2,500 Graft Repair of Two HT "Sins" | Feller & Bloxham | Dr. Bloxham, NY, NYC, LI

[Dr Blake Bloxham]

There are a few cardinal "sins" in the hair transplant field. And while I doubt a standard list of these deadly sins exist, the general consensus is that they include things like: wasting/not respecting the donor, going too low/flat with the hairline in a patient with future loss, etc.

 

This patient presented after undergoing a "mega session" at another clinic where I believe two of these "HT sins" were committed.

 

The outside clinic attempted a large session on the patient to treat his Norwood VI pattern hair loss. In my opinion, however, two things were done that should not have been:

 

1) An inappropriate amount of grafts were spread way too far all over the entire scalp

 

2) The donor was harvested (FUT) in an awkward manner (likely an attempt to to a mega session harvest by a clinic that doesn't do a lot of them) and this limited the available donor for future surgeries.

Here is how he looked after his procedure at the outside clinic:

 

 

 

He was completely gone on top before the first surgery, so all the hair you see on top is the result of the transplant. As you can see, too few grafts spread too far.

 

But what really made this case a "repair" is the state of the donor. The first clinic started the FUT incision high in the back of the donor area, and almost pointed it downward (opposed to naturally curved upwards) on the sides. This meant in order to obtain a good harvest (which was now limited off the bat) and leave the patient with one acceptable linear scar in the back, I had to harvest above the old scar on the sides and below it in the back.

 

 

Despite the donor challenges, I was able to obtain 2,500 grafts from the donor. And instead of spreading these all over the scalp in a less dense manner (like previously done), I used these to dense pack the frontal scalp and strategically fill the mid-scalp as much as possible. Obviously this doesn't result in as much area being covered, but it's what gives us those dense, natural results.

 

 

And here is how he looked only 6 months after surgery:

 

 

 

 

And here are some with surgical lines to demonstrate the plan and where we worked:

 

 

 

Now the patient has an appropriate result and a framed, natural look. And while it's always nice to get as much coverage as possible on high Norwood patients, it's rarely a good idea to to it at the expense of cosmetically significant density or the state of the donor. Thankfully the patient still has laxity so he is planning on doing one more large FUT session aimed at filling the rest of the mid-scalp and crown. After that he will likely be a good candidate for FUE to finish off any little areas.

 

Thank you for reading. I will update this thread when the patient comes back for a 12 month follow-up -- especially because the camera wasn't being overly cooperative during his appointment and a lot of the pictures didn't come out.

 

But I hope this case serves as a reminder to those with high levels of hair loss looking to undergo big procedures; make sure good, strategic density is utilized and make sure to keep the donor is the best shape possible for future surgeries -- because you may very well not be able to do everything in one shot.

 

Dr Blake Bloxham

Feller & Bloxham Medical, PC

[TakingThePlunge]

Really impressive early results with more to come! He must be extremely pleased.

[Dr Blake Bloxham]

David and Spex,

 

Thank you for the kind words. The patient is very happy with his progress, and even happier to discover that he's really only half way done maturing.

 

Growth in repair/finishing patients is always interesting. Some seem to grow ahead of schedule; my guess is that this would be secondary to the increased vascularity in the scalp from the prior transplant. Others seem to grow noticeably slower; and my guess here would be that this is from the increased scar tissue in the area which is less hospitable to healthy follicle growth.

 

So a bit of a "catch 22" I suppose. Second round patients may grow quicker (like this patient) or they may grow slower.