Dr. Lindsey Stage 2 of a 3 step procedure to repair a failed flap surgery

[Dr. William Lindsey]

This fellow is now a year out from 2600 grafts, of his relatively fine donor hair, and returns for step 2—to remove his failed flap procedure from the 1980’s. You may recall that because he had a large flap, which ultimately failed years ago, that his donor region is not terribly dense, and he has moderate quality hair. Step one was to do a hair transplant behind his flap. He’s done quite well this year. These pictures were taken the day before starting step 2. I posted that story separately on the forum.

Step 2 will be to excise the flap and scar, and to place whatever hair we can get, at the back of his first transplant. Step 3, next year will be a second strip case to augment the frontal hairline, touch up any scar issues, and increase density.

The first few pictures are from last year. Preop, intraop, and 1 month scar and recipient site views.

For this procedure, I had the patient do scalp stretching exercises (on his forehead) for 1 month prior to the case. Then, in an upright position, I outlined the flap containing hair, and the hairless scar-flap centrally, for excision. Nerve blocks and only a medium amount of numbing medicine were required and he was awake and talkative throughout the case. Shown are the failed flap being elevated and ultimately being removed. Undermining of the forehead down to just above the eyebrows allowed the forehead to be advanced upward, but by not freeing up the eyebrow musculature—he should be able to avoid that “surprised” appearance sometimes associated with browlifts. On the hair side of the incision, undermining toward the crown allowed the hairline to be advanced a little and a fairly tension free trichophytic style (albeit without hair in this particular incision) was done. He’s staying 5 days and will have suture removal overseas.

 

We got 1050 grafts out of his failed flap and its “stalk” and these were placed behind his first case. The scalp in this area had excellent blood flow and I’m hopeful that this will grow well over the next year. Unfortunately he bumped his head on the taxi van and dislodged about 35 grafts which we replaced… a tough way to conclude an otherwise excellent and satisfying case.

He’s amenable to coming on and posting his story on occasion so I’d like his thoughts on this quite complex and challenging case.

Dr. Lindsey McLean VA

[Blake Bloxham]

Dr. Lindsey,

 

I've been looking forward to "phase 2" of this procedure for quite some time. Great work! Definitely an interesting case. Excited to see "phase 3."

[Dr. William Lindsey]

I am too. Although he has limitations placed by his donor hair quality and quantity I think we've made good headway and should make a lot more change as this case heals and a third and final case is carried out.

 

Dr. Lindsey McLean VA

[Mickey85]

Dr Lindsey, this looks like a very interesting case. Was using FUE to extract the hair out of the flap a possibility or was the hair just too dense that the scarring would have been just as noticeable as excising the whole flap?

[Dr. William Lindsey]

The real problem WAS the flap... First off, the distal end (toward his right) had died, probably due to blood vessel kinking right after surgery. That left him with a thick piece of shiny white scar tissue running across his forehead. Once you get to the part of the flap where the hair actually lived, the color mismatch wasn't too bad, and indeed if you could get all that hair out with FUE, all you'd have seen were two scars (top and bottom edges of the viable flap). But his main goal was to get rid of the flap entirely, and that worked well with the goal of using the really quite decent hair contained in that part of the flap, to augment his first transplant.

 

When you think about it...that hair that came out of his flap was essentially "virgin hair" in that it was from the donor strip prior to any stretching or scarring that I had to deal with when excising a strip last year.

 

Good question.

Thanks

 

Dr. Lindsey Mclean VA

[Mickey85]

Thanks for the detailed answer Doctor.

[Dr. William Lindsey]

Day 14 scar update from Patient. Looks way better than expected at this early stage.

 

Dr. Lindsey McLean VA

[Dr. William Lindsey]

3 week scar check picture sent by patient. The scar is redder and lumpier, as expected, and should start to improve in about 3 more weeks. Incidentally, he still has a blue suture that was difficult for his wife to remove at day 7. Hopefully he'll get that out now that its easy to see. It shouldn't alter the end result.

Dr. Lindsey McLean VA

[greatjob]

Thanks for the updates Dr. Lindsey, very interesting case.

[Mickey85]

Should be a nice faint line by the time it fully heals.

[Dr. William Lindsey]

Yes, I'm possibly more excited about the final result and change for the patient than he is. Still 18 months away though. (Part 3 possibly later this year and then 1 year to grow in)

 

Dr. Lindsey

[Dr. William Lindsey]

4 week pic from patient. Starting to fade as expected.

Dr. Lindsey McLean VA

[Nick153452]

He's in great hands! I can't wait to see the end result!

[Eman]

Great progress. Looks so much better already. Thank you for sharing this journey with the community.

[Dr. William Lindsey]

I just hope he shows up for part 3. On one hand I would understand if the marginal return from another trip and surgery and money is nowhere near the return he's gotten so far, but I think one more case could really add refinement to his result.

 

We'll see what happens.

 

Dr. Lindsey McLean VA

[Eman]

For his sake, I hope that he does as well

[wylie]

I just hope he shows up for part 3. On one hand I would understand if the marginal return from another trip and surgery and money is nowhere near the return he's gotten so far, but I think one more case could really add refinement to his result.

 

We'll see what happens.

 

Dr. Lindsey McLean VA

 

Did this patient ever return for part three?

[Dr. William Lindsey]

Yes. He had part 3 about 2 weeks ago and I was out last week. I hope to post it today or tomorrow.

 

Thanks for the inquiry. I have a very similar guy from another part of Europe who has been communicating with this patient. I'm hopeful we'll help him too.

 

Look on the forum later today for part 3 pictures.

 

Dr. Lindsey McLean VA