Incision one day, grafts th next day

[tomyco]

I have had a total of 5 strip method hair transplants over the last 15 years, with 3 different surgeons. The first four the incision and grafts were placed the same day with an hour or so. The last one which was done about 8 months ago, the surgeon I used did the incision the day before he inserted the grafts.

 

I'm not seeing any new growth like I did the previous times after 8 months and wondering if it's because he did the incision the day before. Is this practice common? I have not been back to the surgeon because he is several hours away. Any one familiar with is practice and should I be worried?

[Al - Moderator]

Are you saying the Dr. removed the grafts from the donor area and then had you come back the next day to implant them into the recipient area? This should never be done because hair transplant grafts will only survive for several hours outside the body. Was the surgery planned this way?

 

I have heard of making the recipient holes one day and then doing the actual removal and implanting the next day for supposedly better and faster healing, but I don't know if that works.

[tomyco]

Sorry if I didn't explain this right. You are correct, the surgeon made the recipient holes the day before and then removed the grafts from the back of the scalp and inserted them the next day. Again, it's been 8 months and I don't see any growth where in my previous transplants I did see growth after 5 to 6 months.

 

My other procedures everything was done the same day. I don't know if doing it over two days would make any difference. But very discouraged about this.

[Spidey]

who is this latest Dr? I'm no Dr, but I would assume that if the recipient sites are created a day prior, it would already be healing up and scabbing by the next day... seems very odd ... those sits would probably be closed by the next day....

[harin]

Sorry if I didn't explain this right. You are correct, the surgeon made the recipient holes the day before and then removed the grafts from the back of the scalp and inserted them the next day. Again, it's been 8 months and I don't see any growth where in my previous transplants I did see growth after 5 to 6 months.

 

My other procedures everything was done the same day. I don't know if doing it over two days would make any difference. But very discouraged about this.

 

In solid organ transplant world the time outside the body the tissue spends is called ''COLD ISCHEMIC TIME''.

 

It is well known in solid organ transplantation that the more time the organ spends outside the body - less chance of survival.

 

Same thing happened to your hairs, it is irresponsible for the doctor to extract the hair the same day and keep it overnight and transplant the next day.

[Spidey]

Pretty sure op meant sites were made Day one. And day two grafts were removed and implanted. Not sites made and grafts removed day one, and implanted day two. If he did mean the latter, that would be ridiculous... Not that making sites a day prior is not ridiculous already.

[Garageland]

I have not heard of incisions being made one day and the surgery the next it makes no sense and the incisions would be healing up 24 hours later and would make the placing of grafts impossible/very difficult. I have seen incisions made and several hours they are starting to close to make the implanting more difficult.

[Bill - Seemiller]

Honestly, the sounds alarming to me. For starters, recipient incisions made a day before would most likely close up by the time the grafts were being inserted. Thus, incisions would have to be made again even if they are made in the same location. Secondly, grafts should spend only a minimal amount of time outside of the body before being inserted. The longer they spend outside of the body, the more likely they will not survive and will not grow when implanted.

 

I see absolutely no benefit to doing surgery this way other than perhaps splitting the time so that the clinic doesn't have to do everything in one day. But there are significant downsides Which includes a high risk that the grafts will dry out, die and not grow - and The fact that incisions would have to be re-made because the incisions would have at least partly healed and closed up.

 

I'm sorry if you sent this before, but how many months are you postop? And what was your doctors reasoning for doing surgery this way?

 

Best wishes,

 

Bill

[Stig]

Honestly, the sounds alarming to me. For starters, recipient incisions made a day before would most likely close up by the time the grafts were being inserted. Thus, incisions would have to be made again even if they are made in the same location. Secondly, grafts should spend only a minimal amount of time outside of the body before being inserted. The longer they spend outside of the body, the more likely they will not survive and will not grow when implanted.

 

I see absolutely no benefit to doing surgery this way other than perhaps splitting the time so that the clinic doesn't have to do everything in one day. But there are significant downsides Which includes a high risk that the grafts will dry out, die and not grow - and The fact that incisions would have to be re-made because the incisions would have at least partly healed and closed up.

 

I'm sorry if you sent this before, but how many months are you postop? And what was your doctors reasoning for doing surgery this way?

 

Best wishes,

 

Bill

 

 

Bill,

 

I mean no disrespect, but one of your recommended surgeons Dr Bernstein has been advocating this practice for a while now. See his article below:

 

Pre-Making Recipient Sites in Hair Transplants (2012)

 

Once again I mean no disrespect, but I would think you would be aware of and all over these types of things, especially if recommended surgeons start switching things around in their practices.

Edited March 21, 2016 by Stig

[Mick50]

I have also read of this practice of creating the incisions the previous day but I can't remember where ,something along the lines it's easier to insert the grafts and they grow better somehow, will try to remember where I read it

[Dr. David Josephitis]

This is a good topic of discussion. At Shapiro Medical we also routinely make the incisions the night before a large FUE case. It does sound strange, I know, but you must look at the logic behind it. All grafts, especially FUE grafts have a limited time they should stay out of the body. The sooner they can be placed back into the recipient sites the better. Having said that, we routinely like to make site prior to extracting any grafts. If the surgery is somewhat smaller, (1800 grafts or less) we can make the sites in the morning and then extract the grafts followed by planting in the afternoon. If the grafts are extracted first in the morning and then the site are made, the grafts must wait an extra 1 -1.5 hours (average time it takes at SMG to make sites) before being planted. This is not ideal.

 

 

The reason we would make sites the night before is that if we plan on doing a larger surgery (1800-2500) we won't be able to make sites in the am and do 4+ hours of extraction followed by placing. The patient would be in the office until 8 or 10 at night! That is not good for the grafts or the patient experience.

 

 

Finally, on the question of practicality of making sites the night before. We typically have the patient come in around 2pm and we go through the plan thouroughly. We cut the hair and make the sites. The patient is out of the office in 2-3 hours. We dye the sites so that they are easily visible the next day. Believe it or not, the sites are very easy to work with the next day. Our staff at SMG routinely pre -dilate the sites (open them with forceps) prior to planting the grafts anyway so we put as little trauma on those fragile FUE grafts. Our staff actually feels that the pre made sites are sometimes easier to work with and the grafts may be less likely to pop in a dense packing situation. Also, there may be some theoretical benefits to making the sites earlier. There may be some growth factors and early revascularization occurring overnight to the area that may make the grafts take better. We don't have any good data on that, but it is a possiblity.

 

 

In my mind, the only negative issue is that the patient would have to be numbed another day. In our office, we don't rush our procedures, so prior to making sites the night before, we had all 2 day FUE cases where we would do 50% of the case on each day.

[harin]

Bill,

 

I mean no disrespect, but one of your recommended surgeons Dr Bernstein has been advocating this practice for a while now. See his article below:

 

Pre-Making Recipient Sites in Hair Transplants (2012)

 

Once again I mean no disrespect, but I would think you would be aware of and all over these types of things, especially if recommended surgeons start switching things around in their practices.

 

Dont know about this sequence:

 

1. Recipient sites are made.

2. Grafts are harvested onday #1

3. Grafts are placed on day #2

 

The above is reciepe for disaster.

 

What Dr. Bernstein is advocating is called Direct Hair Transplant (DHT)which my doctor did. It is practiced widely in India and elsewhere. infact my result is the proof that it works better than traditional FUE.

 

Here are thesteps.

 

1. Reciepient site slits are made.

2. Same day Grafts are harvested.

3. With in few minutes of harvesting those grafts those grafts are implanted into reciepient sites.

 

Steps 1-2-3 total takes around maximum of 1 hour,some times few minutes only.

 

Nothing wrong with No # 2 - its innovative, allowing very little time for grafts to remain outside the body and gives excellent results.

[Stig]

Dont know about this sequence:

 

1. Recipient sites are made.

2. Grafts are harvested onday #1

3. Grafts are placed on day #2

 

.

 

My interpretation of what him and SPG do is as follows:

 

1. Recipient sites are made on day#1

2. Grafts are harvested onday #2

3. Grafts are placed on day #2

 

.

[tomyco]

I thought I cleared this up in my follow up message. Only the sites were prepared the day before late in the afternoon. Spidey got what I was saying The 2nd day, first thing in the morning was when the grafts were removed and implanted. It's been 8 months and have not seen any growth.

 

I was just wondering if anyone heard of this practice or had it done this way and what were their results. My previous sessions were with another surgeon and everything was done the same day. Sorry for the confusion, I didn't mean to Stir the Pot!!

[Stig]

I thought I cleared this up in my follow up message. Only the sites were prepared the day before late in the afternoon. Spidey got what I was saying The 2nd day, first thing in the morning was when the grafts were removed and implanted. It's been 8 months and have not seen any growth.

 

I was just wondering if anyone heard of this practice or had it done this way and what were their results. My previous sessions were with another surgeon and everything was done the same day. Sorry for the confusion, I didn't mean to Stir the Pot!!

 

looks like Dr Bernstein and the surgeons at Shapiro Medical Group are doing the same practice. If Dr Ron Shapiro does it like that, then I highly doubt that's the reason for your bad result.

[gillenator]

I concur that this method of making the recipient incisions the day prior to implantation is not ideal because of the added trauma of having to re-open the recipient sites in order to place the grafts.

 

I have read that some docs who do this feel that the grafts adhere better when placed one day later yet if the incisions are made at the right size and depth, and also the grafts are dissected and trimmed to their proper size, there's no reason for the grafts to need any other help to stay in place.

 

Blood coagulates within minutes once the bleeding commences and it's the clotting that helps hold them in place.

 

My premonition is this method is why there has been a poor yield.

[Rashid36]

What harin said above,

 

i read that for some people the grafts start growing directly as normal hair does