*PHOTOS* How an HT should look post-op - Dr Blake Bloxham, Great Neck, NY

[Dr Blake Bloxham]

We recently had a patient come in for staple removal 11 days after his procedure. The patient followed our post-operative instructions religiously, and it clearly showed. We tell patients that the transplanted area should look like a "clean buzz cut" after the initial swelling and "pinkness" goes down, and I thought this was a perfect example.

 

Here are the details:

 

The patient is a diffuse patterned thinner, and we needed to steal as much hair as we could via FUT to cover a large area of scalp.

 

 

 

 

We ended up with 2,500 grafts and utilized it conservatively to balance density and a large area requiring coverage. Here are the post-ops:

 

 

 

 

And here is how he looked on staple removal day (post-op day 11):

 

 

 

 

As you can see, it looks like a nice, clean buzz cut on a regular head of hair. This is what we aim for! However, many times patients are apprehensive about cleaning the donor or recipient area because they fear it will damage the grafts. But this isn't true. We generally see better overall growth and a much less stressful post-operative period in patients who wash as instructed and keep the transplanted region clean.

 

Hopefully everyone finds this interesting -- and maybe it will even serve as a reminder to follow those post-operative instructions "to a T."

[Petchski]

Nice post, the dude got no redness whatsoever, a good healer and a good cleaner!

 

I'm going for my 2nd HT on 1st December, i will remember to clean and not be too soft to loosen the scabs.

[Petchski]

Actually looking again at the post op pics he doesn't even seem that red or cut up on the immediate post op pics.

[win200]

The only thing that I think should be clarified is that patients are frequently (usually, I think) much more red than this guy at this point post-op, and that's totally normal. I just wouldn't want anyone who's red at three, six weeks to freak out because this guy looks untouched at less than two weeks.

[Dr Blake Bloxham]

Pet and Win,

 

Thanks for the kind words.

 

And you both bring up a good point with respect to the "redness." I always give patients the following information about the redness during my post operative discussion at the end of each case: the redness generally lasts a few days to a few weeks. Some patients -- like the one above -- have almost no pinkness or redness 48 hours after surgery; other patients may have some slight pinkness for up to 3-4 months. All of this is considered normal.

 

I've noticed less redness in patients with "tanner" skin tones -- Indian Americans, South American patients, et cetera; and it's probably the most prevalent in light skinned Caucasian patients. These kinds of unique physiological factors probably play the biggest role, but I do see less redness in patients who follow the post-operative instructions closely. It probably has something to do with decreasing the overall "excitement" in the transplanted area and subsequently decreasing the body's own inflammatory response.

 

Overall, we seem to achieve pretty reasonable amounts of "pinkness" with minimally invasive techniques and thorough post-operative instructions -- and I think all patients want to minimize this as much as possible!

[voxman]

That looks like it will be a stellar result.

 

I'll be over in 10 min for mine!

[Dr Blake Bloxham]

Our chair is always open for the Voxman!

[Dolph1969]

Blake,

 

Do you think anti inflammation meds and saline spray reduces the redness, or is it down to getting the scabs off quickly and regular washing?

[Dr Blake Bloxham]

Dolph,

 

Anti-inflammatory meds as in "NSAIDs" (non-steroidal anti-inflammatory drugs) like ibuprofen or naproxen, or anti-inflammatory like steroids? I don't think an oral NSAID would help too much with the redness, but a steroid might. However, I don't think many would recommend using a lot of steroids in the post-operative period because they can halt normal healing as well.

 

I think washing and keeping it clean, and using things like saline sprays -- if your clinic recommends it -- would help more.

 

Keep in mind that surgical technique (small blades, properly trimmed grafts, et cetera) and physiology play a huge role in the post-operative redness too.

[Melvin- Admin]

This is the first patient I've seen with substantial hairloss from feller and bloxham, Norwood 6 possibly Norwood 7 in the future, I'm eager to see his results, keep us posted on the progress.

[Britanium]

2500 grafts does not seem enough to cover such a large area? Or is the goal to have more procedures ??

[hairthere]

Looks like super-clean work as per usual. This should yield a nice result!

[Dr Blake Bloxham]

JohnBoy,

 

Yes, the goal was to balance density and coverage over a large area back to the bridge in the first procedure, and then re-evaluate and determine our game plan for work in the midscalp and crown during a second procedure -- and maybe even a third to really finish the crown or refine any other regions after the bulk of the work is done. This will probably be done via FUT and then later mFUE -- based on the patient's donor characteristics.

 

Hairthere,

 

Thanks!

[Britanium]

Sounds like a good plan to me. Be interesting to follow. Thanks for reply.

[jesse23]

These pictures show some great results. I would love to see the end result. Amazing what washing and keeping the area clean can do.

[bunsenburner]

Very interesting presentation. I hope to have a similarly short period of irritation and inflammation after my procedure as well. Thank you for sharing.

[Dr Blake Bloxham]

Jesse and Bunsen,

 

Thanks for the kind words.

[Melvin- Admin]

Dr. Bloxham, can you post some updates? I believe this patient should be close to the 12th month mark right?

[Dr Blake Bloxham]

HTsoon,

 

Impeccable timing! This patient literally came in today for a 12 month follow-up. I didn't even know he was coming in until I saw the schedule before starting surgery this morning. Couldn't believe it.

 

He looks great and is very happy. As you said earlier, he is progressing to a NW VII pattern, so this still remains a very strategic situation. He now wants to do as much of the rest of the midscalp and crown as we can (despite the fact that we were really walking that fine line between density and coverage here, he's very pleased with the density in the areas we worked). I think I can do another FUT of similar size on him (approximately 2,500 grafts), fill the midscalp at similar density, and then strategically work with his natural whorl pattern in the crown to place some grafts back there (loaded on one side) and give him the ability to get some good coverage in the posterior parts of the scalp with some length and styling.

 

I'll put together his pictures and throw them up when the case is done today.

 

Again, thank you all for the continued interest.

[Melvin- Admin]

Thanks for the Response Dr. Bloxham, these are the cases that really intrigue me, because it really illustrates the importance of strategy and planning. I agree with the plan as well, as I had a similar plan, I chose to strategically place maximum density at the top of the crown weighed from left to right to really maximize the styling and illusion, I'm lucky enough to be maintaining the lower portion of my crown with the meds I take, I'm very interested to see his 12 month photos. I'm also interested to know whether or not this patient is on any form of medication like Finasteride or Minoxidil?

[JeffC45]

HTSoon, wondering what type of meds you're taking that you've had some success with. If you don't mind me asking.

[Melvin- Admin]

HTSoon, wondering what type of meds you're taking that you've had some success with. If you don't mind me asking.

 

Sure i've updated my signature with my most current regiment, I've discontinued using the dermaroller, Dr. Diep advised me that if you're to aggressive you could actually cause trauma to the follicles and cause a shed similar to shock loss.

[Dr Blake Bloxham]

As requested, below are some 12 month update photos on this patient (just taken today!).

 

He's definitely progressed to a clear NW VII pattern now. These pictures are presented as a way to showcase the results of how you can really make a big cosmetic difference in patients with limited donor and advanced hair loss if the grafts are utilized strategically and wisely. Obviously he does have open scalp behind the transplanted areas, but I wanted to really focus on the transformation here.

 

And, as I said before, he's going to come back for another to do the midscalp at the same density and try to get some grafts into a specific portion of the crown. I'll do this as another FUT. He's very lax, so he can likely do more FUTs after that. Impressive for a NW VII donor area! In the upcoming procedure, we will also address some of the "dropping sides" in the midscalp.

 

Finally, I do apologize for the different "greens" in the background there. The bright green we normally use (as you see in the befores) is currently hidden behind the green screen (the green you see in the afters) we are using to film a new crop of videos.

 

And to an earlier question: no, he is not currently utilizing any preventive medications. Nor do I think he plans to.

 

 

 

 

 

 

 

 

 

 

 

 

[Melvin- Admin]

This is a big improvement, I think this a perfect example of why facial framing is so important thanks for updating us, I can certainly understand why he would not want to take any preventive medications. I hope you will continue to update us once he decides to do the next procedure. I hope you took video, this is certainly an intriguing case for YouTube.

[Dr Blake Bloxham]

Thank you for the kind words!

 

Patient is extremely happy as well. And couldn't have happened to a nicer guy. Very excited to tackle the next one. And yes, I'll update.

 

By the way ... I completely agree with Dr. Diep's assessment of the dermaroller. I've recommended that a few patients stop using these as well.