Bad SMP Repaired with 3,103 graft HT | Dr. Bloxham | Feller & Bloxham, NY, NYC

[Dr Blake Bloxham]

Like many other procedures in this field, SMP is a great tool with the potential to help a lot of patients when done correctly by a skilled practitioner. However, like just about everything else in life, not all SMP clinics are the same and not all practitioners work with the patient's best interest at heart.

 

And that is where our story begins; and it's a little bit of a different case, so I hope members enjoy and I really hope it lets others know there are almost always options to improve upon old or bad work, so don't be afraid to consult and discuss your possibilities.

 

The patient here is a male in his early 40s who initially presented to an outside hair transplant clinic for a consultation years before. He consulted with the hopes to have a hair transplant to treat his Norwood level V-VI patterned hair loss. At that time, he was told that he did not have the donor for surgery and was not a candidate.

 

Discouraged, he looked into other options and found SMP. So he decided to go to an SMP clinic and have permanent SMP done on the entire scalp. Unfortunately, the clinic initially went very low and flat (and somewhat crooked) with the hairline, and the permanent ink partially faded into an unnatural blueish hue overtime.

 

He watched some of our YouTube videos where we had repaired previous bad SMP work and decided to come in for a second opinion about a transplant.

 

Here is how he looked during the consultation/before surgery:

 

 

 

 

 

His donor was definitely below average. In fact, the gaps and spread nature almost made it looks like he had prior surgery. Initially, we discussed doing an FUE to try and create a "haze" of thinner hair on top to blend with the SMP and give him a more 3-D cropped look. But I didn't think his pseudo-afro hair follicle type would do well with FUE, and he had great characteristics otherwise for an FUT approach. I also thought he would received excellent coverage with his follicle type.

 

Here is how his donor looked:

 

 

So we decided on an "AMAP" or (as much as possible) FUT procedure aimed at rebuilding a more appropriate hairline (above the previous SMP hairline) and filling as much as possible with a slight emphasis on coverage over density.

 

Despite his well below average density, I was able to harvest 3,103 grafts via FUT and use them as described above. Surgery went beautifully. Here's a surgical overview:

 

 

 

He came back for a 6 month follow-up and looked great. Even with his hair cut quite short (and the patient cuts his own hair so that is why there is some unevenness in the 6 month pics), he clearly achieved his goals. This is precisely how the patient wanted to style his hair from the get go, though he is going to try growing it a little longer in the future:

 

 

 

 

 

 

 

 

 

Based on the patient's excellent laxity and healing in the donor, we're going to do the rest of the mid-scalp and crown in the not-so-distant future.

 

And although he was concerned initially about starting the hairline above the SMP, I explained that I've done this many times in the past and it usually blends quite well. Particularly when he grows his hair out a bit.

 

But a very satisfying result on a challenging case, and an end to the daily worry about the bad SMP for this patient.

 

Hope you enjoyed. Look forward to your comments.

 

Dr. Blake Bloxham

Feller & Bloxham Medical, Hair Transplant Institute

Hair Transplant & Restoration Services in New York

[forgotpassword]

well done Doctor; looking forward to his 12 month results

[TakingThePlunge]

Very impressive outcome!

[Dr Blake Bloxham]

Forgot and David,

 

Thank you for the kind words.