Had HT on 22nd Dec with Dr. Madhu

[SHANGLA]

Originally posted by pink:

now lets get back to the 2 scar thingy..... i haven't seen this before. 2 strips taken for 1 transplant????? How does this benefit?????

 

Dear All

The reasons because of whcih I think double scar surgeies should be avoided are :

 

Ist, If the lower scar is below the occipital protruberence, means below the small little pumb of bone then this scar unless proven otherwise will widen.

Second, I think the space between two scars is more then they can be corrected at any time in future.

Third I believe that the upper scar is way too high and if he recedes to type VII in future, he will definately loose hair from that scar and the scar will show at the upper end of the receding donor hair.

 

these are my personal views

 

patient Advisor To Dr Humayun Mohmand

[Bill - Seemiller]

Guys,

 

Upon further discussion and thought, I imagine a double scar approach might balance the distribution of tension, reducing the amount of tension on each wound. Assuming both strips are harvested above the occipital ridge and aren't too wide to minimize tension, there shouldn't be any additional risks of stretching. I'd be interested to hear Dr. Madhu's explanation as to why he feels he can get more grafts this way.

 

The disadvantage is that the patient will end up with 2 scars instead of one. However, as long as they're both minimal in appearance and the patient understands the risks, I'm willing to keep an open mind about this approach - especially since Dr. Madhu only performs it on a select few patients he feels may be good candidates and who also agree to the method.

 

These are just some of my additional thoughts. Hopefully Dr. Madhu will share more of his professional opinion on this.

 

Bill

[Dr. Timothy Carman]

Interesting thread.

The main concern I have with the removal of two strips as shown is the chance of necrosis (tissue death) in the portion between the two donor areas. This, in my opinion, is very very risky. That middle section's superficial vascular supply has now been limited to the lateral portions; i.e., there is compromise in the blood supply which may result in disastrous consequences-large tissue loss requiring serious reconstruction. This technique falls far outside basic principles of surgical practice, again, in my opinion. Dr. Madhu did point out he has some criteria for which most patients do not qualify, and I am curious as to what specifically would make a patient a candidate.

[rpachigo]

Primum non nocere. Future patients, do not let anyone do this to you. You are playing with fire here.

[Dr. Pathuri Madhu]

Hello All,

 

External occipital protuberance, nucal lines, similar terminology can be called as Anatomical landmarks, which mainly helps in descriptive purposes and aids in indicating the position. Furthermore the Norwood classification 6, 7, etc is for staging of baldness at that particular period, but to the hair transplant surgeon it is the zone of permanent hair Bearing (bald resistant area), otherwise safe donor area & its characteristics which are very important. The characteristics can be like density, laxity/elasticity, mobility on the skull and its width and length and also on the contour & size of the skull.

 

All bald scalp characteristics are not one and the same. It varies from person to person such as, in all patients it will not go into Norwood class vii, and even the speed and extent of progression of baldness varies from person to person. So this procedure is not for all, here the Surgeon's discretion plays a role.

 

While doing surgery, in some cases it may become difficult to extract even 0.8cms width of bit and in others it can be up to 2cms rarely even up to 2.5cms. So while doing surgery we proceed in such a manner that there will not be any difficulty in approximation of the two edges.

 

While donor harvesting, I follow a simple technique which can be called as an approximation test. At each step I go bit by bit of 4-5cm length then I will do the approximation test, if it is still allowing then I go a bit wider, if I feel like it is tight I go narrower, hence my bit width varies from place to place and from bit to bit. But many surgeons they go at a stretch, as I am following the above method I am not getting any problems in approximation.

 

In double strip method, we look for good and wide permanent hair bearing zone or safe donor area. If we don't think that we are in safe zone it is better not to venture for this, so while doing this procedure in the first instance I take lesser width of bit for E.g. if it is yielding comfortably around 1.6cm, I go for 1.3 to 1.4cm width (little bit narrower) and go as lengthier as possible and while taking the second bit I redo the test to know whether the other area can yield safely or not, then in that area we may get up to 1 to 1.2cm wide bit, hence the total width combining comes to around 2.4 to 2.6cm wide. Other wise it's like doing two surgeries in a single stretch. So, the more the width the more no. of grafts.

 

 

For venturing into this procedure scalp examination (donor) is a must. As I mentioned in the earlier post, only 5-10% of the patients may be suitable for the double strip method. Because of the wider bits we are able to get more no.of.grafts, in other words we are able to get 40-70% more grafts, mostly >than 4000 units in a session. At the same time the surgeon should have the capability of implanting all the grafts possibly in less than 6hrs or max in 8hrs, if they don't have the capacity to implant within the time frame it is better not to venture into this, because the graft survival rate decreases as the time progresses.

 

 

 

It is not a great method; it is a simple variation from the routine method. Regarding the width of the scar I have already mentioned in my earlier post about the main points that need to be considered . They are:

 

 

1) Tension on the suture line,

2) Healing capacities of the patient &

3) Technique like trichophytic closure.

 

 

 

Always a surgeon should try to minimize the scar by reducing the tension and by adapting the latest techniques i.e. trichophytic closure method, but a factor beyond the surgeon's control is healing capacities of the patients. In the recent past I am trying a gel called contractubex and finding faster and better healing with lesser width of scar. These are my personal observations on few patients.

 

 

 

All these are small trials in a hope to give much better output to the patient and at the same time not compromising on the important things. Above points regarding the gel are not yet established nor discussed in the scientific conferences and journals.

 

The studies have to be done on some more patients and are to be presented. For that it needs time & co-operation from the patients. The results will become much more convincing scientific facts only after presentations & publications. I am telling you that I am not doing on all patients, only doing on a selected few candidates, till now all are happy and I am still observing the cases for the conclusion.

 

Regards,

Dr.Madhu.

[Dr. Pathuri Madhu]

Reg. Tissue Necrosis:

 

Tissue necrosis is a point to be considered but, it hasn't happened in any of my patients. The tissue necrosis is a theoretical risk in a few patients where vascular compromise occurs because of over tension on the mid bit. The first point to be avoided is the tension on the part in between the two suture lines.

 

Actually while cutting the strip, we don't go beyond hair root depth where there is a chance of cutting a vessel. Because as we are following OPEN Method of dissection, we are not even cutting a small vessel or disturbing the inner vasculature. The inner vasculature is in a very safe zone well below the hair root level. So, practically and to a some extent theoretically also there will not be much vascular compromise.In reality we are not getting any vessel to be ligated and to be cauterized.If at all it occurs, it is to a very very small, almost invisible cutaneous vessel.

 

As an experienced pilot knows how to negotiate a flight safely in hard circumstances, similarly an experienced surgeon knows how safely he can operate in that particular circumstance. Hence, only after evaluating the local factors and attaining full confidence, one should venture.

 

Regards,

Dr.Madhu.

[Bill - Seemiller]

Dr. Madhu,

 

Thanks for taking the time to explain your approach and the science behind it. If you have photos showing mature double scars to further demonstrate your technique, I think it would edify this community.

 

Best wishes,

 

Bill

[subbu]

dear Dr.Madhu

photos of double mature scars shall clarify our doubts about this procedure

[Dr. Pathuri Madhu]

Hello,

As I performed only on a few patients recently, I dont have any mature scars as of now. I'll post one more similar case in my next post, other few patients haven't come for follow-up for their own reasons. Whenever i get such pictures I'll definitely post. In some patients the only difference i observed so far is a little bit more shock loss around the suture line which is a temporary phenomena.

 

Regards,

Dr.Madhu.

[subbu]

thanks doctor for your reply

[Add]

hi,

 

your pics are looking gr8. could u plz put some more pics.

[Pratik]

Hey Guys,its been almost 7 weeks since HT,Now I am getting some pimples where the grafts were transplanted. Is that normal?

Updated my blog with recent pics.

[Pratik]

Thanks Add.Added recent pics .

[Dr. Mohammad Humayun Mohma]

Dear Dr Madhu

 

I agree with your description of donor area and mobility check.

 

What I have reservations are

 

As we all know that Donor area is limited and it has to be above the occipital protrubence and minimum 1 cm below the miniturized hair of the occipital area.

now usually this donor area is not more than 3 to 4 cm depending on the type of baldness. I refer this as true donor area or viable donor area.

 

If you want to do two scars there has to be at least 1 cm of good skin with dense donor area.

So if you leave a healthy strip between two scars you might be at the edge of donor area where the thinness will start and the patient will loose all the grafts that were harvested from that donor area which now over the period of time has gone bald.

 

I am sure we have seen so many punch grafts of previous time having these problems. This is one of the reason I am not a fan of FUE that you tend to go to these non true donor area for harvesting grafts.

 

Second, I am sure that the best way is to evaluate the mobility of the entire donor area, but if the mobility is there then you can always take more strip. If the mobility is not there then even if you go a cm or two below or above the previous scar the wound dynamics will not change, so there will be high tension on the scar and hence more chances of having one of them going wide scar.

Mind you, even one strip cannot guranttee the fine scar irrespective of whether you do tricophytic or not.

 

So my point is why to take unnecessary chance on patients for the sake of 1000 1200 grafts. a single wide scar is not worth the risk. I try to be very conservative but still fail in 1% of cases and it is for the safety reason that I am a two surgery man not one stop surgery.

 

I know some greatest names are one stop proponents but in my hands, I can produce better results with 4000 grafts in two sessions then doing 4000 in one go.

 

I feel that by doing two scars in one go, I am taking about 50% more risk than normal cases. Plus I also think that in future there would be more chance of these patients to have visible scars then ones with single scars.

 

I feel its better to be safe than sorry. If some one cannot understand two sessions, I have not done those patients. I think they are not ready for hair transplant in my view.

[rogained_Youth]

I did a HT w/ Dr. humayun on Oct 21st 2009. They told me 4 months the hair will grow a bit.

Damn I am impressed with craftsmen ship and the price.

I am very happy with his work.

His assistance Shahid answered all my questsions personally, even when I woke him out of bed.

All honest work, and honest results.

I am very very happy. I feel like a 25 year old again.

[Megatron]

Originally posted by Pratik:

Hey Guys,its been almost 7 weeks since HT,Now I am getting some pimples where the grafts were transplanted. Is that normal?

Updated my blog with recent pics.

 

Hey Pratik, I very well could be mistaken but it looks like you've got some growth in your 1m pics. I could be mistaking it for miniturization, but you say that you have acne which is often a sign of hair activity so perhaps, just maybe you're one of the lucky early growers.

 

You have good hair groupings (60% doubles, 13% multi) which always helps too. Did Dr. Madhu implant into the crown area and midscalp too? If so, then that's a big area for 3,300 grafts.

[Pratik]

Megatron,HT was done till mid scalp from frontal area.Crown area is not touched yet.

[Pratik]

Guys,Updated my blog with three month pic's.Please comment

[Bill - Seemiller]

Pratik,

 

Thanks for updating us on your progress. It look like you've healed very well.

 

This is where the journey really begins. New growth typically starts between 3 to 5 months so I suspect it will start any time now :-).

 

Keep us posted.

 

Bill

[Chandu]

Hmmm

I have similar baldness and now the results seem to be matching...I got operated on Dec 21st with Madhu. Lets wait and see how many days will it take to cover the worst part of head .

[kris_hyd]

I had my surgery on 2nd Jan 2010.. Even my results are similar...My scar is now covered under the hair,I can see a few hairs just growing out(I could see them from the 2nd month onwards but they donot grow i.e they are the same size from 2nd month to the 3rd month, dont know if this is normal)... I can say my results so far are not what I expected and not worth all the hassle and pain...I know its just 3 months but some patients on this site have posted excellent results at 3 months, especially those with surgeries done by Dr Feller, Hasson etc.. Do these doctors use some special techniques? How are their patients able to retain more hair at 3 months than many other doctor's patients?

[suresh_reddy]

I had my surgery in Dec 09 and I see same results too.Even am wondering wether all the pain was worth it.

Guys,

BTW I used to apply minoxidil about a year back but had stopped it bcoz fo itching. Post surgery when I informed the same to Dr.Madhu he said its better to avoid if itching was seen.

Recently I got tugain 2% and applied it before sleep, but next morning I see more hairs coming off and hence stopped it. I have heard applying minox initally causes some hairfall....what are you experiences with minoxidil pre and post surgery?

[Chandu]

last 2 postings say they are not happy with the results(atleast for now), but remember we have to wait for another 5months. Infact I am satisfied with the results, but we need to wait for atleast 8months after HT is done to see the results(as said by Madhu or Bill). So guys be positive and forget about the growth for now. Anything you want to add Bill?

[Bill - Seemiller]

kris and suresh,

 

Since you've had surgery only 3 and 4 months ago, you are far too early to evaluate your results. In fact, most patients only just start to see signs of new growth at this early stage.

 

Your donor and recpient areas need time to heal and transplanted hair takes up to a year and even longer sometimes to grow and mature.

 

Hang in there guys!

 

Bill

[suresh_reddy]

Guys,

Maybe am getting too anxious in this waiting period.

Infact am very happy the way my donor area healed.

Btw any experiences on usage of mintop/tugain post op?

 

-Suresh