ACell with Dr. Hitzig (My photos)

[HARIRI]

Dr. Feriduni who will perform my scar revision this summer offered me Acell but I refused it although it was free of charge. I insisted on having a traditional scar revision without any Acell sheets. I know that Spencer Kobren (The bald truth show) promoted it last show by saying it can make the dead scar tissue area into a normal tissue which will be easier to implant hair into it in the future (FUE into scar). However I wont risk it as I have seen what it can do to the patient if anything goes wrong "Massive stretch back "???

[Chris12]

Dr. Feriduni who will perform my scar revision this summer offered me Acell but I refused it although it was free of charge. I insisted on having a traditional scar revision without any Acell sheets. I know that Spencer Kobren (The bald truth show) promoted it last show by saying it can make the dead scar tissue area into a normal tissue which will be easier to implant hair into it in the future (FUE into scar). However I wont risk it as I have seen what it can do to the patient if anything goes wrong "Massive stretch back "???

 

Hey Hariri what made you choose to go to feriduni and not bisanga? thanks

[HARIRI]

Well many factors, I will state them in points...

 

1) I'm looking for scar revision first to reduce the gap of the scar then FUE into scar after a year. Dr. Bisanga refused to do the scar revision and insisted on FUE into scar which will requires me 800 grafts using beard hair. I found it a loss of money and donor. However Dr. Feriduni accepted my idea and encouraged it.

 

2) Feriduni is recommended by HTN so I feel more safe to go along with him as if something went wrong, the community will support my case. However lately Dr. Bisanga is recommended at the IAHRS which is a good thing.

 

3) I was impressed with Dr. Feriduni representatives and their full attentions with me as a customer plus I managed to speak to Dr. Feriduni for 30minutes via skype in order to answer all of my doubts and questions. I couldnt get that with Dr. Bisanga.

 

Dr. Bisanga is a great FUE surgeon and no doubt about it. Also he is one of the best surgeons in using beard hair which is great for covering scars. I might think of him in the future AFTER i revise my scar first and remove the low hairline grafts below Dr. Rahal new hairline by FUE them out with Dr. Feriduni.

 

I really do not want to hijack the thread but I hope this explains all :-)

[Chris12]

Well many factors, I will state them in points...

 

1) I'm looking for scar revision first to reduce the gap of the scar then FUE into scar after a year. Dr. Bisanga refused to do the scar revision and insisted on FUE into scar which will requires me 800 grafts using beard hair. I found it a loss of money and donor. However Dr. Feriduni accepted my idea and encouraged it.

 

2) Feriduni is recommended by HTN so I feel more safe to go along with him as if something went wrong, the community will support my case. However lately Dr. Bisanga is recommended at the IAHRS which is a good thing.

 

3) I was impressed with Dr. Feriduni representatives and their full attentions with me as a customer plus I managed to speak to Dr. Feriduni for 30minutes via skype in order to answer all of my doubts and questions. I couldnt get that with Dr. Bisanga.

 

Dr. Bisanga is a great FUE surgeon and no doubt about it. Also he is one of the best surgeons in using beard hair which is great for covering scars. I might think of him in the future AFTER i revise my scar first and remove the low hairline grafts below Dr. Rahal new hairline by FUE them out with Dr. Feriduni.

 

I really do not want to hijack the thread but I hope this explains all :-)

 

Thanks for ur explanation

[d2001chen]

I read all the posts in this thread. I am wondering how the scar from the FUT can be attributed to use of ACell and not just poor surgery. I just didn't see any reasoning convincing that use of ACell caused the poor scarring.

[Dr. Paul Shapiro]

We do use ACell at SMG and have not found any detrimental effects. Just because a surgery had a poor outcome and ACell was used does not mean that ACell is the cause of the poor outcome. There are many other factors that could cause a wide donor scar and poor outcomes.

ACell is a wound healing product made of Extracellular Matrix, which is the structural tissue between cells. In this matrix are structural proteins, growth factors, and anti-infective peptides. The structural proteins work like a scaffolding for the body’s cells. There are many studies which show Acell promotes wound healing. It has been shown to be effective in surgeries involving the heart, esophagus, hernia, surface injuries, bladder, orthopedics, and ear drum. It has helped humans heal fissures in skin, ligament, and muscle tissues. It can inhibit fibrotic scarring and promote the production of new blood vessels. It also has been shown to recruit cells which promote tissue regeneration.

In hair transplant surgery ACell has been used in a few different ways. ACell comes in a powder form and a flat sheet. We use the powder to coat the graphs before we place them into the skin. We do this in all our FUE cases and sometimes in our Strip cases. We do think we have had superior growth in our FUE cases with the use of ACell. Some physicians are putting ACell in the FUE extraction sites to promote healing. We have not done that.

The ACell sheet is used in wound healing. I have tried using ACel strip in scar revisions but have not seen a significant difference. I do not think ACell is effective in scar tissue. But the results were never worse than expected. Since the last International Society of Hair Restoration Surgery meeting I have been using thin strips of the ACell sheet in all cases in which I think they will be a second case. Dr. Jerry Cooley presented his experience with ACell and donor scars. In his experience the width of the donor scar is not affected by ACell. That is determined by many factors such as donor tension, circulation, skin tissue characteristics, and proper adherence to post op instructions. What he did notice is that the quality of the tissue under the scar is less fibrotic and softer. I find this to be significant, because the underlying fibrosis of the tissue after an initial surgery will limit the laxity for the next surgery. So if we can reduce this fibrosis when a patient needs a second surgery there will be less tension. This will enable us to remover more donor and get a better yield with a good closure. Below is a photo from Dr. Cooley’s lecture. As you can see, when comparing the ACell side to the control side, the donor scar looks very similar on the surface. But there is much less fibrotic tissue underneath the skin on the ACell side. You can see using ACell was not detrimental, but helped the donor healing. So using the ACell sheet will not affect the way the donor scar looks, but will affect the tissue quality.

[HARIRI]

Thanks for the explanation Dr. Shapiro, So if you think Acell Sheet has nothing to do with it. Then what do you think the main reason of what happened to this patient's scar after Acell use? Can you elaborate on that please so we can believe?

[Bill - Seemiller]

Hariri,

 

ACell is a wound healing agent and in itself, I see no way that it could possibly worsen any condition let alone be the cause of scar stretching. Scars stretch for a number of reasons, the most probable causes being too much tension on the wound during closure and patient physiology.

 

ACell also doesn't do anything to reduce the width of the scar. It only makes it feel and appear smoother.

 

For more information on ACell, view the Hair Loss Q&A Blog article "Dr. Jerry Cooley’s Presentation on ACell MatriStem in Hair Restoration and Hair Duplication (Formerly Known As Autocloning)"

 

Note that we will soon be providing an update to Dr. Cooley's research on ACell, so look for it at www.regrowhair.com in the coming days.

 

Best wishes,

 

Bill

[Bill - Seemiller]

Dr. Paul,

 

Thanks also for providing your expert input on the use of ACell in general and at your clinic.

 

Best wishes,

 

Bill

[Dr. Paul Shapiro]

 

Harriri:

Like I stated there are many reasons for a wide scar. The most common reason is too much tension on the closure. There are various methods we use to estimate the laxity of a patients donor area. Usually we estimate correctly but sometimes our estimates are off. Sometimes the difference of just .1cm in the width of the incision can make the difference between a good closure and a tight closure.

But there are many other reasons for a wide scar. Some patients have thick tissue that does not approximate as easy the doctor thinks it will. I find that patients who have played American football, Hockey, or Soccer can sometimes have thick tight tissue. If a patient has had previous surgery the area will have more tension than expected. I have some patients who had a lot of falls as a child and find some deep scarring from previous injuries. Often I will ask the patient and then he will remember some old fall or injury as a child.

Decrease circulation can contribute to scarring. This can be due to undiagnosed atherosclerosis or diabetes. The blood vessels that supply the donor area are deep below the dermis. Sometimes they are not so deep and some get cut. If blood vessels are cut this can sometimes compromise blood flow to the donor and contribute to a large scar.

 

It is important that patients follow the post op instructions to get the best scar. I suggest no heavy exercise for at least 2 weeks to get the best scar. I know it is difficult for some patients to adhere to these post-operative instructions. Too much exercise or lifting prior to healing can cause the scar to stretch.

There are some patients who have “loose” collagen tissue and just tend to scar easy. In these patients a doctor can do everything correctly and there still will be a wide scar. Scar revisions usually don’t work in these patietns. They just stretch again. Some of these patients will have known collagen tissue disease but most do not have any specific syndrome.

There is one way I believe Acell could contribute to a large scar. The ACell strip needs to be placed deep in the closure below where the dermal tissue is approximated. If the strip ends up between the dermal tissue it can cause a wider scar, so the placement of the ACell strip is important.

So as you can see there are many factors that can affect donor scarring. I am not sure why this particular case had a wider then expected scar.

I hope this is helpful

Dr. Paul

 

[HARIRI]

"There is one way I believe Acell could contribute to a large scar. The ACell strip needs to be placed deep in the closure below where the dermal tissue is approximated. If the strip ends up between the dermal tissue it can cause a wider scar, so the placement of the ACell strip is important"

 

BINGO, I got it. Now I started to understand that its not about the ACell Sheet, its about how its placed. Thank you very much Dr. Shapiro...

[UnfinishedSymphony]

Forgive me for not uploading pictures this time (maybe I will later, if it looks like anyone reads this), but I went back to Dr. Wong for scar revision a while ago and its much better now.

 

I want to add, because this is what Dr. Wong told me and I see there has been discussion about this after my original post, that if ACell was allowed in Canada he would use it. He said the wide scar was due to poor skills by the surgeons, not the ACell. Dr. Wong's scar revision was operation number 4 for me. Two good HTs by Dr. Wong, one MISTAKE operation by Hitzig's team, and then a revision by Dr. Wong. Over the span of about 10 years.

 

What I failed to mention in the original post is that Dr. Hitzig immediately suggested I up my dose of Proscar (actually, generic finasteride at that time, more about that further down...) to 1/2 a tablet daily at the consultation. That was part of his trick...

 

These men (Hitzig and Prasad) are swindlers. They are shameless (possibly sociopaths) NYC con-artist garbage scum bags and they deserve to be scalped. :mad:

 

I happened to have a big chunk of money land in my lap before I came across the Hitzig videos on YouTube. When I went in for the consultation with Htizig, instead of asking how much the procedure costs, I stupidly said "Is it less than 20 thousand?" He held back some of his excitement, and had his assistant lady tell me "So, the procedure is 19,000 but Dr. Hitzig would like to offer it for 15,000."

 

I had more than enough, but still, that's awful. I paid 15K for someone to take what was a perfectly fine job by Dr. Wong and totally mutilate my donor area. I had (and sometimes still have) nightmares where I'm looking at the back of my head in a mirror and it looks like raw bacon back there.

 

You know what my scar used to look like? It used to look like nothing! It was like having no scar. Dr. Wong is excellent. I'm telling you, it was like having no scar, you had to really try hard to find it. His revision fixed what Dr. Hitzig did, but its still not what it used to be

 

Now, I'm coming to find out that there may be a problem with generic finasteride. Some time before the Hitzig thing, my pharmacy asked if I'd like to switch to cheaper generic so I said sure. That's what I was using when upping to 1/2 tablet a day. Then after scar revision I went back to a quarter every other day and its looking thinner. I have been advised by Dr. Wong to switch back to Proscar and go back to 1/2 a tablet daily.

 

I want to mention that because this might be useful info. They're (Dr. Wong's office) is telling me that they have had patients switch to generic finasteride and experience loss, then switch back to Proscar and, in many cases, they say, have seen gains. So, I'll have to wait and see!

 

Also, does anyone else here struggle with doubting their own perception? Its crazy. I cut my own hair. Finding out that you're loosing more hair because your DHT drugs aren't strong enough kinda sneaks up on you when you you've already had HTs. Plus, the length and style and product and how the light hits it gives me such different results. Sometimes I think I need another transplant, then I cut it, and its fine! Its really hard to consistently get it just right with all this growing, cutting, over very slow gradual time.

 

- Unfinished Symphony