Importance of two layer closure when closing donor site?

[hairlossguy222]

Hi Everyone,

 

I had a question that hopefully some will have knowledge on. How important is it that a doctor close the donor site with a two layer closure? From what I have heard, this minimizes tension, thus creating the best possible healing environment for the scar.

 

Here's a quote from Dr. Lindsey regarding this method:

 

"I would add however, that EQUALLY important, is a deep layer closure to limit widening of the scarline after skin suture/staple removal. Even if you have a great trichophytic closure, if the skin retracts-widening the scar-a poor result will result.

 

Thus, I would suggest that in our hands, BOTH a trichophytic closure, AND a 2 layer tension free closure is most likely to lead to the best scar possible.

 

Dr. Lindsey McLean VA

 

 

William H. Lindsey, MD, FACS

McLean, VA"

 

 

 

 

 

So what do you guys think? Could either the doctors or doctor's consultants please provide information on the method they use? If a doc doesn't use this method, can you give a reason why?

 

I am VERY curious to hear some feedback, as this is the last thing I am researching before I embark on a transplant.

 

 

Thanks!!

[Blake Bloxham]

hairlossguy222,

 

I commend you for doing such thorough research before your hair transplant procedure. This work will be very worthwhile in the end! As you previously mentioned, the two layered closure is a mechanism used to relieve tension from the donor scar.

 

The idea is that less tension on the scar means less stretching and a less noticeable scar. Obviously, the wider the donor strip, the more tension in the closure, and the higher the probability of stretching. Personally, I've read that anything over one centimeter width requires a two layer closure. Now, that's simply what I've read and this could be simple conjecture. Here is a reply (on the subject of two layered closures) from Coalition physician Dr Bernard Arocha on the Hair Loss Q & A blog.

 

On the subject of trichophytic vs. standard closure - I've, again, heard differing things. Here's another article from the Hair Loss Q & A blog that addresses differing closure techniques. Also, here is a series of different closure examples from Coalition physicians Dr. True and Dr. Dorin.

 

I hope this helps. You should continue researching on the forums, and possibly discuss some of your closure questions with your hair transplant surgeon. Good luck!

[hairlossguy222]

Thanks FutureHTDoc, great info.

 

I am really interested in if Dr. Feller, Dr. Hasson, or Dr. Ron Shapiro practices this technique. Does anyone know?

[Blake Bloxham]

Hairlossguy222,

 

I would try to contact their representatives on this site:

 

-Spex represents Dr. Feller.

-Jotronic represents Hasson and Wong

-Janna represents Dr. Ron Shapiro

 

Good luck, and please keep us updated!

[Bill - Seemiller]

hairlossguy222,

 

Each physician slightly varies their donor closure technique. Dr. Hasson and I believe Dr. Feller use staples while I believe Dr. Ron Shapiro uses a double layer closure with sutures in most (if not all cases). All of them however, use the trichophytic closure.

 

Because there are varying opinions on an optimal donor closure, I recommend consulting each physician you're interested in about their donor closure technique and why they feel it's optimal. Personally, I've seen exceptional results with minimal scarring from all 3 surgeons you mentioned.

 

All the Best,

 

Bill Seemiller

[Dr. William Lindsey]

For me, a 2 layer tricho closure is important in getting the best scars we can. My scars are often, although not always, pretty nice after maturing.

 

Other docs do fine work with and without that same technique. Its important for the patient to ask what works for their doc and if the patient and doc are "on the same page" the technique itself--or whatever that particular doctor uses--isn't important. For ME, I get better results with the technique that I use...that is why I use it. But another physician may get equally good results with one layer of staples.

 

As part of our consultation we usually show several scars at 1 week, 3 months, 6 months, and a year out. And our portfolio has some FANTASTIC scars, and some average ones too. Its important to know the range of outcomes whether with scars, or hair, or any medical treatment in order to make an informed decision.

 

The reader will note that I said that in the quote that was excerpted.

 

Thanks

 

Dr. Lindsey McLean VA

[Blake Bloxham]

Dr. Lindsey,

 

Thank you for the expert reply!

[hairlossguy222]

Thanks Doc - much appreciated