assumption that Dr. Cooley blindly experimented on you without informed consent which I find a little hard to believe. Can you clarify this for us?

 

I look forward to your response to clarify the above concerns,

 

Bill

[azn_guy]

Azn_guy,

 

I find your most recent post a little concerning given that it contradicts previous posts and then you claimed that much of what you wrote previously was inaccurate. If you claimed ACell wasn't used previously, how did you come to the conclusion that it was? Can we assume you had a discussion with Dr. Cooley recently where he went over the details of your procedure?

 

What's most concerning is that your last post leads us to the assumption that Dr. Cooley blindly experimented on you without informed consent which I find a little hard to believe. Can you clarify this for us?

 

I look forward to your response to clarify the above concerns,

 

Bill

 

Ah, yes, let me clarify. Simply put, ACELL was used on me. I asked Dr. Cooley and they explicitly said it was used.

 

And yes, I did have a conversation with Dr. Cooley about this about the details of the procedure.

 

Bill, I'll Private message you about your last question.

[azn_guy]

Hair me out, Sparky,

 

Let me talk to Bill before I post anything else...I don't want to stir anything by accident

[Sparky]

I think its already out there, Bill did ask to clarify for "us". Can't possibly imagine that Dr Cooley was doing experiments on one of his patients.

[ej]

prp was experimental and still is to the best of my knowledge , lots of Drs offer this as a treatment , acell was / is experimental . I think the point is one of hindsight , if the scar had healed super thin and undetectable then it would be a knock out result , as this is not the case I can fully understand feeling dissapointed and wishing to have gone with the `traditional`tried and tested methods , unfortunatly no one has a crystal ball to determine the outcome .

 

For the Informed and consenting patient ,I think the worse case scenario is that the result would be better than the standard procedure, or at the very least similar if not the same , the problem arises when the`new`procedure used produces a lesser result than the everyday standard procedure ,

hope you get sorted azn guy

regards

ej

Edited November 20, 2010 by ej
spelling

[azn_guy]

Hey Everyone, I decided to wait and get all the facts before I add fuel to the flame. I thought it would only be appropriate and fair to everyone.

 

So the situation was this, Dr. Cooley was trying a new suturing technique, he used it for a period of time and simply noticed that the results were not that good. So when it came to my main strip, it widened simply because of the technique that was used.

 

I was told that during the latest 2010 Conference that many Doctors were still promoting this technique, but Dr. Cooley has decided that it did NOT provide the best results for the patient.

 

As far as the Secondary Strip, it was needed to reach the 3000 grafts. Many of you may wonder why the Secondary Strip didn't produce the same results, it is because when extracting the strip from the side of the head, it is not required to use a deep layer suture technique.

 

ACELL was used in my procedure and while it may have not been verbally clear, I believe it was of the best intention for Dr. Cooley to use this because he believes that the pros outweigh the cons.

 

I want to be clear that the current results I have are very good, there are 2 things I would want fixed. #1 is the donor scar which will be fixed in a month with a scar revision, and #2 the secondary strip on the side of the head is visible to my eyes (again, we are our own worst critics)

 

I'd like to apologize for using the words "experiment" because that really leaves a negative connotation and this was not my intention.

 

Dr. Cooley is simply outstanding, and I think it's great that he is open to trying new things for the evolution of the HT industry.

 

By the way, I mentioned earlier that I had hesitation with ACELL, but after reading and getting a better understanding of it, I am choosing to use it during my scar revision procedure because I believe it will only help the situation.

 

Moral of the story is, the Suturing Technique that was used was the culprit of my donor scar issue.

 

Bill, thanks for highlighting this, I know you had contacted Dr. Cooley about the situation and I think it helped speed up the process to clarify the situation.

[Sparky]

All good then, gl with the revisions.

[Blake Bloxham]

Azn_guy,

 

Thank you for keeping us updated. Good luck with the revisions!

[omy]

Good luck with the revision . Keep us posted . If you get a chance can you describe what the acell procedure is like . Is it a liquid injection or a powder etc ... On your scar the smaller strip had the double layer sutures or did the main one have them ? Dr Cooley has some of the best looking results .(yours included) and he is a stand up guy I think you will have a excellent result .

[LadyNeedsHair]

AZNGUY,

 

As a patient of Dr. Cooley's also, I would like to know if he used the

Trichophytic Closure on you?. I am fairly certain that I read in one of your older posts that he did not due to something about your skin or it's condition.

 

Is that possibly the reason you did not get the scar results you expected?

[azn_guy]

Good luck with the revision . Keep us posted . If you get a chance can you describe what the acell procedure is like . Is it a liquid injection or a powder etc ... On your scar the smaller strip had the double layer sutures or did the main one have them ? Dr Cooley has some of the best looking results .(yours included) and he is a stand up guy I think you will have a excellent result .

 

OMY,

 

This is my personal opinion, so this is not a fact, but I believe ACELL is a powder/strip.

 

Also regarding the smaller secondary strip, again, my opinion, double layer suture was not used, it wasn't needed since the strip was so small.

[azn_guy]

AZNGUY,

 

As a patient of Dr. Cooley's also, I would like to know if he used the

Trichophytic Closure on you?. I am fairly certain that I read in one of your older posts that he did not due to something about your skin or it's condition.

 

Is that possibly the reason you did not get the scar results you expected?

 

Hey LadyNeedsHair,

 

Trichophytic Closure was used, I have all the information in my weblog for you to read up on

[Dr. Jerry Cooley]

Hi All

 

I just want to clarify some things. We certainly don't experiment on people without their consent. We do mention ACell when it is used, but we did not emphasize it in this case and it was not part of the controlled studies we did. We had to take a second strip simply because the first strip did not yield our target grafts. By the time we did this case, I had enough experience with ACell to know that it would provide a modest benefit to the result, not changing the overall look, but ehancing the feel by reducing fibrotic scar tissue under the surface. It was not used on the grafts in this case.

 

In my opinion, the problem came in with the running subcutaneous suture. Over the years, my strips have gotten wider as we're doing larger cases (3,000-4,000 vs 1,500-2,500) and I'm always on the lookout for ways to optimize the results and reduce closing tension. A couple of years ago, many of my colleagues were recommending a type of subcutaneous stitch where the stitch runs continuously from one end to the other. When I tried this, the immediate effect was outstanding: it brought the edges together nicely and made the surface suturing easier. Unfortunately, I found that in my hands, the long term results were on average worse than my 'tried and true' interrupted subcutaneous sutures. My feeling is that the running subcutaneous stitch holds the tissue too tight and does not allow the wound to 'breathe' (ie restricts blood flow to the edges) which explains the scars. Interestingly, at our recent conference, a well known surgeon from a respected clinic was telling me about a complication he had with necrosis all along the donor wound. I asked him if he used the running subcutaneous suture, and he replied, "yah, how did you know?"

 

Also, its important to keep in mind that even with the ideal closure technique, some people just heal better than others, and no one can exactly predict how well the scar will look. A trichophytic closure will make the scar look better only if there is adequate blood flow and not too much tension. I always aim for the best results in every patient, and when there are problems, I offer to fix them.

 

Regards

 

Dr Cooley