*VID/PICS* 1,500 Graft "Hair Plugs" Repair - Feller & Bloxham / Dr. Blake Bloxham

[Dr Blake Bloxham]

Hi,

 

Wanted to share a different type of case today. And one that I think the community with find interesting.

 

The patient in the video -- Bob -- had a series of "old school" "hair plugs" done at a clinic in the late 80s/early 90s. Like many of these plug patients, he continued to aggressively lose hair and ended up with an unnatural island of plugs on the top of his scalp.

 

He visited several clinics over the years and was basically told his donor was too damaged (he stuck with it and had more plug sessions than the average patient) and he was out of options. He came to see us not expecting much, but was pleasantly surprised when we thought he could be repaired.

 

So I removed as much tissue as safely possible via the FUT technique from the donor and ended up with 1,500 grafts. Although there was a lot of areas requiring attention, I decided on naturalizing the hairline and filling the alleys that had opened up on the sides. It was a very challenging case all around, and I was eager and anxious to see how he progressed!

 

He came back 8 months later and was a new man! He was very happy and actually asked to do a YouTube video with us to try and reach others who may be in the same situation.

 

Give the video a watch. It goes through the case and also gives a little background about "plugs" and how we deal with these cases.

 

Hope you enjoy! And let's all be grateful that we've moved beyond the "hair plug" days!

 

Video:

 

 

Pictures:

 

 

 

 

 

 

[Triple7]

I want to that this guy for making a video. He looks 10 times better and has to be thrilled. Great job by Dr. Bloxham.

[home1212]

I absolutely LOVE seeing successful repair work like this - primarily because I had those 90's plugs too! Congrats Dr. Bloxham, your patient must be extremely grateful for your work.

[Spanker]

Great job. The hairline profile is perfectly natural in that the recession is deep, no temple points, and luckily the hairline was not too low to start with.

 

That said, Bob doesn't look like a guy that you'd want to question about his hair.

[hsrp10]

Very dense natural looking repair result.

Nice work Blake.

[ModernHair]

Impressive! So natural looking now!

[Dr Blake Bloxham]

Glad members found this interesting and enjoyed the case. I'll put a few more of them up.

 

Repairs are always extremely satisfying. Unfortunately, there are a lot of them out there; good news is that they usually do have some options (especially with multiple harvesting techniques available today) and we can provide them with a natural result via modern transplants!

 

Triple, home, Spanker, HS, and Modern,

 

Thank you for the kind words.

 

Spanker,

 

Agreed. But luckily, he's a "gentle giant." Truly a great guy, and I'm very pleased he's happy.

[Harebrained]

Nice presentation. Good to see the video. Hopefully we will see more before and afters like this in the future from more Doctors. Personally my transplant looks very similar to Bob's before. I have a repair procedure with Dr Wong in two days! I hope to post some before and afters as well. Amazing what 1500 grafts can do! Great Job Dr Bloxham!

[DMO]

Does he have any further donor hair available?

[HockeyGuy]

Great work. What a life changer that is for him.

 

Can you give what area (sq/cm) you covered and what the graft density ended up being? Did a lot with 1500 grafts.

[Dr Blake Bloxham]

Hi HockeyGuy,

 

Great questions. It is difficult to assess the area or the density of this patient because of the prior plug work. However, The largest surface areas were the two "alleys" that opened up between the recessed donor region and the prior plug work. Of the 1,500 grafts, I would say around 1,100 to 1,200 grafts went here. And I would say the density in this region was good but likely a little less than my standard dense pack. So I would say around 35 FUGs/cm^2. So we can probably reverse engineer to figure out the surface area:

 

1,200 FUGs * 1/35 cm^2/FUGs (inverse) = 34.2 cm^2 for the "alleys"

 

Now, for the hairline: this was a higher density of singles; likely around 50 FUGs/cm^2 (still lower than a standard dense pack, but good nonetheless).

 

Because the density was slightly lower than a frontal band dense pack, I probably used approximately 300 singles (giving us the full 1,500).

 

So 300 FUGs * 1/50 cm^2/FUGs = 6 cm^2

 

So if my reverse engineering math holds true here, it looks like I treated around 40 cm^2 with a density between 35 to 50 FUGs/cm^2.

 

Fair warning, I just reasoned this as I was typing it out so it could be off!

 

But I will say this: strategy was everything in this case, and I definitely had to work with the limited donor and the established density of the old plugs to create a natural and full look. Repairs are some of my favorites! I think I'll put another repair case up this week because the community seems to really like them as well.

[HockeyGuy]

Thank you, sir. Very well and thoroughly explained!

[Harebrained]

Not that he necessarily needs or would want it but does he have anything left for FUE?

Was removing and disecting any of the plugs ever a consideration?

Again great work! Amazing how 300 singles in the hairline softened things up but closing those "alleys" really made this a home run repair.

[Dr Blake Bloxham]

Hockey,

 

No problem! Glad it made sense.

 

Harebrain,

 

Yes, he does have some grafts left to steal out.

 

If I didn't think he had the grafts to camouflage the old work and use the plugs to enhance the overall result with brute density (and plugs are great at this), I may have considered extraction and re-distribution. The success of this is variable, but sometimes it is necessary.

 

Thank you for the kind words! I do love these repair cases. Especially when we can make a little bit go a "long way" like this.

 

I'll have to put up some more of them because the community really seems to enjoy.

[Harebrained]

Looking forward to seeing more repair results. I think one reason repairs are so intriguing is due to the fact how challenging they can be, especially when ones donor has been compromised. A naturally thinning or bald head, although sometimes acknowledged, is rarely given a stare or second look. However someone walking around with poor transplant work has a very different and often much more stressful situation to deal with. Successful repairs are a life changing and a very rewarding event for the patient and a reason for the contributing surgeon to take pride in those results as well.

[Sean]

Blake, I like the way you think. A very calculated approach and strategy towards grafts. Well planned and for the stage of recession and on top of repair, this is a great job. Hair looks dense where it should. Please do share more repairs and I am glad you are taking repairs. A lot of docs shy away from repair cases. It would be really nice to see if you have any FUE repairs. Especially those with lots of fuE extractions and those FUE cases that did strip afterwards.

 

It's great seeing repairs succeed.

 

There are many folks needing repairs as some docs do risky things detrimental to patient safety. You nailed this, great job!

 

Rarely, do you ever see docs give a graft breakdown like that. Some dont even mention how many 1s, 2s, 3s, groupings of grafts. This helps see tge bigger picture and I hope you continue giving detailed info.