Dr Mwamba +My WHTC -3141 grafts FIT shaven 6 months post op

[Dr. Patrick Mwamba]

This young patient had a previous surgery in another clinic (3000 grafts by the FUE technique).He walked in our consultation room with pluggy look hairs, low density coverage and unnatural hair angulation in frontal zone. We could also observe some thinning on top and vertex which announces future loss in those areas.

The donor area looked someway thin with some patchy spots of lower density.

His goal was to build his frontal zone.

Our first concern was his donor area .A bad donor area would disqualify him for the surgery .Fortunately he had a density of 100 Fu/cm2 with medium fine, dark brown, slight wavy hairs.

In the Norwood scale, he was at level 3Vertex moving toward a NW5 .He was on finasteride (for the last 9 months) and minoxidil (for the last 6 months).

 

Our plan was to recreate a new hair line in front of the old one without going to low .We were pleased his existing hair line was at 8.5 cm from the eyebrow which gave us enough room to build a decent, conservative hair line at 7.5 cm.

We grafted the hair line at 40 to 50 Fu/cm2 ( because a high density in the micro scarring area could yield a poor growth ).In the frontal area and central top , we kept a density of 30 Fu/cm2 and in the temples 35 Fu/cm2 .The entire procedure was carried out in 3 consecutive days as outlined below :the pattern we followed ( from back to front and from the center to the sides ) take into account the nerves anatomy to lower any discomfort in the following days .

The patient sent us his 3 months and 6 months results as illustrated below.

 

Edited January 31, 2013 by DrPatrickMwamba
work on pics

[Dr. Patrick Mwamba]

The patient sent us his 3 months and 6 months results as illustrated below.

 

 

We even up the donor look

 

His hair line looks natural with a decent coverage for 6 months.

 

 

We will now present a summary of before and after with dry and wet pictures.

Dry pictures

 

 

 

Wet pictures

 

 

 

[Blake Bloxham]

A definite improvement! Thanks for sharing.

[Mickey85]

Very very nice. Great to see Doctors pushing the boundaries on what can be done with FUE and not sticking to just small sessions.

[hairshopeing]

Can't understand why so few comments?? I think after 6 months this is very,very good!!!

[Spanker]

I think this is an excellent result. It is a shame he wasted so many grafts going to a clinic that puts out sub-par results. I wonder how many he has left?

 

I have noticed that this doctor has done some excellent repair work in the past.

[GNX1]

very nice and densely packed

[Dr. Patrick Mwamba]

Thank you for your comments .

His current donor had an average of 94FU/cm2 ( measures took on 14 different zones across his donor .We also calculated the number of follicular unit present : 20391.

 

We harvested some area up to 25 % and some area only 12% as I mentioned to even up the donor look .

 

After this surgery , we should still have 17250 grafts .And in theory , you can take up to 40% without thinning to much his donor ie 6900 grafts .

[Mickey85]

Thank you for your comments .

His current donor had an average of 94FU/cm2 ( measures took on 14 different zones across his donor .We also calculated the number of follicular unit present : 20391.

 

We harvested some area up to 25 % and some area only 12% as I mentioned to even up the donor look .

 

After this surgery , we should still have 17250 grafts .And in theory , you can take up to 40% without thinning to much his donor ie 6900 grafts .

 

Thanks for that, great to know. Great that there are Doctors out there explore FUE to it's fullest extent rather than just opting for the strip method.

[Bill - Seemiller]

Dr. Mwamba,

 

In my opinion, this is a great result for only 6 months. Do you happen to have any dry after photos showing the top of the patient's scalp? I think this would help to evaluate the progress of the result to date.

 

Best wishes,

 

Bill

[Dr. Patrick Mwamba]

Bill ,

The patient didn't send dry top pictures .I will ask him for the 9 months post op to not forget getting that shot .Usually they also come around 12 months for the in person consultation and we can get our usual set of pictures ( dry and wet ) .

 

Thank you

[Spanker]

Thank you for your comments .

His current donor had an average of 94FU/cm2 ( measures took on 14 different zones across his donor .We also calculated the number of follicular unit present : 20391.

 

We harvested some area up to 25 % and some area only 12% as I mentioned to even up the donor look .

 

After this surgery , we should still have 17250 grafts .And in theory , you can take up to 40% without thinning to much his donor ie 6900 grafts .

 

If you counted the grafts he wasted on the first procedure that would equal around 13K grafts. Wow.

[Mickey85]

If you counted the grafts he wasted on the first procedure that would equal around 13K grafts. Wow.

 

Hmmm I'm not so sure the math would equal 13,000. They harvested up to 25% and 12% in some areas. For this patient to have 13,000 extractable grafts going by the 40% rule, he would need over 32,000 donor grafts originally. Would be nice for Dr. Mwamba to elaborate

[Dr. Patrick Mwamba]

Hi Mickey ,

 

We could still extract 6900 grafts as I mentioned above .

The density and the number of follicles we calculated is the current one at that specific time ie after he already harvested the previous 3000 grafts .It could imply that at the beginning he came from 23000 grafts to get to the 20000 we measured .

From those 20000 , we harvested another 3000 .Now he remains with 17000 grafts .

To be safe , you need to harvest up to 40% of the final number ie 40% of 17000 which gives you around 6900 grafts .

Thank you

[Mickey85]

Hi Mickey ,

 

We could still extract 6900 grafts as I mentioned above .

The density and the number of follicles we calculated is the current one at that specific time ie after he already harvested the previous 3000 grafts .It could imply that at the beginning he came from 23000 grafts to get to the 20000 we measured .

From those 20000 , we harvested another 3000 .Now he remains with 17000 grafts .

To be safe , you need to harvest up to 40% of the final number ie 40% of 17000 which gives you around 6900 grafts .

Thank you

 

Thanks Doctor. Also just wanted to ask, do you use a manual FUE punch or motorized? What are your views on both?

[Dr. Patrick Mwamba]

I used mostly manual FUE but I do have motorized FUE as well ( The FUE extractor from LEAD company with a combination of oscillated mouvements and non oscillated mouvements ).

 

Manual punch allows you to get a feeling of the difference in tissue resistance , especially when you have curve grafts or splay grafts .resistance of the hair shaft is different from the surrounding connective tissue and with a manual punch you will feel it and stop your penetration .With the motorized punch you are loosing a lot of that feeling .But with time , I know you can have some kind of feeling too .

 

Second thing is the heating of tissue from the punch .With motorized FUE , when the punch get dull , you don't feel it necessarely , but the machine will still use it forces to cut .With forces , you can heat or get some torsions of the tissue .

 

One thing also we need to face is hands fatigue with the manual technique .

When I use the motorized FUE , I usually start with the manual punch to get all the characteristics of the patient :skin fragility , grafts angle and splay .And if I feel comfortable and I found out it is an easy case , then I switch to the machine to preserve my hands .And most of the time , I asked the patient if he feels comfortable with it .

 

My transection rate is equal with both techniques .In terms of speed , I am faster with the manual technique as I got much practice with it .I tend to be more cautious and not in rush when I use the motor to overcome the weakness of the latter technique .

 

I am not fan of the speed gain with the motor that everybody seems to voice out .What matters is the quality of grafts you are producing and if you can get it faster , then fine .I do not think that multiple days of surgery will impair the graft yield .

[Mickey85]

thank you for the detailed reply doctor.

[colin1971]

Thank you D. Mwamba for sharing ! GREAT JOB .