Senior Member ALEXD Posted May 29, 2015 Senior Member Share Posted May 29, 2015 Hello Everybody, Below we would like to present a very interesting case. The patient before consulting HDC Hair Clinic had one unsuccessful Strip procedure from a clinic in Greece, with minimum result and a visible scar. We suggested maximum FUE harvesting of his donor area, in stages, in order to avoid overharvesting and a possible depletion of the donor. FUE Overharvesting is something that we have noticed happening more frequently. Some doctors or clinics, offer FUE procedures of 4000 – 5000 grafts in one session. This increases substantially the risk of donor depletion and FUE scarring and many times not allowing any additional FUE procedures. In HDC we believe that a successful Hair Transplant safeguards the donor and gives state of the Art cosmetic result for the recipient area. This is why more patients contact us for advice regarding the correct strategy of how to achieve coverage, with appropriate donor management. So for the case we present below, we have divided the FUE extraction in 3 sessions as follows: 1st HT 20, 21-03-14 for 2940 FUE 2nd HT 13, 14-10-14 for 2446 FUE 3rd HT on 22, 23-04-15 for 2222 FUE I am presenting result photos up to the second HT. I have also included photos of his last 3rd FUE as this was performed in just over a month ago. The result of the 3rd FUE will be presented also in this thread as it comes out in a few months. Please share your thoughts Regards Alex BEFORE 1st FUE IMMEDIATELY AFTER 1ST FUE 7 MONTH PROGRESS OF 1ST FUE DONOR AREA AT 7 MONTH PROGRESS OF 1ST FUE IMMEDIATELY AFTER 2ND FUE RESULT AFTER 2ND FUE IMMEDIATELY AFTER 3RD FUE JUST OVER A MONTH AGO Alex Demetriades International Patient Coordinator HDC Hair Transplant Clinic --------------------------------------------------- Dr. Maras is recommended on the Hair Transplant Network Link to comment Share on other sites More sharing options...
Senior Member hairweare Posted May 29, 2015 Senior Member Share Posted May 29, 2015 I am complete agreement with your approach and am not convinced either that 5000K FUE procedures are advisable. I think the final result in this case will be very good and will help dispel the notion that subsequent FUE procedures are impeded by subcutaneous scarring in regard to both yield and quality of the grafts. Should the pt elect to address the linear scar I believe that 300 beard grafts would hide all traces of any previous HT. Link to comment Share on other sites More sharing options...
Senior Member Wwiizzkkiidd24 Posted May 29, 2015 Senior Member Share Posted May 29, 2015 Nice approach for this gentleman..i like the staggered hair line as well looks natural. The patient must be happy. I agree with the above person that if he chooses to adress the scare he could fill it in with a bht procudure and know one would be none the wiser he even had a ht. Link to comment Share on other sites More sharing options...
Senior Member ALEXD Posted June 3, 2015 Author Senior Member Share Posted June 3, 2015 (edited) Hi Everybody, Thanks for sharing your thoughts I have prepared below comparison photos of the 1st and 2nd FUE with before and after result, for quick reference to the result and I am sharing it with you. Regards Alex Edited June 3, 2015 by ALEXD forgot to place the photos Alex Demetriades International Patient Coordinator HDC Hair Transplant Clinic --------------------------------------------------- Dr. Maras is recommended on the Hair Transplant Network Link to comment Share on other sites More sharing options...
Senior Member HairJo Posted June 3, 2015 Senior Member Share Posted June 3, 2015 Why would he have FUE if he already has a strip scar? Couldn't he have had another strip and have part of the scar removed? And why did his hair grow so poorly from his first procedure and better in his FUE surgery? He certainly looks much much better. I'm happy for him. Great job HDC. Link to comment Share on other sites More sharing options...
Senior Member PupDaddy Posted June 3, 2015 Senior Member Share Posted June 3, 2015 Hi Alex, First, lovely FUE work, as we've come to expect from Dr. Maras. Second, can you please expand on this statement from your original post: "Some doctors or clinics, offer FUE procedures of 4000 – 5000 grafts in one session. This increases substantially the risk of donor depletion and FUE scarring and many times not allowing any additional FUE procedures." What do you see as the main challenges/problems with mega FUE sessions ("session" meaning one hair restoration surgery, whether preformed in a single day or over multiple days)? Why, in your experience and opinion, do sessions of, say, > 3,000 FUE (a) substantially increase the risk of donor depletion, and why do they (b) substantially increase the risk of FUE scarring that could prohibit future additional FUE sessions? As to "a" (increased risk of donor depletion), is it because yield will likely be poorer with such large sessions, resulting in wastage of hundreds if not thousands of donor grafts? If so, why is it that yield likely will be poorer with mega sessions? Other reason(s)? As to "b" (increased risk of donor scarring that could interfere with or prohibit addition FUE extractions in the future), is that because such large sessions result in subcutaneous scarring to adjacent or nearby un-extracted follicular units? Other reason(s)? Thanks in advance for your response. Link to comment Share on other sites More sharing options...
BUSA Posted June 4, 2015 Share Posted June 4, 2015 gotta love Dr. Maras's hairlines. its amazing how natural they look after they have healed. they seem a little too creative at first but in the end they look totally natural. Link to comment Share on other sites More sharing options...
Senior Member BaldingBogger Posted June 4, 2015 Senior Member Share Posted June 4, 2015 Love Dr Maras's and HDC work. Ethical sensible staggered approach. Great clinic. Look forward to seeing the final result. I also do not agree at all with these 5000 FUE single sessions from Turkey. Far too much trauma for scalp in one hit which can affect yield and donor. That Strip Scar looks awful btw. Really hope the patient FUE's in to it in the future so he can keep a close cut. Link to comment Share on other sites More sharing options...
Senior Member hairweare Posted June 4, 2015 Senior Member Share Posted June 4, 2015 I have been consistently written the same in several previous posts. Rather than categorizing all FUE as one universal method critics would be more credible if they directed their arguments against the yet unresolved differences in FUE technique, i.e., motorized v. manual, robotic, limited sessions v. mega, tech extractors v. physician only, slits v. implanter pen etc. These are the true issues that should be under discussion not whether the 100 best FUT docs produce better results than the 100 best FUE ones. That is a straw man's argument as ultimately how a transplant will look has more to do with the individual patient characteristics either good or bad than the type of surgery. While FUSS may be improved by Dr. Lindseys and Feller's new procedure, FUE is not going to fade away. It too will be further improved and become more refined as time goes by. One has to give credit to docs like Vories who demonstrate flexibility and the integrity to change course when they believe another methodology is superior as well as to offer it at an affordable price point. Link to comment Share on other sites More sharing options...
BUSA Posted June 5, 2015 Share Posted June 5, 2015 One has to give credit to docs like Vories who demonstrate flexibility and the integrity to change course when they believe another methodology is superior as well as to offer it at an affordable price point.I agree 100%. well said hairweare! Link to comment Share on other sites More sharing options...
Senior Member ontop Posted June 5, 2015 Senior Member Share Posted June 5, 2015 That is a good result it must be said from where this Pt came from. Nice work. Shame about that scar though but guess that could be fixed with a few hundred FUEs maybe snag some from the body if he choose. Good work though. Link to comment Share on other sites More sharing options...
Senior Member ALEXD Posted June 10, 2015 Author Senior Member Share Posted June 10, 2015 Hi Alex, First, lovely FUE work, as we've come to expect from Dr. Maras. Second, can you please expand on this statement from your original post: "Some doctors or clinics, offer FUE procedures of 4000 – 5000 grafts in one session. This increases substantially the risk of donor depletion and FUE scarring and many times not allowing any additional FUE procedures." What do you see as the main challenges/problems with mega FUE sessions ("session" meaning one hair restoration surgery, whether preformed in a single day or over multiple days)? Why, in your experience and opinion, do sessions of, say, > 3,000 FUE (a) substantially increase the risk of donor depletion, and why do they (b) substantially increase the risk of FUE scarring that could prohibit future additional FUE sessions? As to "a" (increased risk of donor depletion), is it because yield will likely be poorer with such large sessions, resulting in wastage of hundreds if not thousands of donor grafts? If so, why is it that yield likely will be poorer with mega sessions? Other reason(s)? As to "b" (increased risk of donor scarring that could interfere with or prohibit addition FUE extractions in the future), is that because such large sessions result in subcutaneous scarring to adjacent or nearby un-extracted follicular units? Other reason(s)? Thanks in advance for your response. Dear Pupdaddy there is nice article in our blog addressing most of your questions. The title is: “Avoiding scarring and depletion of the donor in large FUE sessions” And you can find it in this link. http://www.hairtransplants-hdc.com/lang-en/Avoiding-scarring-and-depletion-of-the-donor-in-large-FUE-sessions/pageid-422/ Please read it and then I can answer more specifically in your queries. Regards Alex Alex Demetriades International Patient Coordinator HDC Hair Transplant Clinic --------------------------------------------------- Dr. Maras is recommended on the Hair Transplant Network Link to comment Share on other sites More sharing options...
Senior Member ALEXD Posted June 16, 2015 Author Senior Member Share Posted June 16, 2015 Why would he have FUE if he already has a strip scar? Couldn't he have had another strip and have part of the scar removed? And why did his hair grow so poorly from his first procedure and better in his FUE surgery? He certainly looks much much better. I'm happy for him. Great job HDC. Hello Hairjo, To Begin with, I would like to point out that I believe bad hair transplants are offered by doctors and clinics that consistently cannot produce state of the art hair transplant results. This is the main reason why this patient’s hair grow so poorly from his initial Strip procedure. When you consult a patient with a poor Strip result, you never know what could be below the Strip scar. By harvesting then a second Strip, you run the risk of ending up with the same or even worst scar. Additionally we have seen patients with multiple Strips that their FUE donor was affected as well and especially below the Strip scars, due to excessive tension of the skin when closing the wound (Strip). Below you can see an example of affected FUE donor after multiple Strips. Ultimately this patient has achieved full coverage over three FUE sessions and it only now remains, a small session to disguise his Strip scar either with scalp FUE or BHFUE if he so wishes. Regards Alex Alex Demetriades International Patient Coordinator HDC Hair Transplant Clinic --------------------------------------------------- Dr. Maras is recommended on the Hair Transplant Network Link to comment Share on other sites More sharing options...
Senior Member Wwiizzkkiidd24 Posted June 16, 2015 Senior Member Share Posted June 16, 2015 Hello Hairjo, To Begin with, I would like to point out that I believe bad hair transplants are offered by doctors and clinics that consistently cannot produce state of the art hair transplant results. This is the main reason why this patient’s hair grow so poorly from his initial Strip procedure. When you consult a patient with a poor Strip result, you never know what could be below the Strip scar. By harvesting then a second Strip, you run the risk of ending up with the same or even worst scar. Additionally we have seen patients with multiple Strips that their FUE donor was affected as well and especially below the Strip scars, due to excessive tension of the skin when closing the wound (Strip). Below you can see an example of affected FUE donor after multiple Strips. Very interesting i didn't know the area below the strip/strips could be affected it does make sense if im honest. So does this happen with every patient with one/two or multiple strip scares. Because some doctors say get strip until your striped out and then go for fue But if the scar affects the surrounding area for fue. Most doctors don't tell you about that. Link to comment Share on other sites More sharing options...
Senior Member ALEXD Posted June 22, 2015 Author Senior Member Share Posted June 22, 2015 Very interesting i didn't know the area below the strip/strips could be affected it does make sense if im honest. So does this happen with every patient with one/two or multiple strip scares. Because some doctors say get strip until your striped out and then go for fue But if the scar affects the surrounding area for fue. Most doctors don't tell you about that. Hello Wwiizzkkiidd24, There are three main reasons why Strip and especially multiple strips affect the available safe zone donor area for FUE. The minimum effect that one strip can have is summarised in the following 3 points: Firstly when a Strip is removed the two ends of the skin are pulled together and stitched. If let’s say hypothetically the Strip dimensions was 1.5cm X 30cm then already the actual donor surface for FUE harvesting is reduced by that 45cm. Secondly, the skin stretches in that particular area and will have approximately 20% less density than prior to the initial Strip, therefore the available FUE from that area is reduced. The third reason has to do with the pulling and stitching the wound. The skin is pulled together and stitched which in many times results to the change of the direction of the hair follicles under the skin especially near the sutured area and below the scar. This is something that can affect FUE extraction as it can result to higher transection rate in the area that the direction had changed. Overall Strip and especially multiple Strips affect negatively the FUE safe zone area and reduce the number of grafts that could be harvested. Regards Alex Alex Demetriades International Patient Coordinator HDC Hair Transplant Clinic --------------------------------------------------- Dr. Maras is recommended on the Hair Transplant Network Link to comment Share on other sites More sharing options...
Senior Member BaldingBogger Posted June 24, 2015 Senior Member Share Posted June 24, 2015 Very interesting i didn't know the area below the strip/strips could be affected it does make sense if im honest. So does this happen with every patient with one/two or multiple strip scares. Because some doctors say get strip until your striped out and then go for fue But if the scar affects the surrounding area for fue. Most doctors don't tell you about that. Hello Wwiizzkkiidd24, There are three main reasons why Strip and especially multiple strips affect the available safe zone donor area for FUE. The minimum effect that one strip can have is summarised in the following 3 points: Firstly when a Strip is removed the two ends of the skin are pulled together and stitched. If let’s say hypothetically the Strip dimensions was 1.5cm X 30cm then already the actual donor surface for FUE harvesting is reduced by that 45cm. Secondly, the skin stretches in that particular area and will have approximately 20% less density than prior to the initial Strip, therefore the available FUE from that area is reduced. The third reason has to do with the pulling and stitching the wound. The skin is pulled together and stitched which in many times results to the change of the direction of the hair follicles under the skin especially near the sutured area and below the scar. This is something that can affect FUE extraction as it can result to higher transection rate in the area that the direction had changed. Overall Strip and especially multiple Strips affect negatively the FUE safe zone area and reduce the number of grafts that could be harvested. Regards Alex Very interesting and as I expected seems at odds with a lot of pro FUT information posted on this forum recently. Would be great for readers to have other clinics chime in also with their opinions and experiences on this subject. Link to comment Share on other sites More sharing options...
Senior Member Swooping Posted June 24, 2015 Senior Member Share Posted June 24, 2015 Great job! Alex, great information. A questions to you, - Do you feel that in these days FUT still holds the advantage over FUE in terms of yield in state of the art procedures? If so, to what degree? Proud to be a representative of world elite hair transplant surgeon Dr. Bisanga - BHR Clinic. Hairtransplantelite.com YouTube Online consultations: damian@bhrclinic.com Link to comment Share on other sites More sharing options...
Senior Member Arrie Posted July 2, 2015 Senior Member Share Posted July 2, 2015 Dr. Maras always seems to take a conservative approach that ends with a "wow" result... I like this Doc and clinic a lot! best wishes to the patient, You only live once... Link to comment Share on other sites More sharing options...
Senior Member JohnCasper Posted July 3, 2015 Senior Member Share Posted July 3, 2015 Excellent post "Hairweare". You are absolutely correct and FUE continues to be the procedure of choice for many. You are also correct regarding Dr. Vories who continues to refine the FUE process and who performs 100% of the extractions and insertions himself, with minimal tech support. I am an online representative for Carolina Hair Surgery & Dr. Mike Vories (Recommended on the Hair Transplant Network). View John's before/after photos and videos: http://www.MyFUEhairtransplant.com You can email me at johncasper99@gmail.com I am not a medical professional and my opinions should not be taken as medical advice. Link to comment Share on other sites More sharing options...
Senior Member voxman Posted July 3, 2015 Senior Member Share Posted July 3, 2015 I have been consistently written the same in several previous posts. Rather than categorizing all FUE as one universal method critics would be more credible if they directed their arguments against the yet unresolved differences in FUE technique, i.e., motorized v. manual, robotic, limited sessions v. mega, tech extractors v. physician only, slits v. implanter pen etc. These are the true issues that should be under discussion not whether the 100 best FUT docs produce better results than the 100 best FUE ones. That is a straw man's argument as ultimately how a transplant will look has more to do with the individual patient characteristics either good or bad than the type of surgery. While FUSS may be improved by Dr. Lindseys and Feller's new procedure, FUE is not going to fade away. It too will be further improved and become more refined as time goes by. One has to give credit to docs like Vories who demonstrate flexibility and the integrity to change course when they believe another methodology is superior as well as to offer it at an affordable price point. Excellent post Doc - this is a cut and paste for my files! I'm serious. Just look at my face. My Hair Regimen: Lather, Rinse, Repeat. Link to comment Share on other sites More sharing options...
Senior Member Britanium Posted July 3, 2015 Senior Member Share Posted July 3, 2015 I like this approach. I pretty much done the same for my own FUE HTs. Looking at this fellow he seems to have a decent beard he can tap in to. That would be my next step - some BHT in to the strip scar and using it to top up the density. Link to comment Share on other sites More sharing options...
Senior Member pkipling Posted July 3, 2015 Senior Member Share Posted July 3, 2015 Excellent work, and a very interesting case. I love seeing successful repair cases, and I'm glad to see this guy is on his way to a very positive outcome after getting off to a not so great start with the first strip procedure. These are the cases where a great HT surgeon's job must be extremely gratifying. Thanks for sharing. I am a patient advocate for Dr. Parsa Mohebi in Los Angeles, CA. My views/opinions are my own and don't necessarily reflect the opinions of Dr. Mohebi and his staff. Check out my hair loss website for photos FUE surgery by Dr. Mohebi on 7/31/14 2,001 grafts - Ones: 607; Twos: 925; Threes: 413; Fours: 56 Link to comment Share on other sites More sharing options...
menashe30 Posted September 27, 2015 Share Posted September 27, 2015 A great work of dr maras. What is the density of the donor area of the patient? Link to comment Share on other sites More sharing options...
Senior Member ALEXD Posted November 3, 2015 Author Senior Member Share Posted November 3, 2015 (edited) Hello Everybody, We have created a two minute video presenting this patients case and evolution. Regards Alex Edited November 3, 2015 by ALEXD tRY ADDING YOU TUBE VIDEO Alex Demetriades International Patient Coordinator HDC Hair Transplant Clinic --------------------------------------------------- Dr. Maras is recommended on the Hair Transplant Network Link to comment Share on other sites More sharing options...
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