How are Rahal's scars ?

[dakota3]

I'm just wondering ! I know his results are great with the hair, but how do his scars match up ? I ask because I had a procedure done years ago by Bosley and the transplant didnt take. I'm thinking about another one but I keep my hair short . And in case it's just me and hair doesn't take to my head for some reason I still have only the same scar. The existing scar isn't pretty by any means but I've seen worse. I am thinking about using the existing scar to get as many grafts as possible without taking any unnecessary Chances on having a wider scar. Fyi The scar doesn't go from ear to ear . So does anyone have any comments on Rahal's scars ? Thanks

[Mickey85]

From what I have seen his scars can vary. I have seen a few fine scars from him but have seen stretched scars also. Hasson and Wong I believe have the best donor closure technique, I really think they take more time, effort and have more knowledge on strip closure than any other surgeon out there.

[HARIRI]

From what I have seen his scars can vary. I have seen a few fine scars from him but have seen stretched scars also. Hasson and Wong I believe have the best donor closure technique, I really think they take more time, effort and have more knowledge on strip closure than any other surgeon out there.

 

H&W scars are better because of the usage of staples. Sutures leaves bad marks like train rails. If anyone considers a strip, please do insist on your surgeon to use staples on you.

[Mickey85]

I believe Hasson and Wong's whole donor closure technique is better than even other surgeon's who use staples. Joe has said that they take an hour and a half from start to finish, paying attention to the tension in every part of the patients scalp and accommodating the width of the strip accordingly. Who knows what other tricks they use that they keep to themselves.

[RecedingTide]

Dr. Hasson is the best in the world when it comes to strip excision and donor closure. He pretty much wrote the book on maximising strip extraction while providing a great cosmetic scar. As a result he can also extract more donor over multiple procedures. Look at London Lad post op after 11200 grafts.

 

As for Rahal he is quite good but it's in dense packing and yield where he excels. I've seen fine scars and stretched scars from him; no different than most other surgeons. Remember though that physiology is important when it comes to wound healing and also your laxity for minimal tension on closure.

 

Feriduni has very refined tricho closures and is up there on all fronts. He can do it all. Both himself and Hasson are big proponents of staples these days.

[RecedingTide]

I believe Hasson and Wong's whole donor closure technique is better than even other surgeon's who use staples. Joe has said that they take an hour and a half from start to finish, paying attention to the tension in every part of the patients scalp and accommodating the width of the strip accordingly. Who knows what other tricks they use that they keep to themselves.

 

They do extensive undermining as well. This is a big part of the 'secret'.

[Shampoo]

I recently had a haircut and asked my stylist who knows I had a transplant a little over a year ago if he sees any scar on the back of my head from my surgery?

 

He emphatically said "NOPE....none".

 

I guess if he really looked he could find it, but nice to know the scar is a zero issue in my case.

[hairthere]

I've had sutures from a terrible, inexperienced HT doc, and staples from a top, highly experienced HT doc. Both scars widened about the same. Now, it's possible the latter scar widened because of the first scar which was taken too low, and also because I had it stripped three times already. I can't really be sure. But I think the fate of a scar has more to do with physiology than anything else. That being said, going with a top doctor will surely increase odds of a good outcome.

[Cant decide]

My scar from Rahal was 1mm in most places after my 5000+ procedure. So far the scar from procedure #2 seems to be healing pretty well.

 

In general, I think Rahal has very good scars.

[Mickey85]

They do extensive undermining as well. This is a big part of the 'secret'.

 

What exactly is undermining??

[HARIRI]

What exactly is undermining??

 

Undermining is like the wound is spread out underneath the skin that surrounds the visible part of the sore. So... the wound is bigger than what appears at first glance. You use a cotton tipped applicator to feel under the wound edges to see if the tip will go "underneath" the skin. If it does, the wound has undermined. Sometimes when packing a wound with wet to dry dressings, if the wet dressing touches the healthy tissue surrounding the wound, it affects the integrity of the healthy skin and can cause undermining.

[Mickey85]

Ahhh i see. From the pictures it also seems Rahal takes the strip below the bump in the back of the head. This raises the chances of a stretched scar because it is too close the the neck muscles.

 

Shapiro seem to produces excellent scars for the most part.

[RecedingTide]

We're probably not supposed to post links so google Dr. Bernstein FUT undermining or something along those lines and he explains it well.

 

In a nutshell, it is possible to kind of shear the skin and most superficial layers away from the deeper layers so that they are almost separate in the region of the excision (well kind of, hard to explain without a diagram). While only putting in one layer of staples it is still possible with this method to close the donor in such a way that the deeper layers carry more of the tensile forces than the superficial layers because in the region of the closure they are not really a continuous layer.

 

So in effect you have the deep layers carrying the tension while the superficial layers and skin close pretty much with no tension ensuring a fine scar. You need to really know what you're doing with undermining but that's part of the reason Dr. Hasson maximises a patient's donor better than everyone else. He's really good at tapering the width of the strip to ensure uniform tension on closure and he knows how to undermine when required to keep the tensile forces deep in the scalp to ensure the the wound edges and skin heal properly and deliver a cosmetically acceptable scar.

[Jotronic]

I do not wish to hijack this thread about Dr. Rahal but I feel compelled to address the issues brought up about H&W so there is no confusion.

 

Undermining is only part of the equation and is not such a major requirement as you may think. We have several little "tricks" that we perform but basically it comes down to taking the strip from the correct region, constantly gauging the tension and taking the time to line the edges of the wound properly with the least amount of tension. Removing the strip in sections is important as is varying the width of the excision based on the tension in the immediate area. The time it takes for us to remove a virgin donor strip is between one hour and one and a half hours (depending on how much we are taking).

 

Repair cases can and do take longer depending on the amount of pre-existing scarring we run into. Doing strip properly takes a lot of time, a lot of knowledge and experience, and a lot of care in order to do it right.

[StaggerLee123]

I have to say that Dr. Hasson is the only strip doc that I have heard really emphasize the technique of varying the width of the strip and endlessly checking for tension during strip excision. Varying strip width, especially over the occipital/mastoid processes where there is more tension than the back and sides, seems to be a key factor in reducing tension on the wound. Also the amount of time that he (and Doc Wong) takes during the strip excision is very telling.

[Mickey85]

I do not wish to hijack this thread about Dr. Rahal but I feel compelled to address the issues brought up about H&W so there is no confusion.

 

Undermining is only part of the equation and is not such a major requirement as you may think. We have several little "tricks" that we perform but basically it comes down to taking the strip from the correct region, constantly gauging the tension and taking the time to line the edges of the wound properly with the least amount of tension. Removing the strip in sections is important as is varying the width of the excision based on the tension in the immediate area. The time it takes for us to remove a virgin donor strip is between one hour and one and a half hours (depending on how much we are taking).

 

Repair cases can and do take longer depending on the amount of pre-existing scarring we run into. Doing strip properly takes a lot of time, a lot of knowledge and experience, and a lot of care in order to do it right.

 

Thanks Joe.

[Peacebuddy]

I had a 2.5 hour revision with Dr Hasson on Monday.

Joe if my case can help some guys please feel free to contact me so we can get some pictures on here.

Dealing w a bad scar is hard on the psyche. I feel even worse when guys go thru a revision to only end up where they started or even worse w stretch back.

Choosing a dr that will give you 100% is really important in a revision.

[Mickey85]

I had a 2.5 hour revision with Dr Hasson on Monday.

Joe if my case can help some guys please feel free to contact me so we can get some pictures on here.

Dealing w a bad scar is hard on the psyche. I feel even worse when guys go thru a revision to only end up where they started or even worse w stretch back.

Choosing a dr that will give you 100% is really important in a revision.

 

Who did your first surgery? Was it just to revise the bad scar or were there grafts extracted also?

[Peacebuddy]

Hi Mickey85,

 

My first surgery was by a Dr in Florida. (Is it ok to mention the name here?)

Dr hasson was able to remove the bad scar and get grafts to thicken my hairline.

[Mickey85]

Hi Mickey85,

 

My first surgery was by a Dr in Florida. (Is it ok to mention the name here?)

Dr hasson was able to remove the bad scar and get grafts to thicken my hairline.

 

I don't see anything wrong with mentioning a surgeons name who did the work. Photos would be awesome too. I hope you get a very thin scar.

[hsrp10]

Sometimes these are too low even for the best of surgeons unfortunately. Damn b@stards at B...

 

Seems like to get rid of a Bosley scar you have to have a separate procedure and have a lot of downtime and or wear a neck brace for several months unfortunately.

[dakota3]

Thanks Spex! I definitely value your opinion! My scar is about 2 inches above the hump on the back of my skull . Not sure what the proper terminology for it is but I think you probably get my point :-) is that normal or too low ?