Scar repair

[newjersey774]

Hello I am 13 months post op from my Mfue procedure and I am not satisfied with the scar. I need some guidance/advice from other users or surgeons. I am African American descent and my hairline started receding when I was 20 years of age (2010). I have been using Rogaine since then but started doing extensive research in 2012 about permanent solutions. I consulted with Bosley in 2012 to discuss hair transplants as well as other products (propecia). They also explained to me how the FUT procedure was performed but I was not interested because of the linear scar that would be noticeable based on how short I get my hair cut. In 2014 I did more research and looked into hair forums and studied the FUE procedure. In early 2015 I had an online consultation with Dr. Umar and he gave me a recommendation of how many grafts would be needed performing the FUE procedure and I strongly considered it but decided to hold off on it and do more consultations. I joined the hair restoration network and looked at different individuals post and came across a couple of different Doctors who were recommended with high praise.

 

In the summer of 2015 I consulted with Dr. Alan Feller in regards to getting a hair transplant for my receding hairline. I wanted to discuss the FUE procedure but based on my hair type the doctor did not think FUE would yield a good result. Dr. Feller suggested I consult with Dr. Blake Bloxham and the new MFUE procedure.I consulted with his partner Dr. Bloxham the following year August of 2016 to discuss the MFUE procedure. Dr. Bloxham explained the mFue procedure in more depth and that the hair transplant results provides the yield of the FUT procedure with fue scarring and that simply getting the fue procedure does not provide good quality grafts. I viewed the thread on the website hair transplant restoration network titled “Introducing mfue” thread created by Dr. Bloxham where there was a patient who received the mFue procedure from another doctor and the patient was wearing a very low buzz cut. I looked at the pictures of the patient and I could not see the mFue scar. This is why I was most intrigued by the MFUE procedure because I thought I was getting strip quality grafts with minimal scar appearance like FUE. Based on my hair loss in the corners of my hairline Dr. Bloxham decided I only needed about 250-300 grafts. I decided to make an appointment for the procedure September 2016.

 

The morning of the procedure Dr. Bloxham asked me if I had a preference on where the scars would be. I then asked him “where should the grafts be taken from?” because I assumed the grafts are always taken from the back of the head. He decided to take the grafts from 4 different places. I did not understand why he decided to take some of the grafts from locations on the side of my head but he told me the scars would be 2 centimeters. He took the other grafts from the back of my head and from each side of my head. My head was shaved in the donor area where the grafts were taken as well in the recipient area where the grafts were placed.

 

Once the grafts were taken the doctor and his team used staples to close the wound. The procedure was about 4 or 5 hours. Once the procedure was complete Dr. Bloxham told me that they took 900 grafts total as opposed to the 300 grafts he recommended however he did not charge me the full price of 900 grafts. The additional grafts that were taken were for future hair loss that may occur. I was told to leave the staples in for 10 days and then I can go to a doctor to remove them or come back to the office and get the staples removed. I decided to come back to the office and get the staples removed. I experienced a lot of shock loss in the donor area and temporary shock loss in the recipient area. Once I got my first haircut which was about 15 days after the procedure I was not pleased with the length of the scars and I had two dents on the side of my head. The dents that I had on the side of my head were underneath the scars and the dent on the left side of my head was much more exaggerated. Dr. Bloxham told me that the dent area would heal once the tissue relaxes. I also had what I thought was a bump at the end of 3 of my scars. I was concerned so I went back to Dr. Bloxham and had him take a look at the scars and he explained to me that what I had was extra skin at the end of the scars and that they will flatten out as the scar matures and he said it was caused by the folding of the skin when the wound closes when the staples were used.

 

I asked the doctor if there was anything I should put on the scars he recommended Vitamin E only. I used Vitamin E for a few days and stopped because it made the area feel very weird and itchy. The temporary shock loss in my recipient area went away in a bout 2 months but then I experienced possible seasonal shedding at the 5 month mark in the recipient area and around it. I was not sure if it was because I stopped using Rogaine or if it was seasonal shedding so I continued using Rogaine for my hairline.

 

Before the hair transplant procedure when I got a haircut I always told my barber to use a 1.5 guard but ever since then I tell him to use a 2 guard but unfortunately you can still see the scars when I get a haircut. With one of the scars on the right side of my head that had extra or stretched skin on the end of it, it appears to still be trying to heal or hopefully contract but it is like hitting a bump in the road whenever my barber shaves on it.

 

I have been considering cortical steroid injections and cool laser treatment by a dermatologist to help flatten the scar or reduce it. From what I have seen when I look at scars in general they are flat but my scars are not. From my research and what the doctor told me scars take about 12 months to mature and we are passed that point. Please provide your opinions, thoughts, experiences suggestions etc. Last time I spoke with the Dr. Bloxham about FUE into the scar he thought the scars looked fine and were not noticeable to the average eye but I disagree and prefer to wear my hair shorter. The Pictures below are 1 day after getting my haircut with #2 guard.

Edited October 10, 2017 by newjersey774

[JayLDD]

Mfue is a nonsensical and poor procedure. Sounds like it was recommended more so they could add a black patient with curly hair type to their mFUE portfolio to show off (or experiment to see if it was effective for), and it didn't go as planned. Guarantee you wouldn't have had the same issue with FUE.

[Dr Blake Bloxham]

I was just made aware of this thread.

 

I will post more information including pictures and video of this patient with a 1.5 guard hair cut and and explanation of why larger pieces (and not the traditional smaller mFUE pieces) were taken in this patient specifically.

 

I'm starting a surgery in a few minutes, but will update as soon as I get the chance. As this patient knows, my door is always open to him.

[Dr Blake Bloxham]

Here are the before/after photos and video showing how NJ744 actually appears in reality. These include the hairline results of the procedure itself, which he chose to omit. These results are shown with the patient’s hair buzzed to a # “1.5” guard, which is below the #2 guard the patient was informed (verbally and in writing in the consent form) would be the minimum he would need to successfully cover the scars.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If the goal of a hair transplant is to cover bald skin with growing hair, then by any rational standard this procedure was an unqualified success. And I expressed this to the patient during our 12 month follow-up. I was extremely pleased with the results in both the recipient and the donor.

 

Having said that, I understand that the patient is not happy about the scars. And he went to great lengths in his photographs to present the scars in a manner that exemplifies his point. If he left his hair at the length agreed to prior to surgery, then the casual observer would never know they were there. A lot of thinking, planning, and discussing went into how the donor area would be harvested. NJ744 was involved in every step.

 

All hair transplants leave scars. There are no exceptions. What’s more, these scars represent something very important in hair transplant surgery: a trade-off. This patient rejected FUT. And probably rightfully so. With African American skin type, the chances of hypertrophic and keloid scarring are higher. And a large connected FUT scar that is stretched to this level could have been unacceptable in the donor. However, the trade-off for this would have been excellent yield. Dr. Feller rejected FUE for this patient because he simply didn’t have the characteristics for it and it would have likely resulted in unacceptable transection and a cancellation of surgery after only a few test attempts. He would have had smaller and more frequent scars in the back, but the trade-off would be the almost guarantee of damaged grafts and poor yield. So what we offered this patient was the best and most carefully considered trade-off: let us take small (2cm) “hits” from very strategic areas in the donor. This will leave you with scars like this – which were discussed and known to the patient far beforehand. In return, you will get minimal scarring in the back that is well broken up and eliminates the chances of a long, connected bad scar, but you will get quality grafts and good growth. And as you can see, this is precisely what was delivered: excellent results and very reasonable scarring in the back. So much so, in fact, that I have done this approach now on many patients and it’s a hit. Ironically enough, I’m in the process of actually renaming this approach and creating a video sharing the technique and this patient’s specific case is one that inspired me to keep pursuing it.

 

Knowing everything I know now, I still would not do anything differently on this patient. He has excellent results in the front and can even cut his hair down to a 1.5 with obscured scarring that looks more like trauma than it does surgery -- although a #2.0 or greater was recommended. Despite a rejection of pretty much all my recommendations during the post-operative period – which were given over the course of dozens of email exchanges and several in-person consultations -- his results are undeniable.

 

In the end, he is my patient and I want nothing but the best for him. I want him to be happy. There seems to be this growing idea online that doctors and patients are “adversaries,” but nothing could be further from the truth. I treated his scalp in the same way that I would treat my family members, my personal friends, and ask my own to be treated. We all want a procedure that gives great growth with tiny scars but today's technology demands a trade-off between the two and is a reality all potential patients must recognize and understand.

 

Dr. Bloxham

Edited October 10, 2017 by DrBlakeBloxham

[jjsrader]

So, for a measly reco'd 300 grafts (you gave him 900) you gave him several scars that are very notice-able on short Afro hair, which the vast majority of black guys wear their hair very short.

 

Sorry, you should have told him with his basically non-balding pattern that you didn't want his money.

 

All doctors make errors in judgement; this is one of them.

 

How many neurotic (we ALL are neurotic when losing hair) patients do you turn away w/very very little hair loss when they are young?

 

And yes, Feller was my doctor for about 2.25K grafts back in the day - so I'm not picking on you.

 

And you are showing his identity (eyes) in your rush to publish a video. I think you are very good at your craft but this case of MFUE seems a bit of 'doctor greed' if you ask me.

[Dr Blake Bloxham]

Also, just for clarification purposes: this case was actually 971 grafts.

[newjersey774]

1) Blake I would ask that you either edit or delete the video to block out my face for confidentiality purposes.

2) My haircut in the photos you posted was 3 or 4 days after getting my haircut using 1.5 guard and the purpose of me shaving with the 1.5 guard was so you can examine my scars more closely because they are raised and are not flat which is why I am concerned and why I met with you that day so you can take a solid look at them and guide me.

3) The contract did say do not go below a #2 guard but when I get my haircut using a #2 guard the scars are still noticeable that is why I am not satisfied with the scars. I also showed you a picture of how short I wear my hair prior to surgery and I asked you if that length was fine after a transplant (it was an old photo of me after 1.5 guard haircut).

 

The thread is called scar repair so that is why I posted the scars to get some advice and suggestions. If the yield was my main dissapointment or thought the yield was poor I would have posted the hairline. The frontal hairline improved slightly. I did not go through great lengths to show the scars. It was hard to get solid pictures of the back but overall the pictures of the side were pretty simple. The lighting in the doctors office is a little dark and those pictures with the flash were not a great representation of the scars which is why I did not use them in this thread so I took my own. Forgive me because I am occupied and struggle to read everything off of my phone so I will respond again later.

[Dr Blake Bloxham]

I thought the patient's face was sufficiently blocked in the video. But I'm going to pull it right now, review it again, and then put it back up if I see any areas where it wasn't blurred enough.

[HTREGRETS]

So what happens when the patient has future loss? Do you spread out more ridiculous 2CM scars on the patient?? He should have never been operated on. This is shameful.

[Dr Blake Bloxham]

So what happens when the patient has future loss? Do you spread out more ridiculous 2CM scars on the patient?? He should have never been operated on. This is shameful.

 

If the patient were to lose more hair, the same scar lines would be used in the exact same manner that they would be with an FUT scar. He wouldn't have additional scars.

[Wem1]

If the goal of a hair transplant is to cover bald skin with growing hair, then by any rational standard this procedure was an unqualified success. And I expressed this to the patient during our 12 month follow-up. I was extremely pleased with the results in both the recipient and the donor.

 

I am lost for words at the above, how you can be pleased with the results in the doner area is beyond comprehension, if this is a case where your happy with the results in the doner area I'm shocked I truely am.

 

I understand that the patient is not happy about the scars. And he went to great lengths in his photographs to present the scars in a manner that exemplifies his point.

 

It then goes from bad to worse when you make the above statement about the patient, can't belive you have come on a forum and tried to defend yourself like that...

 

Knowing everything I know now, I still would not do anything differently on this patient.

 

We all want a procedure that gives great growth with tiny scars but today's technology demands a trade-off between the two and is a reality all potential patients must recognize and understand.

 

Maybe you should have never taken him on, as for a trade off im at a loss how you think this is a fair / normal trade off shocked to the core at at your response to be honest.

 

Things might not always go how we want or expect granted, but your reply as this mans Doctor on a forum has shocked me and that has told me even more of a story than the outcome of the HT.

[Dr Blake Bloxham]

Edited video has been put back up. I made every possible attempt to make sure identity was completely blocked.

[Dr Blake Bloxham]

Everyone is entitled to their own opinion. That's fine.

 

But I'll say it again: I would not change a thing about this case.

 

This patient presented with a very challenging donor -- with respect to both the hair and skin-type -- and both traditional FUT and FUE were off the table. I was able to go in, remove FUT-quality grafts, achieve an excellent result in the front, and leave him without a long FUT scar in the back -- which, trust me, would have been the real issue with the overall nature of his donor. If any doctor would like to come on and discuss the merits of my approach or what they would have done differently, I'm happy to have that discussion.

 

The images and video I presented are 100% accurate. Like I stated before, this is the same environment I use to take all my pre and post-op photos. What you see there is what the public sees. Period.

 

If NJ feels the need to revise his scars, then, again, that's fine. I spoke with him about this and really do not believe it is necessary. With the thin, spaced nature of his donor, I simply don't think they are overly noticeable or look surgical. And I believe the result in the front was an absolute worthy trade-off.

 

Like I said before as well, this approach is really just a middle ground between procedures. I've presented it to many patients who are worried about a connected strip scar, and they happily opt for it. Works great too. I'll present more cases of it soon.

 

And for the record, it would be much easier and more convincing to do something like SMP or grafting into a small area like this than it would be a full FUT scar. So if NJ does opt for this, I'm sure it will work well.

 

And to NJ,

 

I'm still more than happy to discuss this with you further. You have options to address the scars if you really feel the need. I had thought we had discussed this thoroughly during your last appointment, but I am here if you would like. And if you chose to seek treatment elsewhere, I wish you nothing but the best.

[Melvin- Admin]

NJ there's not a whole lot you can do to scars besides transplanting hair to the scars, which will then cause even more scarring in a different location, unfortunately there is no surgery with out scarring, however the scarring from the MFUE procedure is not what I would call appropriate scarring for a procedure that is supposed to have "FUE" like scarring, I agree the scars are clearly visible, I doubt the average person would pay close attention, but if they did they would most certainly see the scars.

 

The only logical thing to do is let your hair grow out longer to cover the scars, I know it sucks but its really the best option that would be free and wouldn't cause additional scarring. I don't think steroids would do much because the scars appear stretched. I don't know much about laser therapy but again I would be weary about spending extra money on a scar that is permanent.

[TheRealDeal23]

That, in my opinion, is not an acceptable scar and the doctors response to it shocking. While I get surgeries can have unexpected results and don't always go according to planned, the doctor should own up to the fact that this is one of those cases and that is not an acceptable result. If the scar is noticeable at a 2 guard when you were promised it shouldn't be, that is just plain wrong. That promise should not have been made. Even if it is "slightly noticeable" it's not acceptable. Some doctors have no sympathy to how difficult and distressing it is to deal with scars and play it off as well "there is always going to be some scarring" or "just grow your hair longer"

 

Your best bet is to get some hair grafted into the scar, and then probably finish it off with some SMP to make it look almost unnoticeable because right now it is noticeable. In my opinion, doctors should grant refunds for stuff like this because now you have to dig even deeper into your pockets to fix something that shouldn't have been there in the first place. I wish you the best of luck and keep us updated.

[TheRealDeal23]

I suppose you're the type of person who demands a refund when he goes to McDonald's and gets fat after eating the food...even though they delivered on what was promised. There's a trade off. The hairline work is really quite good. Scarring is unpredictable, and Dr Bloxham hasn't been disengenuous at all. This is not the type of case where a refund is warranted because the patient looks markedly better than his before photos. Perhaps a free scar repair or some grafting / smp is in order. But a total refund is absolutely insane.

 

"Even though they delivered on what was promised" what was promised was a 2 guard cut without the scar being noticeable and that is not the case. The scar is still noticeable. Promising something of this sort should have not been done in the first place since like you said scarring is unpredictable. Thats a mistake on the surgeons part. The fact that scars are often overlooked because now you have hair in the front is what's largely wrong with the hair transplant industry. I understand there is trade offs but the scar shouldn't overshadow the whole procedure. A successful procedure includes cosmetically acceptable scars. That is in no way cosmestically acceptable. A refund is not "insane". The patient is the one that has to live with this disfiguring scar the rest of his life. Free scar repair at the minimum.

[Melvin- Admin]

No, it is not what the public sees. You're using a flash for your photos and the angles of the photos aren't consistent with what the patient showed in his photos. You can't use a flash on your camera and legitimately claim that it is accurate. Flash was invented to illuminate where natural light is lacking but the intensity at which this occurs is anything but natural. It takes time to learn how to use a flash and you can't just turn it on auto and expect it to work well. A typical flash mounted on top of a DSLR puts out about 1.5 million lumens where a typical living room or office will get about 5000 lumens from five 100 watt incandescent ceiling lights. This is the problem with all of your photos. My advice would be to take photos in your studio and set up a standard three angle arrangement of continuous lighting, not flash or strobes. Google three angle lighting photography to see what I'm talking about.

 

The hairline looks good but like the patient said, he's concerned about the scars and I can see why. This isn't FUE style scarring. I don't know if revision makes sense or placing new hair into the scars would work because that might be asking for more of the same. Could a small strip be taken again and take that hair to fill the other scars so that there is only one scar without hair in it instead of four? Maybe revise one of them and take a slightly wider piece to get the hair necessary?

 

I have to agree flash photography is not an accurate depiction, regardless the only thing the matters is the patients satisfaction, whether the clinic or anyone else say it’s not bad is irrelevant, it’s about how the patient feels as it is his head, personally I don’t think his hair loss warranted the scars, and I personally would have told him not to undergo surgery, this is one of those cases where the patient traded in one insecurity for another. Unfortunately, what has been done has been done, I hope he can understand that undergoing further surgery will only cause more scarring, whether it’s scar revision, or FUE, even if he chooses SMP we’re talking about additional time and money spent.

 

This is one of those cases that are important for others to see, because the harsh reality is that no surgical procedure is scarless and if the scar is worse than the hair loss than you should NOT get surgery.

[TheRealDeal23]

I'll let you in on a secret. No decent surgeon makes that promise, and I very much doubt Dr. Bloxham did having been trained by Dr. Feller. They can try their best to minimize scarring, but it is still unpredictable. I don't think the scars look great either, but their closure technique is solid. You don't need to talk to me about destroying a patient's life. My life has been irreversibly altered courtesy of a well known Canadian doctor's tech dismantling the back of my head. In my case, it was over harvested, I had minimal growth, chronic inflammation, and the list goes on. Dr. Bloxham repaired this patients hairline, did not over harvest, made a judgment call to harvest additional grafts safely, and gave the patient clear instructions on post op care. In fairness, I would have just opted for a standard strip. I think Dr. Feller would even agree that MFUE causes more trauma than a standard strip and I'd be reluctant to get multiple scar repairs. I think some light fue grafting and SMP is his best option and he can move on fairly easily. This isn't a failure by any stretch.

 

 

I understand that but the scar is far worse than the hair loss in my opinion. I'm not saying anything about Dr. Bloxham as a surgeon as I'm sure he is a solid one, but this is not a successful case and I just think the patient has every right to be upset. I'm sorry to hear that you have been a victim of poor hair transplantion. I'm sure you understand the distress and misery it can cause. I just believe cosmetic scarring is a part of the hair transplant procedure and if a poor result is created there, you cannot call the hair transplant successful especially if the patient feels even worse than he originally did with the hair loss. Dr. Bloxham said the patient agreed to wear his head at a number 2 minimum verbally and in writing assuring him the scarring would not be seen and that is not the case. What's done is done though and I hope they can work together to resolve the issue.

[Curious]

Could a two layer closure been done to this patient's donor areas?

[Bald36]

I hope the OP finds help. I can't imagine being told I'd have FUE type scarring then come out like this.

[TheRealDeal23]

Keep us updated on how you resolve the issue, newjersey.