Repair by Feller and Bloxham of Great Neck, NY

[FellerMedical]

Hi everyone. Dr. Bloxham asked me to post this patient who had the old style of hair transplantation done years ago. He had the classic dolls head appearance which he was able to hide with long hair but decided it would be best to get it fixed.

Dr. Feller performed one FUT procedure on him with 3,000 grafts and here he is after 3 years.

If any question please feel free.

Tara

Feller Medical, PC

Great Neck, NY

[win200]

Wow, massive improvement. Looks like he had had some recession behind the original grafts, too. How old is this patient?

[Spanker]

Any immediate post op shots? Wondering how far 3k grafts went back.

[Bill - Seemiller]

Dr. Feller and Blake...or I guess I should call you Dr. Bloxham, which is clearly appropriate but strange to call you back after all these years,

 

So for clarification, the title of the topics says this is a repair case by Dr. Bloxham. However, I don't see any detail how about the repair in the body of the text. The only thing I see is that he received an old-style hair transplant years ago and then a 3000 graft procedure a couple years ago by Dr. Feller. Can you provide us with the details of the repair procedure done by Dr. Bloxham?

 

Maybe I missed it somewhere, but I don't see these details.

 

Best,

 

Bill

[Dr Blake Bloxham]

Hi everyone,

 

Win200:

 

Thanks! Yes, he definitely had thinning behind the old work. If you look at picture 4, you'll see how far his thinning extended into the midscalp/anterior portion of the vertex. He was in his mid to late 40s at the time of the transplant.

 

Spanker:

 

The majority of the grafts (2,000+) went into the semi-circle outlined in the frontal scalp. This included rebuilding a hairline (which is always a more challenging task in a patient with thick, dark hair -- because it's difficult to achieve the soft feathering of the microhairline -- AND someone with old work right up into the hairline), densely packing around the old work, and densely rebuilding the entire frontal scalp. The rest were allocated to the thinning behind the frontal portion of the scalp in the midscalp/anterior vertex -- which was well hidden because of the patient's hairstyle.

 

Bill:

 

Dr Feller did the work on this patient. I only asked one of our staff, Tara, to upload the case (because I thought it was a interesting repair job). I think the confusion may be from the "Feller and Bloxham" (now the name of the clinic) in the title, but the first paragraph explains that Dr Feller did the repair job 3 years ago. Sorry for any confusion. Hope this clarifies!

[pkipling]

Fantastic results here. The quality of his hair also looks to have improved, so whatever shampoo/product regimen he's on is clearly working.

[Dr Blake Bloxham]

Thanks, PK.

[bunsenburner]

Great results on another challenging case. I enjoy reviewing these unconventional repair procedures. Thank you for sharing.

[Dr. Alan Feller]

Fantastic results here. The quality of his hair also looks to have improved, so whatever shampoo/product regimen he's on is clearly working.

 

It's funny you write that because I have had several patients tell me that when others would compliment the improvement of their hair after an HT they gave the credit to a new shampoo rather than admit they went for the procedure.

 

In the early nineties most patients wouldn't even admit their hairless bothered them publicly. Now with the marketing of Minoxidil and Propecia people talk about it more openly. In that vane, even the use of HT is becoming more sociably acceptable these days.

 

It is truly interesting to note that people feel less self conscious admitting to using a medicine to restore their hair rather than having a procedure. As opposed as I am to hair mill clinics that spend millions on advertising and aggressive marketing by robot 'turnkey" device manufacturers, they do raise public awareness of HT through their broad marketing campaigns and by frequently inserting their message into the culture, HT in general becomes more accepted and less derided.

 

I would imagine eyeglasses when first used by the public came with some derision. Even today it is considered weakness to wear them and users are still referred to as "four eyes" making many get contact lenses so nobody would know. Human vanity is a force to be reckoned with.

[PupDaddy]

Really top-notch repair work here by Dr. Feller, for a patient whose hair characteristics and prior work made the hairline work a real challenge.

 

I'm guessing for this case that Dr. Feller elected to overwhelm and camouflage the old hairline work by implanting amongst it and in front of it, rather than punching out the old grafts and redistributing them?

[Dr Blake Bloxham]

Pup,

 

Correct. There are usually several approaches to a repair or corrective procedure of this nature:

 

1) Utilize a larger dermal punch to extract the older "pluggy" grafts. There are several options after the initial removal, including: closing the larger defect, giving it time to heal, and then doing a standard transplant in the area; dividing up the plug graft into FUGs and then re-implanting them around the defect; doing a standard, modern transplant around the larger defect, etc. Pros and cons to each approach.

 

2) Utilize a partial extraction of the larger graft to remove some FUGs from each plug region but purposely leaving others behind for coverage -- Dr Beehner just posted an interesting repair case where this method was used. Most will then transplant FUGs in front of the portions of the plug graft left behind for a more natural appearance.

 

3) Leaving the old grafts in place and "camouflaging and overwhelming them" as you perfectly described above.

 

Frankly, I've seen the best outcomes with approach "3." And this is what we generally do in our repair cases -- and we seem to get a lot of them. However, there are instances where the older work is simply too heinous to break up with true FUGs and some sort of extraction and re-distribution method is usually best. Fortunately, we see less of these.