Correcting FUE work on Young Patient w/Dr. Ron Shapiro

[Janna]

CORRECTIVE FUE WORK ON YOUNG PATIENT (mid 20's)

A young patient went to another clinic for FUE work. His receding hairline bothered him a great deal so when he heard he could gain back all that he had lost, he was thrilled at the prospect. However, as we've seen so many times, young patients are vulnerable and can fall for unrealistic promises. The result is afterwards they are left with a lot less money and a head of hair that needs to be repaired. This is what has happened with this patient. After the hairs grew out, the patient realized it was unnatural with the hairline being too low, hairs growing in the wrong direction and the anterior edge being too harsh and straight. He noticed he was already starting to thin behind the transplanted hairs and worried about how this would appear if future loss continued. He did not want to end up with an unnatural ring of hairs in the front with little hair behind it.

He contacted Shapiro Medical when he realized his initial HT goals were not met. He sent SMG several pictures to be evaluated. While we could see why he was not happy with his end result from his pictures, it wasn't until Dr. Shapiro met him in person that he was able to thoroughly evaluate and assess what needed to be done to create a more natural look.

What needs to be corrected?

1) Hairline too low, especially with patient being so young with potential for future loss.

2) Hairline noticeably asymmetrical.

3) Number of 2 hair grafts at the hairline.

4) Hairs growing out in wrong directions.

5) 2400 grafts has already been used - depleting donor supply, therefore, care must be taken to use rest of donor supply efficiently as possible to not waste any donor.

As in many 'REPAIR' cases, it is necessary to conduct the repair cases over multiple sessions to get the best results. In this case, the first session was used to punch out as many grafts as possible that were transplanted too low, too big, or growing in unnatural directions. We recycled the punched out hairs further back where appropriate hairline should have been. At the end of our first session, total of 226 grafts were replanted. The plan for the next punch out session will be to repeat this process. The hope is that these two sessions will get rid of most of the grafts that were planted too low. Afterwards in a final and third session, a regular FUE session with predominantly 1 hair grafts to recreate a natural anterior boarder hairline will be performed. The number of grafts needed will be determined at that time. We've had good results with this approach in the past.

Typically, the tiny holes left by the punches heal well with minimal scarring or notice ability.

 

 

 

[Janna]

 

Short clip of Punch outs:

 

[aaron1234]

Very interesting case Janna. It's too bad this patient had poor work done on him. He appears to have a decent head of hair in the first place. I'm positive it will look natural in the end. Was strip not an option? Perhaps due to the prior FUE session?

 

Dr. Paul did around 2 dozen punch outs on me due to the multi-haired grafts in my hairline from my first HT. Punch outs may look somewhat gruesome and do take a bit longer to heal than normal recipient sites. In my experience they eventually healed and became unnoticeable between the third and fourth month. Just in case anyone was wondering.

[Janna]

Originally posted by aaron1234:

Was strip not an option? Perhaps due to the prior FUE session?

 

Punch outs may look somewhat gruesome and do take a bit longer to heal than normal recipient sites. In my experience they eventually healed and became unnoticeable between the third and fourth month.

 

That's correct Aaron as to why he'll be getting FUE instead of strip. Strip is certainly a viable option but he wanted FUE for his first session so he'd have the option to shave his head in the future so we'll continue on with this approach for his future HT work at SMG.

 

Thanks for the additional info on your healing timeline for the punch outs. I think it's really good for people to know this type of info. It never ceases to amaze me how quickly the body heals.

[hdude46]

Janna, typically how far back into existing hair does Dr. Shapiro usually go, especially on a younger patient who may lose more hair and also considering proscar doesn't seem to work as well in the frontal areas?

 

Thanks!

[dakota3]

I feel bad for this poor guy, but he's in great hands now and Im confident he'll achieve his goals with SMG. Good work Janna!

[justincase]

Very interesting case. I imagine that there are going to be a lot of these cases out there like this in the next 10-15 years as guys in their 20's with low aggressive transplanted hairlines age. Janna I have a few questions because Im in a similar situation. What sort of scarring can be expected (if any) from the removal via FUE? Will there be white polka dot effect all over this region now? Also could laser hair removal be used to move the hairline back a cm or 2? Thanks!

[Jotronic]

Janna,

 

These are some really good hi-res photos. Hopefully more clinics will follow suit. Do you have any photos without flash? It is always nice to compare apples to apples and oranges to oranges.

[the B spot]

Originally posted by Jotronic:

Janna,

 

These are some really good hi-res photos. Hopefully more clinics will follow suit. Do you have any photos without flash? It is always nice to compare apples to apples and oranges to oranges.

 

Joe,

 

What are we comparing exactly?

[Janna]

Hi hdude,

They wouldn't go back very far into existing hairs if the native hairs are strong without any signs of miniaturized hairs.

Thanks Dakota.

Justincase,

As long as the skin surface is smooth before the removal of these grafts, the punched holes have been healing fine w/o signs of scarring. We have not come across any white dotting but we use very small size punches. The laser could remove these grafts too but I believe you need about 5-6 treatments to fully rid the hairs.

Hi Joe,

Glad you like our high res pictures, it's the same resolution we've been using for as long as I've been posting our results. You must not be looking, but that's okay, I know you're busy. I think many clinics have followed suit. Off the top of my head, clinics such as True&Dorin, Dr. DeVroye, Dr. Tychocinski, and Dr. Reed all post high res pics. I know there are more clinics but it's almost my bedtime and I'm tired.

 

Being consistent with our photos with use of same camera, lighting, multiple angles, etc. for BOTH before and after pics are important. We've found the shots from above (top-down shots) show through the hairs to the skin more when flash is used, making the density look less. We take pics with flash because it comes out the clearest at our clinic. We also consistently provide as much surgery detail as possible and I'm happy to see some clinics have followed suit. I hope more clinics follow suit in not only taking high res pics but providing all surgery details too.

[conan]

hello all .

 

What is the best procedure to remove an initialy poorly placed/grafted hairline .

 

Brown scar or punching out grafts one per one ???

 

ciao

conan

[BigBill1234]

Any way to see pictures of what a procedure like this looks like after a week? Also, why does he need more punched out of the hairline? It looks good after this procedure.

[Janna]

Conan,

 

Punching out the poorly transplanted grafts will likely be your best option. However, I would say get examined by an experienced ht physician who has a good track record for repairing poor work evaluate you in person so they can determine what's the best option for YOU.

 

Bigbill,

 

This patient is from out of state and he has not sent any pics after his procedure. In regards to your next question, even with a punch out session, not all hairs at the hairline can be punched out in one session. Plus, some of the punched out grafts may not have all come out - for example, when punching out a two hair follicle, one follicle may have remained under the skin. The depth in which some of the grafts are planted vary, along with odd direction of the grafts so it's difficult to predict the angle and depth for punch outs. The second punch out session will not be as extensive as the first. We also do not want to over due the punch out session to see how the patient's skin heals.

[Ventuoguy]

I say we get some hi-res pictures of Janna while we are at it!

 

Kudos to SMG for taking on such a difficult case and posting these photos-good job!!

[BigBill1234]

How long do the little punch out dots stay noticable usually?

[the B spot]

Hi Bill...it really depends on the person...the holes look a little larger because the tissue is expanded a bit to ease the extraction process.

 

As the expansion solution drains the holes close up on their own and form a small scab...generally just like a HT the scabs are gone fairly quickly and may leave a red/pink dot for several days or be unnoticeable right away.

 

Getting a light tan prior to getting a HT is a good idea, as those with fair skin tend to take a bit longer to shed the effects of having surgery.

 

Take Care,

Jason

[mattj]

It would be interesting to know how grafts take to being traumatised for a second time.

 

Do you have any problems with poor growth when grafts are recycled in this way?

[the B spot]

Hi Matt...generally not really. There will always be some slight loss by virtue of doing a HT...regardless of methods...but Dr. Ron has been punching out old work and recycling grafts as a repair approach for many, many years. Once the hair grows it is just as if it never had been moved.

 

I think the only real issue is re-placing into areas that have been punched out due to some decrease in vascularity/scar tissue that can occur as a result of a poor previous surgery.

 

But that is a story for another day!

 

Take Care,

Jason

[tim888]

Hello Janna

Are the any updated pictures of this case?

How does the skin look after the removal of grafts?

 

I am in a similar situation and am looking to remove about 100-200 grafts from the front of my hairline.

 

Thanks

[dsm2894]

Reading this, I am so happy i went to a HT surgeon with an excellent reputation. I keep reading stories of patients in this situation where they had a horrible experience and result.

 

I hope to see an update, but bottom line is to go to a surgeon to do it right the first time.

[tim888]

No update?

[Janna]

Please contact Matt@shapiromedical.com or call him at 1-800-843-1989.

He'll either have access to tupdated pics of this patient or other patients in similar situation.

SMG physicians have a lot of experience with these type of repair work.

[tim888]

Hi Janna

 

I have sent 2 emails- no replies, only read receipts.

 

I see you mentioned this patient had planned to come in for further work.

Could you please kindly post follow up pictures here for the community to see.

Thanks again.

[Janna]

Hi tim888,

 

I will need to check with Matt directly on updates for this patient. I have not been able to access Shapiro Medical data files for some time since moving to the U.K.

 

I'll see what I can do.

 

In regards to your question, "how does the skin look after the removal of grafts?"

 

I have never seen any adverse signs on the skin after fue punch out sessions at SMG. You wouldn't suspect anything was done, the skin heals up smoothly without any discoloration or lack of normal skin pigment from the small punch holes. It's not like the back of the scalp where you get the white dots after fue graft is extracted and heals up.