If you will get a second FUT, should you not get a trichophytic closure?

[olmert]

I understand trichophytic closure is the gold standard for the smallest scar. But I heard that using this for a first FUT will reduce the number of grafts for a second FUT. So if you know you will get a second FUT, you should get a double layer closure instead of a trichophytic one. Is this true?

Edited May 30, 2012 by olmert

[cargo65]

Good question. I'd like to know myself.

[RCWest]

The trichophytic closure does not reduce any graft totals, whether it be first, second of fifth procedure. All the trichophytic closure means is that they chamfer the edge of the incision so that hairs can grow through it, instead of a straightforward incision where hairs will grow on either side of the incision.

 

The trichophytic closure is the best thing to come to the donor area.

[olmert]

RCW, have you read this, and do you believe it is mistaken:

 

"Dr. Rosanelli uses state of the art tools to excise the donor area to minimize the risk of damaging hair follicles and uses a double layer closure to reduce wound tension and the appearance of the donor scar. Though Dr. Rosanelli believes the trichophytic closure technique is the “gold standard” for producing the finest scar, he believes this technique is best reserved for the last surgery. Reserving the trichophytic closure technique for the final procedure allows him to maximize the number of viable grafts for transplanting in subsequent sessions."

 

Thomas Rosanelli, M.D. Hair Transplant Surgeon in San Francisco, California

[cargo65]

Just a guess, but I think even if it was true that you should reserve the trichophytic closure for your last procedure, I really think any loss in potential grafts would be negligible if you chose to go with the suture beforehand.

[aaron1234]

RCWest described Trich perfectly. I will add that it works well for most patients - it didn't work so well for me however. Everyone is different and there is no real way to predict how your skin/scalp will react to a certain closure until you do it.

[olmert]

aaron, are there two schools of thought? Why does Dr. Rosanelli say that, if you do that closure on the first transplant, there will be fewer donor grafts for the next time?

[bonkerstonker]

Tricho closure simply means one side of the scar has a chamfered edge this term is used in joinery but I feel it explains the situation best, basically one edge is cut with a slight diagonal edge so it can tuck up tight to the other side of the scar and the hairs on the diagonal edge can grow up through the scar. If you have a second op as I have had done the scar is removed and the follicles inside the scar are reused.

[gillenator]

Some docs refer to the cutting of one edge as "beveling" so that side can be tucked and meet the other side allowing the hair to grow through.

 

The results are as good as the skill of the surgeon performing the triclosure. I have seen some results whereby too much beveling or too much of the beveled edge is tucked under the other flap, then closed with sutures.

 

As long as the patient has the laxity for the closure method, and the surgeon performs the technique correctly, it should come out with a good result.

 

In some cases, the surgeon may opt for a double closure method or even staples to keep the scar thin.

 

Not everyone is a good candidate for triclosure.

[olmert]

Not everyone is a good candidate for triclosure.

 

1. Are you saying the triclosure makes the scar a little thicker while at the same time better hidden because hair goes through it?

 

2. If this is true, and you expect to get a second FUT, are you always better off getting a non-triclosure on the first FUT, since the triclosure leaves a bigger scar?

 

3. Are people here saying that some doctors disagree with Dr. Rosanelli's view that the getting a triclosure on the first FUT will leave you with fewer donors for the second FUT?

 

4. I heard something about triclosures providing a risk of in grown hair? It is possible that the reason grafts might be lost for a second FUT is ingrown hair from the triclosure on the first FUT?

 

5. Who would be a bad candidate for a triclosure?

[gillenator]

Olmert,

 

1) No, I am not saying that the triclosure leaves a wider or bigger scar on everyone. If not done properly, yes that can happen. Or if the patient does not heal well, the scar can come out wider, but that can happen whether triclosure or not.

 

2) The triclosure can be potentially done on the first, second, third, etc . The key is competence. Triclosure was done on my fourth strip procedure.

 

3) Not all docotrs agree on the same issues, but this is true in any industry or field of medicine.

 

4) If the closure was done properly to start with, then yes, grafts can be harvested carefully from taking out the previous scar. There is always a risk of having some ingrown hair from this closing technique. Having said that, a well trained tech can still microscopically dissect ingrown follicles from the strip. I have seen it done many times.

 

5) IMHO, patients who may be questionable for having the triclosure method would be those who do not have the proper laxity, who tend to heal with more scarring than the average patient, or those who heal with raised scarring, etc.