two scars better than one?

[wrapper]

newhairplease,

Dr Path' is one of the recommended physicians on this site, he does do 2 strip scars, he confirmed it to me today in an email and I posted the reasons he gave, my first HT was done in "normal circumstances", my scar is low and very much in the "safe zone" I was surprised when he explained to me that my 2nd ht would be a 2nd scar, that's why I posted my question, I am definitely going back to him for a 2nd HT but have to have a good discussion with him about this, he's been doing HT's for 20 years, he obviously know's what he's doing, it's early days for me but I was extremely impressed by him and his team, I already have comments about how small my scar is, I have shock loss, if it wasn't for that then my HT would be undetectable, the impression I am getting from the clinic is if the scar is small and undetectable, then why not have another similar undetectable scar, you will get more grafts and the old scar will be left untouched, Dr Path' told me after surgery that he would expect to get 2500 grafts from me on a 2nd transplant, I'm norwood 6, I could do with a high graft count like that, reading about Dr Path' and about HT's in general mainly on this site led me to him, I made a good decision, hopefully this site can again help me with my next decision.

[NEWHAIRPLEASE]

newhairplease,

Dr Path' is one of the recommended physicians on this site, he does do 2 strip scars, he confirmed it to me today in an email and I posted the reasons he gave, my first HT was done in "normal circumstances", my scar is low and very much in the "safe zone" I was surprised when he explained to me that my 2nd ht would be a 2nd scar, that's why I posted my question, I am definitely going back to him for a 2nd HT but have to have a good discussion with him about this, he's been doing HT's for 20 years, he obviously know's what he's doing, it's early days for me but I was extremely impressed by him and his team, I already have comments about how small my scar is, I have shock loss, if it wasn't for that then my HT would be undetectable, the impression I am getting from the clinic is if the scar is small and undetectable, then why not have another similar undetectable scar, you will get more grafts and the old scar will be left untouched, Dr Path' told me after surgery that he would expect to get 2500 grafts from me on a 2nd transplant, I'm norwood 6, I could do with a high graft count like that, reading about Dr Path' and about HT's in general mainly on this site led me to him, I made a good decision, hopefully this site can again help me with my next decision.

You are correct...Dr Path is highly recommended on this site and it sounds like you two have a game plan for future plan of attack and in the end thats all that really matters...good luck!

[wrapper]

hairthere,

good luck with your next surgery, your hair at the back looks very thick and able to conceal scarring, you have said you wish you only had one scar, if a another scar were to produce a lot more grafts, would you consider it?

[hairthere]

Wrapper, Thanks, I am actually 5 days post-op. Yes, you are correct that my donor is very thick and conceals the scarring well. Regarding the second scar, it would have to yield a substantial amount of extra grafts (say an extra 800-1k) for me to want a second one. I would certainly ask Dr. Path how many grafts he feels he could obtain if he excised your current scar.

Edited February 8, 2012 by hairthere

[richie48]

Hi ,

 

This photo was taken in 2007 , 28 days after my first surgery with Dr Feller , I recieved approximatly 2100 grafts , very thin and very neat .

 

 

These photos were taken in 2012 , 13 days after my second surgery with Dr Feller , you can still see the staple holes , again I recieved approximatly 2100 grafts , again very thin and very neat .

 

 

 

In total I have recieved approximatly 4200 grafts from two HTs with Dr Feller , I only have one thin , neat scar and he got the same amount of grafts each surgery .

 

You shouldn't need to have two scars , and this is not the norm .

 

I hope you understand I am trying to help you and not belittle the new guy , if Dr Feller can do it then why won't Dr Path ?

[StaggerLee123]

Hey Wrapper are you a rapper wrapped up in a wrapper who raps? =) NHP is an enthusiastic poster who misunderstood one of your posts, I really don't think he is trying to be a wise ass. We are here for knowledge and support and the occasional off the cuff commentary so stay focused on the positive.

 

I have two stacked strip scars and let me tell you that 2 are in no way better than 1!! If I could turn back the hands of time and just get one scar I would do it in an instant. First off two scars are harder to conceal than one. Logically if you have two scar you need to have your hair longer to cover them because there is more real estate to cover, especially if they are close. If somewhere down the road you wanted to have a different hairstyle and have it much shorter in the back, one scar is definitely better than two. While it's true that taking a second strip from "virgin" territory will increase the yield as oppossed to taking the second strip over the first one, I think the small increase in yield is not worth it.

 

I am probably more self conscious about my scars than I am about the top and front of my head, and I had work done that was much less than "refined" on top. I wasn't even aware that some clinics still take two different strips as a planned strategy anymore, I always assumed that guys with two strips ended up that way because the first strip was either taken way too high, or as in my case, way too low.

 

If your first strip is in a good location and you want another procedure, I would encourage you to do what all the leading clinics do and work off of the first one so that you end up with just one hopefully thin scar. Speak with Jotronic, mattj, or Janna to get really informed opnions on your situation, or go directly to different docs themselves. While it is great to get opinions from other posters, it is always crucial to glean info from the true experts.

 

Good luck and keep us informed.

[wrapper]

thanks guys,

Fabulous help, strange that Dr Path' does 2nd strips when he runs a "leading clinic" I spent more than half my initial consultation fussing over my potential scar, Dr Path' knows how I feel about this, I hardly mentioned my hair, he is the expert and will guide me but I will have the knowledge that you guys have passed on to me, invaluable help and I am very very grateful, surely though I cannot tell a leading HT surgeon how do do his job, yes it's my head but when he starts to inject your head then it's down to him, need him and me to be on the same page if you know what I mean, this does concern me, he get's rave reviews on this, why would he carry out something which seems to be so wrong? no one said this journey would be easy, got to make sure it was all worth by making the right choices.

[NEWHAIRPLEASE]

Wrapper

Thank u for editing your posts...it shows class on your part...sorry for the confusion...I was really only trying to help....

[hairthere]

Wrapper, If you don't want a second scar then you should not get one. Like I said, I have seen only one other clinic do this. I would tell Dr. Path you do not want a second scar and ask him how many grafts he feels he can get. I would also consult with some other clinics. Best of luck, and keep us up to date on what you decide.

[wrapper]

hairthere,

I don't expect I will go to another clinic, I was very happy with Dr Path' and his team, I will have a good discussion on this subject with him, I've already sent him 2 emails today regarding this, a 2nd scar seems like a very bad idea, strange that a "leading clinic" would suggest this, better the devil you know, they say so I will stick with him, every confidence in him that even using my original scar he will be able to obtain optimum results for me, 16 days since my surgery, can't believe the hair I've got on the top of my head, been so long since I had any there, I know it's going to fall out soon, hopefully it will grow back in nice and thick, my crown is very bald maybe that's influencing the good Dr on my next procedure, I guess I will need about 1500 grafts maybe more for that, it was always a long term plan that I decided on, 2 strips followed by FUE in years to come and even micropigmentation as well, getting a 2nd strip wouldn't influence that as I spoke to HIS clinic who tell me covering 2 scars isn't any harder than one, just more time consuming therefore more expensive, the guy at HIS clinic told me they regularly have patients with 3 and sometimes 4 Ht scars, thanks again everyone who helped me.

[wrapper]

staggerlee123,

just read your story there, shame you were treated so badly, good luck with what you decide to do, all I can tell you, is that I am quite bald, 1 year younger than you, noticed my hair falling out when I was 20, didn't want to believe it, up to 2 weeks ago I was nw 6 no hair on top, 2 weeks since my ht, I already look better, don't have to look at my big bald head in the mirror any more, I've all these little hairs growing on top of my head, just looking at them makes me feel good, break my heart when they all fall out, I'm sure you'll be able to make a good improvement with whatever you decide, I say that because I am sure I can make a big improvement to my appearance, wasn't sure before but now that I've made the first step I'm very sure.

[NEWHAIRPLEASE]

staggerlee123,

just read your story there, shame you were treated so badly, good luck with what you decide to do, all I can tell you, is that I am quite bald, 1 year younger than you, noticed my hair falling out when I was 20, didn't want to believe it, up to 2 weeks ago I was nw 6 no hair on top, 2 weeks since my ht, I already look better, don't have to look at my big bald head in the mirror any more, I've all these little hairs growing on top of my head, just looking at them makes me feel good, break my heart when they all fall out, I'm sure you'll be able to make a good improvement with whatever you decide, I say that because I am sure I can make a big improvement to my appearance, wasn't sure before but now that I've made the first step I'm very sure.

 

Its sad to see those newly transplanted hair go bye bye...I had my transplant with Dr Rahal on Jan 19th...every time I apply my rogine now I have a ton of shed grafts on my hands...I had 4800, over 10,000 hairs so that will be a lot of shedding, however, obviously the GREAT news id they all come back!!!

[wrapper]

newhairplease,

we had our hair transplants only days apart, yes it will be sad to see those new hairs go, got hair were I haven't had for 20 years, I'm only 46, wish the techniques and my finances were there 20 years ago, they're there now, got to make the best of it, good luck with your journey, hope you achieve more than you are hoping for.

[gillenator]

Wrapper, If you don't want a second scar then you should not get one. Like I said, I have seen only one other clinic do this. I would tell Dr. Path you do not want a second scar and ask him how many grafts he feels he can get. I would also consult with some other clinics. Best of luck, and keep us up to date on what you decide.

 

Was it the multi-blade scalpel that was introduced several years ago whereby the scalpel actually made several long incisions in the occipital zone where several strips could be harvested in one procedure? Was it Dr. Bauman or Dr. Epstein in South Florida? I am also trying to remember who introduced it.

 

That was scary!:eek:

[hairthere]

Gill, It was definitely Bauman that took three strips. Not sure about the scalpel type he used.

[Bill - Seemiller]

wrapper,

 

Welcome to our community and congratulations on selecting an excellent physician for your hair transplant.

 

While I can't speak for Dr. Pathomvanich, I don't believe he typically creates a second scar with subsequent procedures. However, I know some physicians take this approach on the occasional patient to harvest a greater number of grafts for the second procedure (with the patient's consent). While the obvious advantage is the possibility of more density or coverage (depending on where the extra grafts are placed), the disadvantage is that you'll have a second pencil thin strip scar extending from ear to ear. I recall another physician discussing this approach on this forum in the past.

 

Overall however, this is not common practice. Perhaps Dr. Pathomvanich was referencing the second scar that replaces the first one?

 

Our forum co-moderator Dave has contacted Dr. Pathomvanich asking for his input on this topic. Hopefully he'll have a chance in his busy schedule to share his thoughts on creating more than one scar on this thread.

 

Best wishes,

 

Bill

[wrapper]

Hi Bill,

The reply I received from Dr Path' yesterday confirmed that he does make a 2nd scar, the email goes on to state the advantages of this method, I explained this yesterday and also that no decision will be made before consulting and discussing with the patient, he definitely wasn't as you put it Bill, "referencing the second scar that replaces the first one", I'll send you the email reply if you want, I fear I may not be too popular with Dr Pathomvanic and his staff now, I fully intend going back there in one years time and believe they have done a marvellous job on me and will do so again in one years time but I cannot apologise for researching and trying to find out as much as possible especially in this case where the treatment being recommended seems to go against the norms, as I said before I spoke more about scarring than my actual new hair during consultations, surprising then that I'd be recommended a procedure that could give me more scarring, I look forward to reading Dr Path's response to the forum co- moderator and to his input on this subject.

[hairthere]

wrapper, you raised a very legitimate concern as taking two scars is not common practice, and I wouldn't worry about this having an adverse affect on your relationship with the clinic. After all, it's your head on the line! I think we all look forward to a response from Dr. Path in regards to this.

[NEWHAIRPLEASE]

Yea, Im very curios to see his response...I don't want to beat a dead horse, but of all the consults I had with the 5 plus coalition doctors, eventually going with Dr Rahal, ALL were replacing my old scar and wanting to leave me with just one scar!! Interesting!!

[bigcow]

Hi wrapper,

i had 3 sessions with dr path.

because i had a botch surgery in uk which left me a very low scar i got dr path to leave it and he took a higher strip to achieve 3000 grafts

then i returned 1 year later and i wanted maximum amount grafts so dr path cut a 3rd strip scar higher area where it was denser to achieve 2700 grafts.

so i had 3 scars,

i then returned for dr path to joing the first and second scar together revision into 1 neat scar,its still healing now but looks great so far so good.

my higher scar didnt heal as well as i wanted but it is well hidden

dr path will tell you straight,no bullshit.

so far now i dont see any problem having 2 scars on my donor as its well hidden.

as long as your getting the grafts you want and your donor hides it nicely then 2 scars is no problem in my own view

[wrapper]

Thanks bigcow,

Good to hear the other side of the argument, when I had a consultation with a uk clinic in October, the guy from that clinic had 2 ht scars, I asked to see them, they were both slim and you had to look for them, if in one years time before my next surgery, my first scar is undetectable and the likeliehood was that a 2nd scar would be simarily undetectable but produce a good deal more grafts then maybe it's not such a bad proposition, I would be in the same positon regarding scarring as I was in a year earlier, ie one undetectable scar with a new surgery to come as opposed to no scarring but about to have my first surgery, the fact is though there are very knowledgable people on this forum even Bill the managing publisher suggested I may have misunderstood Dr Path' as the idea seems so against normal practice. this forum is where I learn about Ht's but I'd be surprised if anyone on this forum is as experienced as Dr Path', for me I done the correct thing by raising this issue, I'd love to hear from anyone else whose had a 2nd scar and think it's a good idea.

[Bill - Seemiller]

wrapper,

 

I suspect if Dr. Pathomvanich regularly employs this technique, that he's a firm believer in it and wouldn't have a problem sharing his comments and point of view with the community. After all, this community encourages 100% transparency, especially as it relates to physician technique.

 

While there are some potential dangers with creating a second scar, I have every faith in Dr. Pathomvanich's technique and don't feel he would steer anyone wrong.

 

That said, it's important that patients are aware of the particular strategic hair restoration plan that both the physician and patient should be a part of. This includes whether or not to create one or two scars and discussing the advantages and disadvantages of both.

 

I do hope Dr. Pathomvanich shares his expert opinion on this important subject.

 

Best wishes,

 

Bill

[Dr. Damkerng Pathomvanich]

There's no doubt that one scar is the best for multiple HT sessions. However, subsequent sessions makes the single scar wider depending on the width of the strip that is excised. A 1 cm width strip will leave a minimal or an invisible scar on average, whereas a wider strip will leave a bigger scar. The outcome of a single scar after 2 strip techniques usually results in a scar that is wider than the original since the total width is doubled, more or less.

 

Excising the scar from the first HT session is not easy since the hair follicles within the scar are not aligned in the same direction as do normal hair follicles since they are embedded in scar tissue. Even with trichophytic closure, the hair follicles within the scar are in danger of transection. Careful dissection is very important to avoid damage to these follicles even though I use my open technique with the aid of skin hooks. I still have a hard time in some cases to try to dissect the follicles that are within the scar to avoid transection, since the hair direction of the follicle is distorted due to fibrosis. If we excise the strip and the scar is included at the center it would be much easier, in the same manner as if we avoided dissecting inside the scar. However, slivering a strip inside the scar is more difficult. When you encounter the scar, there is the potential for follicular transection.

 

In my opinion, if the scar is invisible, why bother to incise the same scar causing more potential for follicular transection. If we make a second scar, we do not encounter the old scar and there will be less potential for transection. If the patient needs further sessions, the two scars can be incorporated into one.

 

If the scar from the first HT session is a little bit wider, I will use a single scar by excising the first scar and incorporating the scar inside the strip to prevent an even wider scar when it heals.

 

I always discuss with my patients prior to surgery whether he would want a single scar or 2 scars. Whether to do one or two-scar strip is still a debate. However, majority of the hair surgeons as well as patients will select a single scar, if possible. Majority of my patients still have a single scar after subsequent sessions.

 

I did not say that I recommend 2 scars for every patient.

 

 

 

Dr. Damkerng Pathomvanich

[wrapper]

Thank you Dr Pathomvanich for your thorough response and for clearing this matter up, I feel so much more knowledgable now, sometimes it is not possible during consultations to gather and take in all the information given to you, this site is invaluable for educating prospective hair transplant patients, I look forward to meeting you again in 1 years times for hair transplant number 2, no doubt we will discuss in more detail my next procedure, thank you for taking such good care of me when I visited your clinic in Bangkok and for doing such a good job on my head, post op I've had absolutely no problems whatsoever, as you know I wasn't even at my hotel when you called on the evening of my surgery to check on my wellbeing, I felt ok then to go out that evening and it's been a steady improvement since, all my grafted hairs are growing well and none have shedded yet, couldn't be happier, thank you.

Edited February 10, 2012 by wrapper