Fue 2000 over 2 days cause more shock

[maxxmill17]

After reading alot about shock loss I am left thinking that the shock loss after a 2 day proceedure could be drastic. Thinking about all the shots to the head on the first day and then again ...then again I am not a medical professional..any thoughts Dr's or experienced guys thx..

[RCWest]

It's a greater chance of shock loss if you had a 2 day procedure. That means you endured 2 days of epinephrine shots which constrict the blood flow during surgery. Depending on how much was used and how long it took for graft placement, you could experience some shock loss or a lot of shock loss.

[maxxmill17]

I just did some research on Epinephrine..If I had known I would have never done a 2 day fue procedure..my hair loss has been drastic.. 2 full days atleast 8 hours each day...now the wait sucks I wish I had been advised to do the strip 6 hours in, and out, less drug, less trruma, to the head...now the long wait till I can do a strip to fix.

below is what I fonnd ....

"There are also hypothetical problems with using epinephrine in large transplant sessions. One is that when the drug is infiltrated into the scalp over large areas, it may predispose to post-operative telogen effluvium (shedding). Another, potentially more serious problem, is that when adrenaline is added to an area whose blood supply is already compromised by a large number of recipient sites, the tissue may not receive enough oxygen. Although not proven, it is likely that epinephrine infiltration into the recipient area is a contributing factor in the development of the "central necrosis" that has occasionally been reported during hair transplantation. It is also possible that the intense vasoconstrictive action of epinephrine may contribute to decreased graft survival. "

[nordstrom]

Who is your surgeon. Did you discuss you concerns with them?

[Dr. Alan Feller]

I am not this patient's doctor, and I have no idea who is, but he brings up a VERY IMPORTANT concern that all FUE patients and even strip patients should be aware of.

 

First of all Max, don't worry about the shockloss. The level of initial shockloss does not always correlate with final yield. So calm down and take a breather as you are likely still in the ballpark for an excellent result. Don't panic.

 

By now most know that I am against back to back FUE procedures for the very reasons already presented: scalp trauma, vascular compromise, and fatigue. Back in the 1990's, believe it or not, some clinics were advocating back to back strip procedures as well. In short order this was found to be the wrong methodology and soon abandoned in favor of larger one day surgeries.

 

As far as the epinephrine injections go, Max has done his research and is aboslutely correct. But Max make sure your clinic even used epinephrine in the recipient area before you upset yourself. In my clinic we almost never use epinephrine in the recipient area for the reasons you just cited, perhaps your clinic understands this as well.

 

Epinephrine is used to constrict the small blood vessels in the skin. A valuable tool in HT. In the old days liberal use of epinephrine was fine because the holes were bigger and furhter apart. Bigger holes meant greater bleeding so use of epi was very necessary; and because there was alot of skin between holes there was plenty of vascularity in the scalp.

 

But as the size of the grafts diminished to tiny Follicular Unit size the amount of bleeding dropped off by an order of magnitude. This was great, however, the amount of space between grafts also decreased thereby making the use of epi much more dangerous. More holes means more cut blood vessels, which in turns means you don't want to compromise that in any way.

 

A skilled and experienced clinic can perform 98% of their procedures without ANY epi at all.

 

So relax Max and wait to see where the transplant takes you.

 

I have one more concern, though. You said you experienced alot of shock loss after the surgery of 2000 grafts. Did you have a lot of cosmetically significant hair in the recipient area prior to your procedure? Or was it just a thinning layer?

 

Best of luck and, again, don't panic.

 

Dr. F

[maxxmill17]

Dr. Feller your input is welcomed greatly; in my profession I dont hold back I help those that ask questions even if they were not a client of mine at the time..too many professionals sit back and do not help educate others; again thank you...

 

To my dismay yes I was given the "Epi" all through the surgery and in the frontal part of my head. Everytime the staff would see me feel some pain they would give me another shot they said if I felt pain I would create more bleeding which would not be good for the graphs. I want you to know each time I got Epi I would feel a sort if rush of blood or my heart would pound for a minute which really scared me a bit so in turn I was trying to hide the pain as they were working cause I didnt want more shots ; really the pain was bearable but they saw me squinting a bit...also the epi shoits I think were the most painful part of entire surgery

 

Yes I have good hair in front I was a norwood 1 and am 2 if not a bit worse now...I lost more on the right side even lower as you go towards the ear..

 

I think my biggest mistake was not makeing sure the Dr. oversaw all..He didnt do the extractions or even have any idea of how many epi shots I was given...yes I blame me not him I could have spoken up and been more asertive as to what would have made me more comfortable and possibly given me a better result ..but that only time will tell.

 

my concerns

1.too much epi

2.graphs too close to existing hair

3.back to back surgery 8 hours two days in row

4.extraction semed difficult for them

5.only 1500 graphs vs what I have lost and asked dr how many 1's 2's 3's seemed clueless said guess's most were 2's

[corvettester]

Who performed your surgery? Where?

[maxxmill17]

I dont want to discuss who did my surgery at this point..I dont want to put dr. on the spot . I really just want to learn for now..though I will tell you he is not on this forum.

[Dr. Alan Feller]

Sounds like you definitely had a good amount of epi used in the recipient.

 

Don't beat yourself up about not making sure your doctor oversaw the procedure. A good and experience team does not need such micro-managing.

 

You should post some photos when you get the chance. You don't have to reveal your doctor, but it would be nice to see what you are writing about.

 

To give you some perspective, I just finished up a 872 graft FUE today. We had 250 singles and 622 multi-hair FUs mostly 3 hairs. This guy should look great. We started extracting at 8:30a and finished extracting by 12:30p. I don't like to extract much over 4 hours as I think it affects yield. All grafts checked under microscope and epidermis trimmed, then reimplanted into hairline. I'll post pics later or tomorrow. If you can't post your own pics, tell me if my patient's case was similar to your own.

 

Hang in there.

 

Dr. F

[Dr. Alan Feller]

Here is an 875 FUE graft case performed in one day. Extractions started at 8:30am and finished by 12:30pm. Mostly multihair FUs were harvested.

Grafts were placed in such a fashion as to lower the hairline on either side of the forelock or "mohawk". .9mm Feller Punch was used. Notice that I did not invade any areas of the scalp that contained cosmetically significant amounts of hair. This is how I avoid any chance of shockloss. Also, we did not use any epinephrine in the recipient area at all. Just the way I choose to do it. I hope this information helps.

[maxxmill17]

wow Doc, that job looks beautiful. I will be in N.Y. June-July what is your email? Thank You .

[Dr. Alan Feller]

Hello Max,

 

I appreciate the kudos on the pics. I just wanted to give you an idea of what an FUE procedure looks like to give you some perspective as to density and placement. As you can see there is no chance for shockloss because I don't usually work in areas that contain cosmetically significant hairs.

 

Please give your transplants the time they need to grow before coming to see me. I really wasn't trying to get you to come to me. I don't want to be viewed as "stealing" anyones patient, if you know what i mean. I just wanted to share some useful information with you that might make you feel better.

 

If 18 months after your procedure you wish to visit, then you are certainly welcome. But please speak with your doctor about any concerns you may have first. I say 18 months because the trauma of an FUE procedure can cause the grafts to grow more slowly so you want to give it the time it may need.

 

I wish you the best, and perhaps you can post some photos of your progress. I usually follow FUE growth with great interest no matter which clinic.

 

Grow well.

 

Dr. Feller

[Dr. Glenn Charles]

This looks like a great case with both the recipient and donors areas appearing very clean. Nice job Dr. feller. I also do not like to have the extraction process take longer than 3-4 hours.