Dr. Blake Bloxham: 2,200 Graft "Mini-Graft" Repair | 6 Mnths After | Feller & Bloxham

[Dr Blake Bloxham]

Want to share a case I think the community will find interesting!

 

Case:

 

Patient underwent two "mini-graft" procedures at a local clinic. The first was a 600 graft procedure that created a very low and flat hairline. The patient wasn't happy with the results and returned to the same doctor. The doctor believed the solution was to use an additional 700 mini-grafts to naturalize the results by making the existing hairline "broken-up" and "irregular."

 

Now, this is something we do in modern procedures in order to create a natural, feathered result. So what's the problem? Well, in modern hair transplantation, this is achieved using ONLY 1-haired follicular units. Unfortunately for this patient, it was done using large mini-grafts.

 

So this made the already low, flat, and unnatural hairline even more apparent. When the patient presented for the consult, he described the hairline as a "zipper" in the front of his head, and something he constantly hid with his otherwise great surrounding hair. He also formed a noticeable gap between his native hairline and the transplanted hairline -- exaggerated by how low the hairline was created.

 

Here's how he presented during the consultation:

 

 

 

 

Thankfully he still had good donor and I believed I could work with his existing strip scar. So we decided to move forward with a dense pack repair with true follicular units, aimed at both camouflaging the larger grafts and recreating a normal appearance in the frontal scalp.

 

Surgery:

Surgery presented the following challenges:

 

1) Because of the unnatural appearance of the mini-grafts, I could not create a hairline behind the pre-existing work. This meant the new hairline needed to be created lower and flatter than I would normally work. This also meant it had to be very dense in order to look natural that low -- and very dense packing must be done carefully in repair cases.

 

2) Dealing with the asymmetry of the previous hairline. While a degree of "asymmetric symmetry" is always needed in hair transplant, the previous work was very uneven and I had to be quite "creative" in my surgical plan.

 

But we created this plan and prepped the patient for surgery. Here's a view of the mini-grafts right before I took the strip:

 

 

And here are the new slits ready for graft implantation. As you can see, a very dense pack for the reasons discussed above:

 

 

And here he was at staple removal day. So far, so good! This picture -- when compared with the pre-op shave -- really illustrates the difference between spreading larger grafts, and dense packing follicular units:

 

 

6 Months Later:

 

And here is a video (with wet and dry comb-through) and "before and after" comparison pictures taken at 6 months. I'm very pleased to see the transformation the patient underwent in only 6 months (generally only the "halfway point"), and even happier to report that he's able to style his hair normally for the first time since he "took the plunge" with surgical hair restoration.

 

Video:

 

Comparison Pictures:

 

 

 

 

 

 

 

 

 

 

So, I hope the community finds the case as interesting as I did!

 

Enjoy,

 

Dr Bloxham

 

Feller & Bloxham Medical, PC

[Speegs]

Pretty stellar growth for six months, especially given the contrast between dark hair and light skin.

 

Also, those mini grafts weren't as cosmetically egregious as many procedures of that method I've seen, the density you blended with them salvaged them nicely.

[Dr Blake Bloxham]

Speegs,

 

Good point about the contrast between the skin and hair tone. Always something to take into consideration.

 

And these mini-grafts were definitely less sinful than others I've seen and fixed in the past. The unfortunate part, however, is that the initial surgeries weren't performed that long ago! Normally I see work like this in patients who had surgeries done decades ago, not a few years ago.

 

And thank you for the kind words!

[harin]

Excellent result, made a world of difference to this guy's aesthetics. Great job Dr.Blohxam.

[Mick50]

Exceptional growth for 6 months guy must be very happy

[Spanker]

When I first started looking, around 2009, there was a place in AL that was still in business doing mini grafts. I had not found the forum yet and almost had a small procedure by them.

 

I AM SO LUCKY THAT CONTINUED TO DO RESEARCH!

 

I can't believe there are people doing that kind of work still.

[Dr Blake Bloxham]

Spanker,

 

It was happening in 2009, and it's unfortunately still happening today. After years of being on the forums, I was a little isolated in my thinking that everyone was using true microscopically dissected follicular units. They are not.

 

Harin/Mick,

 

Thank you for the kind words. His growth is great for 6 months; especially considering the fact that his scalp was compromised from the prior procedures.

[Spanker]

Was there any thought of raising the corners with fue instead of transplanting them?

[Dr Blake Bloxham]

Spanker,

 

Yes, we discussed it. However, the patient and I decided to move forward with the plan because of some concerns I had about scarring that low on the forehead and the patient's desired hairline shape.

 

I usually try to transplant around opposed to removing grafts when I can. It requires a slightly larger than normal FUE punch to really get the full graft -- when you're dealing with these minis or some variation of plug -- and the scarring can be an issue in such a visible area. Not to mention that complete extraction in a transplanted graft is not a guarantee. So you could end up with a scar and a persistent part of a mini graft in that area!

[Sean]

Impressive repair and yield considering the finer texture of hair.

 

2200 grafts and the yield is amazing.

[TakingThePlunge]

You really hooked this guy up! I'm sure his expectations were exceeded with this result.

[Dr Blake Bloxham]

Sean and Dave,

 

Thank you for the kind words.