Dr. Lindsey Examples of trichophytic closure results at various time intervals, McL

[Dr. William Lindsey]

I’ve recently had an onslaught of scar repair cases and lots of discussion about trichophytic closure. While I’ve posted a number of threads on my closures and I’m pretty open about our results, this thread should serve as a complement to those posts by me and my recent youtube video on the topic. You can find it elsewhere on this forum and on youtube at:

For the past 6 or 7 years, I’ve done about 120 strip cases. With rare exception, most folks have, or can get, reasonable scalp laxity with exercises starting a month preop. And while I don’t get to see everyone’s scars postop, as a lot of people live out of the area or even the country, each year I do see among my patients: 8 or so perfect scars, that I’d grade an “A”, 4 or so poor scars, done by me as best as I can, that I’d give a grade of a “C”, and gobs of scars that I think are in the “B” range. While I may be biased, Wendy and I almost never see a “D” result in our patients without some other factor playing a role….undisclosed scar history, Neosporin use, hygiene issues due to travel…for example.

 

So here are 4 cases done by me. I would say 2 are “A”, 1 is a “B” and one is a “C”.

 

Case 1 is a 47 year old indian, first timer, who had a 3000 graft case. Shown are his sutures, 1 week of very little cleaning, and 1 month scar check. Note he has hair growing all throughout his scar line. This one is FANTASTIC. “A”.

Case 2 is a 50 year old mixed race, predominantly black guy who had a previous case by me 3 or 4 years ago and now is getting his crown done. He also did no cleaning, looked pretty good at 1 month, and shown is his shaved donor region with the old scar visible at 3.5 years. My scar is the top edge of his new strip. NOTE, HE HAS AN OBLIQUE SCAR ON THE LEFT FROM A CYST REMOVAL ELSEWHERE…NOT BY ME. But his old strip scar looks decent and would certainly never be seen with ? inch long hair over it. Would some semblance of cleaning postop or some scar care have made a difference??? Who knows, but this time I’m pushing him to do a better job and we’ll see. GOOD. “B”.

Case 3 is a 50 year old white guy who had 2700 by me and shown are his sutures, 1 week, and 2 sets of 12 month pictures. One is a close up of the other. His old scar is right in the middle of his new donor strip. I almost always put it at the edge but that scar is so good I didn’t want it at the edge and forcing me to get fewer hairs on his second case. FANTASTIC SCAR. “A”.

Case 4 is a 40 year old indian medical professional who did no cleaning or scar care. Although his hair grew very fast…and he was all grown in by 7 months or so, his scar was mildly hypertrophic and he said he didn’t care to do anything to minimize it. Even so, its not a bad scar but not one I’d put up on the poster out on main street….”C”.

 

So I hope this helps folks understand the range of outcomes possible by good trichophytic closure. I do believe proper surgical technique is a good portion of the result but postop care and genes play a role as well. I’m always a little reluctant to put up anything but “A” results, but even our “C” results are better than many people would expect…certainly hidden with only a ? inch hair cut in almost all patients.

 

Dr. Lindsey McLean VA

[TakingThePlunge]

Dr. Lindsey,

 

Thank you for sharing this informative post!

[Dr. William Lindsey]

Here's a link the that video posted on this site.

 

http://www.hairrestorationnetwork.com/eve/174390-dr-lindsey-trichophytic-scar-video.html

[KD2020]

While I may be biased, Wendy and I almost never see a “D” result in our patients without some other factor playing a role….undisclosed scar history, Neosporin use, hygiene issues due to travel…for example.

 

Dr. Lindsay,

 

Trying to understand your comment here. Are you saying that Neosporin use on the scar area while it is healing adversely impacts the results (scar)?

[TakingThePlunge]

KD,

 

Dr. Lindsey has shared before that he feels Neosporin is detrimental to scar healing. You can find one such comment in the discussion below.

 

Best product to put on donor scar to help it heal?

 

Do what YOUR doc says.

 

But, as I have posted before, I hate neosporin. About 80% of all of my unusual looking scars (at 7-10 days) (meaning red, lumpy, oozy) have a common thread(not sure if its the cause or not)---Neosporin. So I tell every one of our patients NOT to use neosporin, and most listen to that instruction.

 

Now my wife, a pediatric cardiologist, slaps neosporin on anything, and has her patients use it. So go figure.

 

But my kids know that if Dad is around, they better only put vaseline on any cut or abrasion or they'll get a lecture.

 

As to after the sutures are out... vitamin E and mederma are enough for all but the most unusual scar forming patients in my opinion.

 

Dr. Lindsey McLean VA

[KD2020]

David,

 

Thank you, i have never seen that post. I wonder if there are similar concerns with Polysporin?

[Dr. William Lindsey]

Here is my honest doctoring opinion on incision care in my patients. This doesn't mean other doctors would agree.

 

"You can't kill anyone with vaseline". Peroxide and vaseline have worked well in my patients for 19 years and in about 3600 facelift incisions, Wendy and I can attribute ALMOST every scar problem to neosporin use in the first week out from surgery.

 

But, listen to what your doctor wants you to do..

 

Dr. Lindsey McLean VA

[KD2020]

Thanks, that's very interesting.

 

My wife just had a brown spot removed from her arm, and they told her to use. Vaseline or Polysporin, but not Neosporin.

 

I also wonder about the science of why - what would cause that issue.