Dr. Lindsey 6 month checkup frontal 3000 McLean VA

[Dr. William Lindsey]

This fellow popped in the office exactly 6 months out yesterday. While he had some hair in his frontal third preop, it wasn't much and its length helped with layering. He's from a long line of class 6 guys and refuses meds.

 

Shown are operative, 1 month scar check, and 6 month pics. Even without long hair for layering, he looks great and will really be grown in by Christmas. His scar looks good, and this short video shows his result thus far. However his crown has gotten significantly thinner...we'll be back to do a second case sooner rather than later I suspect.

 

Dr. Lindsey McLean VA

 

[Motoro]

Nice job Dr. Lindsey.

 

With this guy's minimal hair/scalp contrast and limited scaring, this is going to be a great example of what a few transplants can do for an individual's overall look. The refusal to try medication is baffling to me, especially since this guy comes from a class 6 background, but he may just pull it off in the end. I'm looking forward to seeing a final update in a few years, after that second round.

[seeker2014]

Dr. Lindsey:

 

Thanks for posting this case...this patient has experienced pretty impressive results considering it is only the 6 month mark. I had a few questions I was hoping you would be generous enough to answer:

 

(1) Do you happen to know the guard number this patient shaves down to for the back?...it appears to be a 3 or 4 guard, but I was wondering if you could confirm this?

 

(2) You mentioned the patient refused meds and comes from a line of class 6 guys. Hypothetically, if this patient lost a significant number of non-transplanted hairs 20 years down the road and, consequently, wanted to shave down to a 1 or 2 guard, what would be your recommendation? Specifically, do you think transplanting FUE grafts into the FUT scar would enable him to reach this goal and, if so, how many grafts do you estimate it would take?

 

By the way, I have really enjoyed reviewing your FUE into scar tissue results...they have helped me with my research.

[Td06]

Nice job doc. great hairline and scar!

[Dr. Alan Feller]

Agreed. Well done!

He is a fast grower, his hairline looks ten times better already and he's just getting started.

 

Excellent and undetectable scar as well. Good to know that above and below that tiny scar line is untouched skin with perfect virgin grafts. Be great to use in the crown to finish him up.

 

Excellent work!

[Dr. William Lindsey]

Sorry for the delay in responding. My son was presenting 2 of our research projects at an international cosmetic surgery meeting last week and actually won the poster contest for one of his topics. Hopefully that will help with the college applications this fall.

 

seeker 2014 I don't know what number he shaves to, but it looks like what my nurse Wendy does to me which is either a 3 or a 4. This fellow was room mates with one of my daughter's teachers before he got married so we'll see him again and I'll try to remember to ask. I really have no preference if people use meds. I educate people on the option and its up to them. As I've posted dozens of times on the forums...I took meds and grew hair and had side effects...and quit. I see one guy a year who grows a LOT of hair from propecia out of the 50 prescriptions I do each year. And seeker...one of the talks my son did was FUE into scar tissue. Its variable but is often worth considering for the right scars.

 

motoro as above...many guys I see want hair to meet females. If they have side effects or even worry about side effects to the point where they have "performance" issues... why have hair? Frankly, I tell all these guys to go to the local mall and look at all the guys who have bald spots but have hair from the front to the crown. That may be the best I or anyone can do for them. If that is ok with them...pick a date for surgery. If not..don't.

 

Dr. Feller yes, the rest of this guy's head is free of scar tissue and ready for harvesting. Had we done 4000 punches to get 3000 fue's his head would certainly be harder to get hair out of the next time and I promise you he would have noticable donor area thinness on the posterior view. Also as I have posted maybe a hundred times on the forums...out of the 130 strip cases I do a year I every year get: 8 perfect and invisible scars hard to fine with a 1 cut. 4 crappy scars about 5mm wide that would take 1/2 inch long hair to hang down and cover. And roughly 120 scars similar to this. Having done 3800 facelifts I think I sew better than most...but still, its about a 1 in 30 risk of having a scar that needs hair to cover it... For guys who can't handle that risk or who really need a crew cut FUE is a fine option and certainly we're starting MFUE in these guys too.

 

Finally, I've started using PRFM, not prp, in guys with skinny hairs. I started about 10 months ago and have held off on posting on this til I knew it was doing something. As of now, 9 months out...I'm pretty sure that it helps start early growth. I'll post more on this separately next week. I do NOT use it in the scar nor do I use it without HT. I simply think its like fertilizer which may help weak "trees" or skinny hairs grow better until the vascular supply of the scalp is back to normal.

 

Thanks

 

Dr. Lindsey

[SADbutTRUE]

Dr.lindsey what would be best for those patients that get a bad scar,would scar revision,or FUE into the scar to improve it,also look forward to more info on PRFM,why wouldn't it be used on all patients if it helps faster growth, shorting the ugly duckling phase would be great, Faster growth would be something all patients would welcome.also great job on this case, this guys hair looks great.

[Dr. William Lindsey]

Scars are a tough thing to give a one size fits all answer to Sad...

 

So the best predictor of how someone will scar next time...is how did they scar the last time they had surgery.

 

So my approach is along the lines of:

 

If I did their strip and they got a bad scar, AND if I thought it was an easy tension free closure...well I think that they physiologically are likely bad scar formers and I'd either suggest FUE into the scar, SMP(dicey in scars), or simply growing their hair 1/2 inch long to conceal the scar. While this may sound conceited...having done 3800 facelifts I do believe that I sew better than most and if I thought it was an easy closure and they still scarred poorly, I'm not keen on re-cutting.

 

If they had a tight scalp and I closed it...well I'd still follow the above, thinking that its likely even harder to get their head closed in a tension free manner if they were hard the last time....

 

If someone else did the original closure...it all depends on their scalp laxity and the length that they want to keep their hair in the donor region and the size of the scar. If its narrow and they want a really short haircut...I'd likely do FUE and we may have to do it once now and a touch up in a year or 2. IF its pretty wide and their scalp is lax...I'd excise it and hope, but not guarantee, that I'm a better closer than the first guy.... That usually works out but certainly not always.

 

I hope that helps on that topic.

 

As to the PRFM....first off, I expected it to help, but since I wasn't sure, and since we have gotten good results pretty consistenly for years without it...I started by using it on thin hair people...again thinking its like putting a little fertilizer in holes in which you are planting skinny trees... which are less hardy than thicker trees or thicker hairs.

 

Now that I'm pretty sure that it is either speeding growth OR keeping some of those skinny hairs from dying and thus looking better earlier...yes I'm offering it to anyone, but its not free. It costs me about 900.00 and frankly alot of people balk at an extra "grand" for speeding up results a few months. Again if it were my money, and I had skinny hairs...yes I would pay it, no doubt. If I had thick curly wavy dense hair...I personally am not sure I would pay for it in my own hair procedure.

 

As per my usual routine, I'm blunt like this when I offer it and some people are choosing to proceed simply thinking that if they are spending a bunch of money, perhaps spending a little more would make it an even better result. Honestly I don't know if that is true, and it would be virtually impossible to do a controlled study and show results.

 

Lastly...PRFM like PRP, in my opinion, does not stop hairloss. Hairloss is caused by DHT...simply injecting your own clotting substances around hair does nothing to block the cause of MPB.

 

To sum up...I do think it works in either speeding up results or making fragile follicular units more likely to survive. For fine hair people with limited donor hair amount and quality, I suggest they consider having this with the procedure.

[SADbutTRUE]

thanks for the info doc,looking forward to more of your results. take care and thanks for responding.

[Dr. William Lindsey]

you're welcome. good question.

 

Dr. L

[Cuttlefish]

Excellent work Dr. L.

 

Question, would you ever offer someone the PRP/PRFM to someone who may have had a transplant with another doctor, but would like to try to increase density or thickness of the hair shaft?

 

I've been classified one of the dreaded, "fine-hair" donors, and opted for FUE. I am on medication, but would like to see what I could do to maximize fullness.

 

Thoughts?

[Dr. William Lindsey]

My personal feeling based on 4 years of wound research with fibrin glue in the late 80s ( which is fairly similar to PRFM ) and recent phone discussion with my research colleagues from that time period who are still involved with said research...is that both PRP and PRFM likely act as "fertilizer" when placed into a recipient field. PRP likely gets washed away fairly quickly, although I CAN NOT prove that at this time....but platelets are only the first part of the clotting cascade that starts healing...its quickly augmented and replaced by a fibrinous clot that is around for the 2 weeks or so that healing occurs in, in normal injury to tissue.

 

Having planted somewhere between 2500 and 3000 actual trees....the farmer, not scientist, in me says that if you have fertilizer for a day or 2...its probably better than nothing, but if you have delayed release fertilizer put in each hole before you plant a tree...almost all of them grow BETTER. I know this from personal experience planting in mostly Virginia clay. Being a relatively simple guy....I "think" this is what is happening in the scalp (or face, when we place it into wrinkles).

 

My old research buddy, still a professor at a Virginia university and I are playing around with a couple of fairly straight forward experiments to look at this but the main problem is manpower. I have little interest in operating on rats again and looking at microscopic slides of tissue for hours. But, some resident will likely volunteer and we can proceed.

 

To answer your question: I think but can not prove, that a person would likely get some benefit from PRFM placed in the first 2 weeks after surgery. After that, I suspect that the dye has been cast and weak grafts will have either died or always be weak....that is what we see in seedlings in the field...

 

A bigger issue for the injector however is that if the HT doesn't grow....who does the customer blame....the HT guy or the injector guy?

 

So I tell people about PRFM at their initial visit, particularly if they have fine hair, and they need to tell me before we start. I think one or 2 guys has changed his mind on day 3 or 4 and I'll inject then.

 

For the record...I do not think PRP or PRFM fixes MPB. Your scalp, my scalp, and almost all healty people have plenty of platelets and fibrinogen circulating around their scalp all the time, and it doesn't do a dog gone thing to block DHT production or metabolism. It may help in selected cases for as yet unknown etiologies....but I offer PRFM to augment surgery. Just as spreading miracle grow on my back yard hasn't yet grown a crepe myrtle or rose....but if I put it in the hole when I plant the speciman, they do grow better in that first year.

 

And just to add....my deal with plants is that I'll fertilize on planting, and water for 3 months. Then they are on their own. In my yard I'm 42 for 43 trees living for 7 or more years. That is a decent track record for a house husband.

 

Good question.

 

Dr. Lindsey