Necrosis Update

[John R]

Thank you to everyone who posted regarding my necrosis.

I wanted to provide you with chronological documentation since my procedure.

I will spare all of you the "drama" I have been living with the past four months.

Right now just trying to heal (emotionally and physically).

Living with a bad mistake..... is for me the hardest part right now.

Thanks again,

J

[NEWHAIRPLEASE]

John R

Honestly, that is one of the nastiest things Ive ever seen...sorry for what you had to go through!! Im assuming you are saying you made a bad mistake getting a hair transplant??? I really like the look of your hair in the next to the last picture...you should be proud of where you are...I don't think it was anything you did!! How is the growth in that area?? Did it actually grow in or do you just kinda have your hair combed over there??

[John R]

The last two pictures you are viewing are my pre-operative photographs.

These were taken the morning before my surgery.

I think the pictures have have dates on them? Maybe not?

[NEWHAIRPLEASE]

John R

I hate to hear that....hang in there bro!!

[Blake Bloxham]

John,

 

Thank you for sharing these images with the community. I apologize if you've discussed this before (it's likely I missed it), but would you mind sharing your story/details about the situation?

 

Frankly, I'm slightly confused (from a physiological) perspective as to how necrosis in the scalp like that even occurs? Was there a serious infection prior to the tissue death?

 

Please, let me know if there is anything I (or any member of the community/moderators) can do.

[RCWest]

Necrosis is the worst possible outcome of a hair transplant. I certainly hope things change for you!!

[Davis91]

John,

 

Future HT Doc has it right. You have support in these forums. Don't beat yourself up about trying the HT or choice of Docs or the outcome. At this point I assume you need to heal up as best you can and if you want, you can think about a repair with a top doc, or you can just leave it alone or even consider other options for hair coverage. At some point, you will look back on this with a new perspective.

[zenmunk]

Very sorry for your situation, but "this too shall pass." I know it's a struggle, but keep trying to imagine a healthy, pain-free future. Meditate on it often. As we think, so we are. You will be OK, friend.

[John R]

Future HT Doctor:

Of course I will share my story with you and your members.

I had posted back in 12/15/11.

You can see the historical photographs (I think) from my pre-op to 3.5 months.

At the risk of offending you ..or anyone on this site, may I ask:

Do you receive any compensation as a moderator, co-moderator or affiliation to this website?

Do any Doctors listed here incur any financial cost to remain viable on this website?

Are you you currently studying or practicing medicine based on your stated profile name?

I wish to post my entire story to your members regardless of your answers to the above questions sir.

Thank you again for your concern.

[Davis91]

According to the physicians selection section of this site:

 

"How this online community is funded.

 

Those surgeons who are carefully reviewed and chosen for recommendation on this site contribute a monthly fee to co-sponsor this online community and display their before and after photos, videos and contact information."

[Blake Bloxham]

Future HT Doctor:

Of course I will share my story with you and your members.

I had posted back in 12/15/11.

You can see the historical photographs (I think) from my pre-op to 3.5 months.

At the risk of offending you ..or anyone on this site, may I ask:

 

No offense taken ...

 

Do you receive any compensation as a moderator, co-moderator or affiliation to this website?

 

Yes, I'm paid for my work on the hair restoration network, hair transplant network, hair loss learning center, and Hair Loss Q & A blog. However, as I'm sure any forums members will tell you, our community is 100% open and honest, and my opinions and commentary is not swayed by any sort of outside source. I truthfully feel like our community is the best hair restoration/hair loss reference on the web, and I was a member here for several years before becoming a moderator.

 

Do any Doctors listed here incur any financial cost to remain viable on this website?

 

Yes, physicians who are approved for recommendation (which is a lengthy, highly selective process) do pay a monthly recommendation fee. However, the physicians we recommend are truly the "best of the best," and the number of requests we receive for potential recommendation far, far outweigh the number of individuals who successfully navigate the recommendation process. The community needs funds to function, but it's a very open, honest network.

 

Are you you currently studying or practicing medicine based on your stated profile name?

 

I'm currently a medical student planning on entering the hair restoration field. However, as stated in my signature, absolutely none of my opinions, commentary, or responsibilities on the site are related to my medical training. We have several other moderators/staff members (Pat, Bill, and David) who essentially perform many of the same tasks I do, but do not have any medical training.

 

I wish to post my entire story to your members regardless of your answers to the above questions sir.

Thank you again for your concern.

 

I hope that was sufficient. Like I said before, we're a very straightforward and honest PATIENT-based community, and I'm more than willing to answer any questions, especially if it will help you share your story.

[StaggerLee123]

John I remember your original post, thanks for the update. I can't imagine going through what you have. I would be ready to go ballistic and probably would have ripped that scab off in frustration.

 

Did they have any reason why the necrosis occurred? Was it Doctor error or what? What is the current state of your hair? Anyway I don't want to bug you, you'll post when you're ready.

 

Best of luck, and it really sucks that you went through this bullshit.

[HARIRI]

John R, Sorry to see this. Its really painful, Who was your nasty HT surgeon? Can you name him so we learn and avoid. Thank you.

[John R]

Thank you Blake.

Please understand I meant no disrespect toward you, this website or any member.

I value everyones contribution here.

I will continue to update with pictures if anyone is interested.

05/01/12 will be the 5 month mark for me. I think the third from last picture posted is at 3.5 months. My procedure was performed at PAI Medical in St.Louis.

All pre-operative and post-operative directions given to me were followed verbatim.

There were approximately 6,000-7,000 donor hairs utilized. The number of grafts actually placed is unknown and that figure has never been provided to me.

It took 82 days for the final and largest scab to fall off.

I still hide in my house most of the time and rarely venture outside.

Right now I am trying to let what is left grow out, so I can do an ugly comb over.

Thanks to everyone for the support.

J

[NEWHAIRPLEASE]

John R

What do you think went wrong??? Can this be complete negligence on PAI?? I really don't know and I would love to hear your or a physician opinion on this....I can't imagine being in your shoes...I truly feel for you and I hope you can't find some peace with this whole issue!!

How does something like this happen??

[marco2]

John,

 

 

 

Frankly, I'm slightly confused (from a physiological) perspective as to how necrosis in the scalp like that even occurs? Was there a serious infection prior to the tissue death?

 

Please, let me know if there is anything I (or any member of the community/moderators) can do.

 

current wisdom is that necrosis in the donor is avascular due to over stretching whereas necrosis in the recipient is hemorhagic due to vascular damage mainly by transecting subdermal vasculature (a depth issue). the central scalp is thinner and also the vessels are terminal (no through connections) so there is little escape for the blood / bruising by anastomosis. As a result it clots and can suffocate the tissue.

[marco2]

John,

 

 

 

Frankly, I'm slightly confused (from a physiological) perspective as to how necrosis in the scalp like that even occurs? Was there a serious infection prior to the tissue death?

 

Please, let me know if there is anything I (or any member of the community/moderators) can do.

 

current wisdom is that necrosis in the donor is avascular due to over stretching whereas necrosis in the recipient is hemorhagic due to vascular damage mainly by transecting subdermal vasculature (a depth issue). the central scalp is thinner and also the vessels are terminal (no through connections) so there is little escape for the blood / bruising by anastomosis. As a result it clots and can suffocate the tissue.

[Blake Bloxham]

Thank you Blake.

Please understand I meant no disrespect toward you, this website or any member.

 

 

None taken, whatsoever. We're all here to help!

 

Did you ever have the scalp evaluated for another physician? Was any sort of post-operative infection identified?

[Blake Bloxham]

current wisdom is that necrosis in the donor is avascular due to over stretching whereas necrosis in the recipient is hemorhagic due to vascular damage mainly by transecting subdermal vasculature (a depth issue). the central scalp is thinner and also the vessels are terminal (no through connections) so there is little escape for the blood / bruising by anastomosis. As a result it clots and can suffocate the tissue.

 

This definitely makes "sense" (with respect to both the donor and recipient region), but John's necrosis appears so advanced that it seems like the vascular damage in the scalp would need to be extreme. It makes me wonder if there wasn't a post-operative infection involved. There are various strains of bacteria that like to attack healthy tissue and blood vessels and could, in theory, cause this level of necrosis (from what I can tell).

[John R]

Marco2:

Ironically my donor area healed well. I almost laugh (almost) when I hear patients complain about a donor area scar. God I wish that was my only problem.

 

Blake:

I am not sure if I will ever know what caused it and the full details of my "condition".

To be honest.. I never heard of the word Necrosis before all of this.

I went to my PCP who obviously in "general" practice is not an expert. He ran a culture swab and it came back negative.

 

The St.Louis area has VERY limited HT doctors. My doctor from PAI Medical does not reside in the state and travels to various multi-state PAI locations. I actually did not have an exam by him again until 39 days after the surgery. I had an exam (2 actually at my own expense) by Dr. Samules 19 days after. His practice is hair transplantation and cosmetic dermatology. He is NOT affiliated with PAI Medical and he and his staff treated me with respect and dignity.

I was going to PAI once or twice a week for the first few months to have a review and exam by a PAI staff member ( I believe her formal credentials is Registered Nurse).

 

Dr. Samules placed me on antibiotics, a medicated shampoo and a regimen of 3 long showers a day and a weak mixture of H.Peroxide and water in a spray bottle.

I used that spray every 30-60 min. of every waking hour for over 2 months.

 

I have been given many possible reasons why this happened to me by my Doctor and staff.

The bottom line is I am much worse off (financially, physically and emotionally) than when I walked in the door. The scaring and lack of hair in such an abnormal area of the scalp does not lend itself to a shaved or cropped style.

[Blake Bloxham]

I went to my PCP who obviously in "general" practice is not an expert. He ran a culture swab and it came back negative.

 

I'm glad he ran a culture. My initial thought was an infection, and I'm glad your physician tested for this as well.

 

The St.Louis area has VERY limited HT doctors. My doctor from PAI Medical does not reside in the state and travels to various multi-state PAI locations. I actually did not have an exam by him again until 39 days after the surgery.

 

My girlfriend is actually from St. Louis, and we were discussing this very issue the other day. It seems like Missouri in general, compared to other U.S. states, has a very small number of physicians performing hair restoration.

 

I had an exam (2 actually at my own expense) by Dr. Samules 19 days after. His practice is hair transplantation and cosmetic dermatology.

 

Dr. Samules placed me on antibiotics, a medicated shampoo and a regimen of 3 long showers a day and a weak mixture of H.Peroxide and water in a spray bottle.

I used that spray every 30-60 min. of every waking hour for over 2 months.

 

I'm actually semi-familiar with Dr. Samuels, and he does seem to be a dedicated, trained hair restoration physician. I'm glad he treated you with respect and put you on the antibiotic/medical shampoo regimen.

 

I have been given many possible reasons why this happened to me by my Doctor and staff.

 

I'm sorry you weren't able to receive a definite answer for what went wrong; this can't help the overall healing process.

 

The bottom line is I am much worse off (financially, physically and emotionally) than when I walked in the door. The scaring and lack of hair in such an abnormal area of the scalp does not lend itself to a shaved or cropped style.

 

John, I'm very sorry to hear this. As I'm sure you're aware, your post-operative issues are far from the norm, and it's very disheartening to say the least. I'm curious, at this point in time, what are you considering? Would you like another evaluation with a different hair restoration physician? Frankly, while I'm not sure how you feel about moving forward with a repair procedure, I do think a consultation with a talented hair restoration physician will really help shed some light on the situation.

 

Please, let me know if I can help with contacting a physician, helping select a doctor, etc.

[wylie]

Hang in there John, you have been through hell, we are all pulling for you and will be glad to help in any way that we can. Stay strong and get a good personal injury lawyer, any future repairs should not cost you a dime

[NEWHAIRPLEASE]

I would love to see John get one of " the Free " surgeries that I've read about on here from time to time. I think bullitnut had one by Dr Ron Shapiro. I think I remember Dr Feller doing one as well. If ever a guy needed a break John R would be that guy. Good luck John. Keep us posted buddy!!

[Sean]

John, I remember commenting on your last thread about necrosis. Very sorry you have had to go through it and go through a lot of stress. Did anyone at PAI St. Louis tell you anything about the condition or how it could affect your transplant? I would expect they will guarantee your transplant because I find it appalling that your doctor was out of town and you had to go to other doctors to seek answers at your own expense. All PAI had was an RN giving you advice? They should have chosen another PAI doctor to take a look at your situation. You should be refunded, especially, since this was caused by the surgery and you didn't have adequate follow up after by a PAI doctor. Or they need to make sure you are satisfied in the future.

 

You got the support of this community.

 

I am glad that your swab test came back negative. That is very important too.

 

I believe you had your procedure in December, so it has been around 4 months. Hang in there. It is still early to see growth but you should see sprouts in a month or 2 and have until the 12 month mark. Just continue to keep yourself healthy. Best of luck with everything and keep us posted.

[Stuart01]

John,

 

I had Dr. Panine take a look at your pictures and he feels you really need to get in to see a dermatologist. Dr. Panine is a Board Certified dermatologist and said if you wanted to come to Chicago he would be willing to see you and get you on the right treatment to help your situation. He also would be willing to do it free of charge for you.