Dr. Lindsey Stage 1 of a 3 stage major flap failure repair case, McLean VA

[Dr. William Lindsey]

This pleasant Aussie-UK fellow had an attempted temporal flap procedure done 25 years ago. Although he describes it getting infected, I’m pretty sure that the pedicle (blood vessel supplying the flap) got compressed or kinked, leading to rapid failure and necrosis (death) of the distal aspect of the flap. I say this for 3 reasons….1: If you look at what’s left, the portion that lived is essentially 3 times as long as it is wide—a standard ratio for random-non pedicled flaps used in facial reconstruction; 2: Its practically impossible to infect the forehead of a young healthy person after clean surgery; and 3: Having personally done about 80 vascularized pedicle nose reconstructions---this is the horror that we all worry about for the first few days—that the supplying blood vessel will get blocked and the flap will die.

Anyhow, he came over last week and our plan is 2 or 3 surgeries. First, we’ll do a strip hair transplant placed in a hairline that he finds acceptable, just a little above his flap. Second, after the hair has started to grow and is doing well, probably in 8-12 months, we’ll excise his flap, and advance his hairline down just a little, while at the same time taking advantage of his loose forehead skin to get a nice closure with hopefully an acceptable scar line…that looks better than the failed flap scar he currently has. We’ll take the hair out of the flap and place this behind his step 1 transplant, more on the right than left, as the blood supply to the right side of his head won’t be compromised by excision of the flap like the left side’s blood supply may be. And third, we’ll possibly do a 2nd strip case a year later to bolster the back.

All in all, quite an interesting case. As usual, he arrived the day before surgery so that we could make sure the plan was acceptable to both of us, then on Friday he arrived at 7:30 ready to go. The pictures show his donor area with some of his old flap scar visible on the left corner. He had an easy 3 layer closure and then received 2700 grafts. If you look at the distribution, you may wonder why there are more grafts placed on the left….and its due to our plan to put his failed flap hair in in part 2. The placers think we’ll get 700 out of the flap, I think it’s more likely to be 500, but I don’t want to put them on the left as the flap excision will cut through the supra-orbital and supra-trochlear vessels. While there is a lot of blood supply coming in from the sides and even the other side…I’m still cautious enough to want to place hair in the middle and right at step 2.

There weren’t any surprises in his case and he emailed me that he’s back in the UK and will get his sutures out on day 7 and then start scar care. I’m really excited about this case and I’m hopeful that his results are everything we both want.

Dr. Lindsey McLean VA

[LETSC]

I would like to begin by thanking Dr Lindsey and his team for being so understanding .

After a very bad experience 30 years ago I have never had the confidence to attempt to put right a extremely bad hair transplant. My journey began by finding Spex on the web,after reading his life experience with hair loss and HT. I made the decision to meet with Spex and at the very least listen to what he had to say. After our meeting my confidence had

grown into thinking something could be done to improve my mistake. The next step was a phone call to Dr Lindsey who suggested a couple of options.

All I can say is Dr Lindsey and his team are ethical and competent in there field . My honest opinion would be to any person reading this is to trust in them. My experience from arrival

at the clinic for consultation, through to having my surgery was totally professional .

[RCWest]

Not only is Dr. Lindsey a great HT surgeon, he is also a great plastic surgeon. I'm sure your scar will be next to nothing!

[HARIRI]

Great work by Dr. Lindsey however I wish to see more after photos of his work, because most of the posts are photos posted in the category are of the strip extracted with pre-op and day 1 photos. I wish to see more 6 -8 -10 -12 months post op which gives clearer picture just like Dr. Feller's. Thanks.

[chrisdav]

This is an interesting case and not one that you would see very often.

 

I am sure by the end of your journey, you will look great and Dr Lindsey is definitely the guy for the job based on his vast experience in plastic surgery.

 

Will you keep us updated on this interesting case Dr Lindsey?

[Al - Moderator]

LETSC,

I hope it works out for you. I've had some horrible hair transplants from 20-25 years ago as well, so I know what you mean about not having the confidence to try to make it right. There's always that fear of making it even worse. Good luck to you.

[NEWHAIRPLEASE]

I can't wait to see the final results of this case!!!

[Blake Bloxham]

Excellent case. Thank you for sharing!

[austinuk]

Letsc, I can't even imagine to comprehend how difficult it must have been to live with this flap surgery. From all my reading, Dr Lindsey is a very good ethical doctor with a great deal of experience and skill in this field.

I look forward to watching your transformation. This is certainly going to be one to watch.

[aaron1234]

Very interesting case. I'm still trying to get my mind around how this flap surgery was done. Horrific, of course. But also a little confusing.

[Dr. William Lindsey]

I want to see pics of the final result too. As much as you guys do I suspect.

 

Yes, this requires a bit of thought, a lot of planning, and a ton of patience...to get to the flap excision--subsequent graft placement and then growth.

 

There is no reason that I can think of that this won't turn out really quite well.

 

Dr. Lindsey McLean VA

[LETSC]

Thanks For Sharing BEHAPPY

[LETSC]

Thanks for sharing behappy

[wylie]

Good luck, I think you will get this repaired , I think you are a good candidate and when the doctor says he is confident he can repair you, then you should feel real good about getting this fixed. Wishing you all the best in your attempts.

[LETSC]

thanks for sharing wylie fingers crossed

[LETSC]

Hi Guys

Approaching three weeks since ht. Transplant area has settled down really well a little pink but not very noticeable. On Flap extraction scar I apply vitamin E capsule split in half twice a day my wife reckons it looks really good, this I did on doc recommendation. Not sure what happening on the transplanted hair waiting for it to fall out (shock loss) is this a process that takes weeks or months? Will post photos to Dr Lindsey on week four . All the best guys will keep you all updated.

[Dr. William Lindsey]

Great. Yes please send pics next week. Vitamin E for 2 months to strip (not flap) scar. It will all fall out by June 15 I suspect.

 

Thanks for the update.

 

Dr L

[Cam Simmons MD ABHRS]

Thanks for sharing Dr. Lindsey.

 

 

You have clearly thought out LTSC's plan carefully. Instead of diving in and fixing his flap right away, you have given him more hair first. He can use that hair to make his flap stand out less and later to camouflage his flap repair.

 

 

Probably all hair docs have seen patients who lost hair behind brow lift scars or neurosurgical scars. More often this is from compromise by tension than by direct vascular damage. Although you didn't specifically mention this possible complication of his flap repair, you mentioned that he has lax forehead skin and have given yourself space between the flap and his transplanted hairline. You have also planned for a 3rd session and that can allow for any further fine-tuning.

 

I hope LTSC gets a great result and look forward to seeing his progress.

[Dr. William Lindsey]

Dr. Simmons,

 

Thanks for the eloquent and thoughtful comments.

 

I think the hairloss that I've seen around browlift (coronal approach) and neurosurgical scars is a combination of tension (brows) and overzealous cautery(neurosurgery). In fact I just did a trichophytic browlift on one of my cutter's family members....and she oozed and oozed and oozed, later admitting to green tea (the bane of my existence) despite my instructions not to drink that for a week preop. And I was in the quandery...do I cauterize and kill hairs which hopefully will cover the scar...or do I let her ooze and maybe have to go back to the OR with a hematoma that night. I gambled on oozing and she did fine...in fact she went camping on day 4 and will be late getting her sutures out tomorrow.

 

I'm not too worried about this fellow losing hair after excising the flap....I think there is plenty of skin and he doesn't ooze much so I don't think he will need much cautery around those new hairs we planted. Rather I do think the the scalp behind the flap excision will have a little less circulation which might hamper new grafts that we'd be placing from the flap....so we'll put most of the hair from the flap on the patient's right side. That should have normal vascularity. Hence we went further back on the left at this procedure, and he ought to be "evened up" after step 2.

 

Thanks

 

Dr. Lindsey McLean VA

[Dr. William Lindsey]

5 months pics sent by patient this am. As expected most of the hair we placed has shed, Scar ok for 5 weeks.

 

Dr. Lindsey McLean VA

[Dr. William Lindsey]

4 month update ( I see a typo in my last update that said 5 month update--it was 5 weeks. This is 4 months, and pics were sent by the patient over the weekend.)

 

 

So, a little fuzz is starting to grow and perhaps some of the hair we placed is turning on too. I'm getting psyched up for part 2, removing the failed flap--hopefully next summer.

 

Dr. Lindsey McLean VA

[s2thoudriver]

Great planning and work Dr.Lindsey, seems very logical, methodical and best for the patient.

 

I'm watching this with great interest and hope the patient is thrilled with the results, i'm sure he will be.

 

Regards

 

Rob

[Dr. William Lindsey]

Thanks

 

Yes, I'm interested in this one too. It should be a huge change when we are done getting that scar and flap out, and hair in!

 

Dr. Lindsey McLean VA

[LETSC]

Well the time is come, i travel to the US on 14th April to have stag two of three stag producer.

Stag two entails cutting out failed flap producer i had done in Brisbane Australia in 1985. Absolutely craping myself one saving grace Dr Lindsey is preforming the operation, who is well versed in plastic surgery. He hopes to excise the flap which has about 600 healthy hairs and transplant on to crown. These hairs have had a proper merry go round ride hopefully the crown will be there final resting place.Dr Lindsey asked that i manipulate the flap as much as possible so when removed will give him a better chance of a grade A scar. Will fly out on the 13th for a week so he can remove stitches before i leave. Wish me luck .

[evil]

You are in very capable hands, a little luck is helpful, but the docs expertise is the reason that you will have an astonishing result, happy growing!