6000 grafts by dr hasson.very sad :(

[Since21]

The strip looks like it is taken very high all around... What if the patient progresses to a higher norwood? The strip scar would be visible AND the implanted grafts would disappear as they were taken from an area susceptible to loss....

 

This was an explanation someone posted. I don't think it applies to this particular case:

 

Dr Hasson has taught most top surgeons a thing or two over the years and i've seen other top surgeons come on here and admit it he's not in the game for making schoolboy errors, also the scar lines are not as high as they look he takes the bottom piece of scalp and pulls it up to meet the top piece making it look a little higher than the actual exctraction strip is.

 

This below was written by Dr Hasson last year he explains the situation better than me - I have copy pasted it for you to read...........

 

You are correct in stating that this patient has a high donor scar but as I would explain there is a reason for this. When we select the strip area in the donor zone there are several issues that we examine before deciding which level of the donor zone to excise. The fundamental issue, as you know, is that we must select permanent DHT insensitive hair. How do we determine which hair this is? Before hair is lost to androgenetic alopecia it undergoes changes in both structural and physiological properties. Structurally the hair shaft gets fine - through a process called miniaturization - and the growth phase of hair cycle shortens. The donor area is closely examined with magnification specifically for the presence of these miniaturized follicles. It remains controversial but it is normal to have up to 10% of the follicles to appear miniaturized even in the permanent zone. These follicles are not undergoing true miniaturization but are healthy "young" follicles in the early anagen phase.

 

So we will select the area within the donor zone that has the very least amount of miniaturization. Most people imagine that this area would lie in the center of the permanent zone but this is in fact an incorrect assumption. The reasons for this are:

 

1.) There is frequently miniaturized hair around the ear which spreads in an upward direction. This is extremely common and is very under recognized. It is called "retrograde alopecia".

 

It is my opinion that NW6 stage hair loss with retrograde alopecia is at least as common as NW7 in patients. The Norwood hair loss scale does not recognize retrograde alopecia (or a phase called diffused pattern alopecia), and I believe that at some stage the NW classification should be revised to include this condition which I have already mentioned is extremely common.

 

2.) The upper border of the permanent zone is in some patients very well defined and sometimes it can almost be seen as a distinct line where bald scalp or miniaturized hair meets mature permanent hair. Many years of experience has taught us that for all intense and purposes this line remains fixed throughout an individual's life.

 

Where there is a more gradual transition from miniaturized hair to permanent hair it is very difficult to determine the exact location of the transition from permanent to DHT sensitive hair. In these cases the donor area will be lowered as much as necessary to be sure that the hair excised is permanent.

 

3.) The density of the hair in the permanent donor zone is usually highest high up in the donor zone allowing a greater harvest and potentially larger transplant session.

 

As for the technical aspects of the donor excision which I use the following is my approach.

 

1.) Always excise as high as possible in the permanent zone.

2.) Subsequent surgeries use scalp below this line with excision of the previous scar on each occasion so as only to have a single donor scar.

3.) The scalp below the strip should be stretched rather than the scalp above the donor area. How is this possible???

 

The skin and subcutaneous fat of the scalp lie above and attached to a tough and relatively inelastic membrane called the galea aponeurotica. In general, because these layers are attached they will generally move together. The scalp skin itself however is usually fairly elastic by nature. If the skin below the inferior margin of the donor strip is gently removed from it's underlying attachments to the galea (undermining) it is usually fairly easy to stretch the skin in an upwards direction. The skin above the superior margin of the strip is not undermined and remains inelastic as it is still attached to the galea. When these two skin margins are brought together for wound closure the vast majority of the movement occurs in an upward direction of the inferior area below the incision line. This technique is also useful as it does not expand the area of potentially balding scalp.