Stretchback: Is it all about laxity?

[MAGNUMpi]

Does it all come down to donor laxity when attempting to avoid a stretched scar?

I've seen a lot of people with good laxity have great scars, but are there any guys out there who had a tight scalp and still ended up after 2 procedures with a thin scar and no stretching?

Is it all about laxity (and a good doc)?

Can massaging a tight scalp really change the laxity in a real way that would make a tight scalp loose for multiple procedures?

Edited September 20, 2013 by MAGNUMpi

[RopainNogain]

I would agree with your statement. It's all about a good doc and some good luck. Good laxity helps, but then if stretch back is a result, the culprit is your physiology. That's what a doctor wants you to believe. I think it's more about donor harvesting and closure technique (good doc) and healing ability (luck). If sutures are removed at 10 days post op because of inflammation risks and the wound isn't healed enough to be strong enough to hold its own, of course it will stretch.

Good scalp flexability will help alleviate the risk for sure, but having a good doctor present all options for each individual and having a detailed conversation fined tuned towards their individual circumstances would benefit so many patients. I don't think that many docs do this. They get good scars on average so they do the same for every patient because they are comfortable with an average. A good doc wants to have a 0% stretched scar rate. Maybe a hard feat to accomplish, but it's certainly possible to get close. So many doctors suture you up and remove them at 10 days post op to hope for the best. Maybe some patients would benefit from staples and removing some 10 day post op and the remaining at a later date. I asked my doc about using staples and he said it's outdated and blew off my question.

I think message techniques can help because it allows your scalp to not have as much tension upon closure than it normally would have had without the exercises. I guess each case is different. Post op care is also paramount!

The sad part is the best answer to your question is "who knows"

We can alleviate the risks, but the possibility of stretching is always present.

[MAGNUMpi]

I think it's more about donor harvesting and closure technique (good doc) and healing ability (luck).

Ouch! I was hoping it would come down to more than luck.

 

If sutures are removed at 10 days post op because of inflammation risks and the wound isn't healed enough to be strong enough to hold its own, of course it will stretch.

That makes sense.

I guess it depends on a good doctor and an individuals scalp healing capabilities, which is not knowable going into a procedure.

Thanks RopainNogain.

[Spanker]

I really don't think that good laxity makes a good scar as much as the tension of the donor closure, meaning, if you have poor laxity, doctors will take a smaller strip.

 

In fact, I have heard that it is actually usually people with high laxity (like me) who get stretched scars, possibly due to high collagen. For sure, there is obviously a technique for the doctors to get good scars, which starts with not transecting follicles the strip removal. Then each patient will have a certain way that it is best to be stitched up and the doctor will have the feel for that, i.e. the depth and angle of the stitch. A good doc will be able to keep a lot of fluid and swelling out of the sutured area, preventing the "rail road track' look that stitches can sometimes make. Then, you have luck.

 

There is a lot that goes into getting a strip, and a lot of it does depend on the doc, and a lot of it is your physiology. Also, keep in mind that a lot of it is following post op instructions as well.

[MAGNUMpi]

 

I have heard that it is actually usually people with high laxity (like me) who get stretched scars, possibly due to high collagen

Wow. I didn't know that. Thanks.

[Mickey85]

People with high laxity may get stretched scars. People with low laxity may get stretched scars. Person X might get a stretched scar with Doctor Y, whilst person Z might have a pencil thin scar by the same doctor. Person A might get a bad scar from Doctor T but may get a thin scar after revision with Doctor B. A patient may get a thin scar with a doctor and then a bad scar with the same doctor on the second procedure. That is how unpredictable strip surgery is and it one of the many reasons why I think FUE is a superior method of hair extraction.

[Nick153452]

I think we are all underplaying how important it is to be easy on the fact that one has just underwent a surgery that requires putting little tension on the scar as it heals. Person X may have gotten a scar because he did such and such activities that put tension on the scar. Too many unknowns to blame physiology or doctors.

[Mickey85]

Of course, that is another variable into an already unpredictable mix hehe.

[Nick153452]

Yeah I agree. There are a lot of scapegoating techniques used in the HT industry. When in doubt, blame the patient. However, I do believe that scars are in large part due to patient error. Numbness is a completely different story.

[s2thoudriver]

"People with high laxity may get stretched scars. People with low laxity may get stretched scars. Person X might get a stretched scar with Doctor Y, whilst person Z might have a pencil thin scar by the same doctor. Person A might get a bad scar from Doctor T but may get a thin scar after revision with Doctor B. A patient may get a thin scar with a doctor and then a bad scar with the same doctor on the second procedure. That is how unpredictable strip surgery is and it one of the many reasons why I think FUE is a superior method of hair extraction."

 

Agreed here Mickey85, i see no compelling argument whatsoever to undergo FUT anymore. HT techniques have moved on.

 

The old BMW M5 was brilliant compared to alternatives on offer in it's day, but today things have moved on, hence the new, completely revamped version.

 

the old one is still good, but doesn't have the benefits of the new.

[Nick153452]

 

Agreed here Mickey85, i see no compelling argument whatsoever to undergo FUT anymore. HT techniques have moved on.

 

The old BMW M5 was brilliant compared to alternatives on offer in it's day, but today things have moved on, hence the new, completely revamped version.

 

the old one is still good, but doesn't have the benefits of the new.

 

I believe that's a bit of an exaggeration. There are still benefits to having a strip procedure that FUE cannot deliver.

[Spanker]

I believe that's a bit of an exaggeration. There are still benefits to having a strip procedure that FUE cannot deliver.

 

 

I agree with this.

 

Even in terms of just scarring, there are times where I see a donor that looks moth eaten and thin post op and I think to myself that the pt would have been better off (or just as well) going strip. Most of the time, you are really talking about a difference of a 1/4 inch of hair in which a stripped zone can look just as good or better, and most of the time, and shaved FUE zone is not undetectable. In the future, it may come to pass that FUE is always superior, but I don't think that day is here yet. Hell, I hope the day comes where standard FUE is the past and there is a scarless donor doubling procedure. We'll call it SDD, you heard it here first folks.

 

While I am wishing I will wish for a pill more effective than finasteride with no sides as well.

[Mickey85]

I agree with this.

 

Even in terms of just scarring, there are times where I see a donor that looks moth eaten and thin post op and I think to myself that the pt would have been better off (or just as well) going strip.

 

Sorry Spanker but I totally disagree here. In the large majority(I'm talking in the 90% range) of cases I have seen, even a patient with a moth eaten donor will be able to shave down shorter with few signs of surgery than a patient with a good strip scar. Case in point:

 

http://www.hairrestorationnetwork.com/eve/168898-my-regretful-hair-transplant.html

 

6,000 FUE grafts in a fairly concentrated area. "Moth eaten". Still less apparent than a guy with a good strip scar shaved down that close. This guy would get less looks walking down the street than a strip patient shaved down that close. That's not even mentioning a guy with a bad strip scar(which cannot be guaranteed).

 

Let's not forget the other factors involved in strip that are non-existent in FUE like the disruption of hair direction, eradication of hair caliber gradation, misaligned hairs emanating from the praised trico-closure, possible increase in scalp tension and permanent numbness...

 

I believe FUE to be the superior procedure and the smart choice in the majority of cases. It's not perfect and not for 100% of patients, but I believe it is better in general.

[Spanker]

Sorry Spanker but I totally disagree here. In the large majority(I'm talking in the 90% range) of cases I have seen, even a patient with a moth eaten donor will be able to shave down shorter with few signs of surgery than a patient with a good strip scar. Case in point:

 

http://www.hairrestorationnetwork.com/eve/168898-my-regretful-hair-transplant.html

 

6,000 FUE grafts in a fairly concentrated area. "Moth eaten". Still less apparent than a guy with a good strip scar shaved down that close. This guy would get less looks walking down the street than a strip patient shaved down that close. That's not even mentioning a guy with a bad strip scar(which cannot be guaranteed).

 

Let's not forget the other factors involved in strip that are non-existent in FUE like the disruption of hair direction, eradication of hair caliber gradation, misaligned hairs emanating from the praised trico-closure, possible increase in scalp tension and permanent numbness...

 

I believe FUE to be the superior procedure and the smart choice in the majority of cases. It's not perfect and not for 100% of patients, but I believe it is better in general.

 

I agree that it is better than a person with a good strip scar shaved down, and that is why I said there is only a 1/4 inch difference in hair for FUE and a good strip that will make the 2 indistinguishable.

 

This is one of the photos that I looked at recently and it was 2800 grafts done on a little over half of the head and allows you to appreciate the difference. I agree that a strip would look worse at that length but my point is that if you actually to wear hair, the majority of people will not notice the difference. If you want to shave your head, FUE is the way to go, but by no means undetectable on many people, especially with dark hair or olive/tan skin line myself.

 

 

I think that a lot of FUE cases are noticeable when shaved short like this (but not all).

 

I also read that one of the top FUE surgeons in the field warrants an 85% growth for FUE, which was lower than I expected. That really surprised me. This may be an unusual scenario but it points to evidence that depending on a person's physiology, even the best doctor may not be able to give the best yield. This doctor himself, I was told from a person that visited the clinic told patient that FUE for everyone based on their characteristic, and he is like the God of FUE and is on the very short list of surgeons that I would have surgery with.

 

I also think FUE education is important because I am seeing a lot of this:

 

 

 

 

 

And other cases that are not so obvious, but it really looks like the boundries are being push in the donor area and hair is being harvested outside of safe zone, which may not be a problem now, but 10 years from now I fear that we will see a lot of "Help...my transplant is falling out" posts.

 

 

I think that there are lots of patients that should go FUE, and lots that should got FUT, it really depends on what the pts ultimate goals are and what their physiology is like. If a person can not deal with a strip scar, then they should not have surgery or have FUE, but that does not mean that the recipient will received as many quality grafts or that the donor zone will be able to be shaved down undetected. It is a give and take for both cases, and I will admit, in the last few years, patients have been able to give less, but to say that FUE is for everyone, and FUT is no longer needed is just not true. Not yet at least.

[s2thoudriver]

I'm simply not going to get into another FUE vs FUT discussion as it's been done to death and quite frankly, after seeing and reading so much about FUT over the last few years, i actually get a little irritated, as i personally (and it is my personal opinion only) think it is borderline unethical for surgeons to even offer FUT anymore. (waits to get shot down by FUT followers).

 

From my perspective (again, on;y what i percieve), the only people whe benefit from FUT are the surgeons... less involvement (disection performed by techs), less time in theatre (cut the strip and hand it over) and keeps them in their comfort zone with older techniques rather than having to invist their time becoming skilled in newer advanced practices.

 

Put it this way...... I have never heard of a successful FUE surgeon say "do you know what, this FUE is good, but i'm going to start offering FUT and stop doing FUE as the results are far superior"

 

It simply hasn't... and i predict won't happen.

 

Surgeons i spoke to when researching and preparing for my HT stopped doing FUT years ago as... in their words... it's outdated and superceeded by refined FUE.

 

Any surgeon who 'mothballs' a patients donor area shouldn't be doing any form of surgery! Careful harvesting and surgery prep is the key to successful results.

 

Rob

[Spanker]

I'm simply not going to get into another FUE vs FUT discussion as it's been done to death and quite frankly, after seeing and reading so much about FUT over the last few years, i actually get a little irritated, as i personally (and it is my personal opinion only) think it is borderline unethical for surgeons to even offer FUT anymore. (waits to get shot down by FUT followers).

 

.

 

Put it this way...... I have never heard of a successful FUE surgeon say "do you know what, this FUE is good, but i'm going to start offering FUT and stop doing FUE as the results are far superior"

 

It simply hasn't... and i predict won't happen.

 

 

 

Rob

 

I have never heard of a successful FUT surgeon only warranting 85% yield.

 

Like I said, I feel, and so do most doctors that offer both that I have researched or spoken with, feel that there is a give and take for each procedure. I feel like you are calling about 3/4 of the doctors on this board unethical for performing FUT, which I do not think is fair.

 

I don't set around and wait to debate FUT/FUE but when the jabs come in unsolicited, I do speak up.

 

This thread was not about FUE at all, so if there is a debate involved about FUE here, it is because someone brought it in here that was not interested in answering the OP's question.

 

I can honestly say that if my own son came to me and asked me for advice on the subject, I would take into account everything about his hair loss, physiology, etc before advising him and would not point straight to FUE as being superior. As long as I can honestly say that, I do not feel that strip is an unethical or unneeded procedure.

[s2thoudriver]

A FUT surgeon shouldn't warrant any yield as it's highly unlikey they will be the ones handling the grafts, they will just be cutting the strip.

 

A lot of surgeons still offer FUT as well as it caters for those on a lower budget and also has a higher profit per workload ratio than FUE for the surgeon.

 

As i said Spanker, each to their pwn and if people want to go down the old FUT route then so be it, i just think it's had it's day. As i stated in my previous post...

many surgeons move away from FUT and now do FUE, but i have not heard of any who have been doing FUE for a few years then 'progressed' to FUT as they feel it's superior, not one (though i'd be delighted to hear of surgeons who have??...)

 

If anybody contacts me to ask about having a HT, i would, under no circumstances, recommend FUT. I would however advise them to choose an experienced FUE surgeon as there are poor practices out there in any field of surgery, which spoil it for the good ones.

 

My comments havent come in unsolicited, the op is asking about FUT scars, my point is... you can avoid that chance by not having FUT to start with

[Mickey85]

My arguement was specifically when you said "Even in terms of just scarring, there are times where I see a donor that looks moth eaten and thin post op and I think to myself that the pt would have been better off (or just as well) going strip.". I never said FUE was undetectable(if you were just making a statement I understand and agree) and FUE cases when shaved down to a zero are noticeable even with say 2,000 grafts. My point was that it still is generally more cosmetically inconspicuous than strip when shaved down short.

 

Surgeons extracting outside the safe zone.. You know how I feel about this. I was vocally against Diep's induction(still am) due to him taking grafts out of the crown of a Norwood 5. But even H&W took a strip from outside the safe zone in Bill's case. Doesn't negate that some FUE doctors are doing this though. Maybe after being informed by the surgeon of the potential risks, the patient gives the approval but I don't condone that because the patient most likely wants as many grafts as possible and has the wrong perspective.

 

In terms of the 85% "warranty" I don't find that low at all. I find that realistic and honest. True and Dorin state "in the rare instance growth rate is less than the anticipated 98-99%". This is an absolute untruthful figure. I don't believe for a second their yield is in the high-90s range. I don't believe the Doctor in Atlanta's claim of 3% transection. I don't believe Bhatti's 97% yield figure. Any surgeon claiming mid-high 90% yield is using exaggerating. Yes even Konior, Lorenzo, Rahal, H&W and Erdogan. Throw in Bisanga too. I still see strip results(and FUE) on Norwood 2s and 3s where it still looks thin in the recipient from a range of surgeons even when using a substantial amount of grafts. I don't believe mid-high-90% yield is the industry standard for a second. Does strip yield more than FUE? Most likely yes, but not by a substantial amount, not when comparing elite surgeons. Maybe a 5% discrepancy.

 

Also, during a strip procedure the follicles that are dormant do not get used because they cannot be seen even under magnification. Given that between 10-20%(let's say 15% as an average) of ALL scalp hairs are dormant at any one given time, this means 15% of ALL single hair follicles in the strip will be discarded, not used at all. That is a running loss and it applies to double, triple and quadruple hair grafts although the percentage is lower the bigger the graft. The more grafts you need, the more dormant grafts are discarded, not used, wasted. That is an inherent flaw in strip surgery that cannot be countered.

[Spanker]

My arguement was specifically when you said "Even in terms of just scarring, there are times where I see a donor that looks moth eaten and thin post op and I think to myself that the pt would have been better off (or just as well) going strip."

 

I did say that, after FUE was brought up in a strip thread. And what I said was true in my opinion, there are times when a patient looks so moth eaten that I think that they would have been better of with strip.

 

I really try not to make any argument about being able to get more quality grafts with FUT or FUE because you really need to use both to truly maximize your donor potential. Yes, you may lose 10 percent (this is the number that I have always heard, not 15 or 20) that are dormant, but the strip is taking most of yous quality grafts, and 100 percent of the available quality grafts in that given area, where as FUE can only take a percentage of the quality grafts in the occipital area, but like I said, people that use all of their donor potential use both.

[scar5]

Ive had strip from three docs.. My best and worst scars came from the same doc. The worst was excised (revised) ne it improved in width but lengthened in, ah...length.

 

Then I had another scar re-opened, by one of the best in the business, and it healed OK, but still, now , it is my worst scar. The scar below it, carried out by the same doc as the original disaster, is as perfect as a strip scar could ever be. After heavy subsequent FUE harvesting, 6 weeks growth will hide it. The bad ones need three months, by which time the crown gas opened up, and I look ten years older unless I eat carrots and bleach my hair.

[1978matt]

Not sure what this fixation is with being able to shave down to a grade 0. I got a tranplant to get hair and to have a hairstyle. If I wanted to shave my head I would have done so years ago and saved my money.

 

My goal is to get the best quality and safest donor hair and replant it at the front of my head. The fact of the matter is that big FUE harvesting is from all over the back of the head in areas that are generally less safe than the FUT safe zone. (If I recall correctly, the safe zone was determined by the early HT doctors examining the backs of pensioners heads)

 

I suspect that in 10-15 years time all those 25 year old NW3-4s who had 4000+FUE, and are destined to be NW6/7s, will wonder why all their transplanted hair is starting to disappear, especially if they are not on meds.

 

The whole disruption of hair direction thing happens in multi-stip cases and is very rare. Just as rare as a stretched strip scar from a good surgeon.

 

...and I can't say I've ever looked at any FUT case and thought "wow look at those misaligned hairs in his Trico closure!" A total non-issue in my opinion.

[Mickey85]

 

The whole disruption of hair direction thing happens in multi-stip cases and is very rare. Just as rare as a stretched strip scar from a good surgeon.

 

 

False. A Bisanga strip result after one(1) procedure:

 

 

Change is hair direction. The surgeon is cutting out a 1cm+ section of flesh and closing two foreign ends together. It IS going to change the natural geometry of the hair.

[1978matt]

False. A Bisanga strip result after one(1) procedure:

 

 

Change is hair direction.

 

1 example...and it's what the hair looks like when it is grown out is what matters

[Mickey85]

1 example...and it's what the hair looks like when it is grown out is what matters

 

Still debunked your theory in less than 2 minutes. Oh and it only matters when the hair looks like when it is grown out... Right..

[scar5]

 

....there is only a 1/4 inch difference in hair for FUE

 

....10 years from now .....Help...my transplant is falling out" posts.

t.

 

What a load of nonsense!!!

 

Have you taken over from Jotronic as the next FUE fear merchant?

 

1/4 inch difference?! Help, my hair is falling out??

 

Difference is like this.

 

Case A.. My hair is still falling out, I'm gonna buzz and be done with it? At least I tried.

Case B..my hair is falling out, but I've got an ear-to-ear scar, so I'm basically screwed.

 

1/4 inch difference? My ass!!!