Dr. Jean Devroye, HTS Clinic / 4418 (78 + 2903 + 1437) FUE Repair

[Dr. Jean Devroye]

 

PATIENT'S DETAILS

✓ 27 years old at the time of the first surgery (Test 2015)

✓ In 2012, he had a previous procedure done in another clinic, 2300 FUE grafts.

✓ Treatments : to be confirmed.

✓ Medium caliber hair.

✓ Fragile follicular units.

✓ Normal % of hair in telogen phase.

 

RECOMMENDED TREATMENT

This patient presented for the first time to my office in October 2013, one year and a half after undergoing a 2300 FUE grafts procedure in another clinic. This previous procedure ended up with poor results and, worse still, two weeks after the surgery the patient started to develop a severe shedding due to psoriasis and dermatitis. This condition (never experienced before) affected him to a great extent both physically and emotionally, so much so that he didn't dare to go out without wearing a cap anymore. During this first consultation, I suggested him to start a treatment based on Nizoral and corticosteroids in order to mitigate the shedding.

In March 2014, the patient showed important improvements in regards to the skin diseases. However, I suggested him to wait further before performing a hair transplant procedure, since the dermatitis was still present at that time.

In February 2015, the patient informed that the symptoms were reduced, nevertheless still evident. Despite that, we agreed upon performing a small test (+/- 100 FUE grafts) in order to check the regrowth rate and if the psoriasis/dermatitis would develop again after the transplant (hence to verify the viability of a more important procedure).

In July 2015, the test was performed - 78 FUE grafts implanted in the vertex area. The test proved to be successful. Nevertheless, I suggested him to wait again for a complete healing before performing an important procedure: analysing his evolution, the symptoms were likely to develop quite rapidly and unforeseeably.

In December 2015, the patient announced that his skin lesions had completely disappeared. So, in February 2016, we were finally able to perform a first procedure to restore his hairline, frontal area and a part of the midscalp - using 2903 FUE grafts. I also suggested him to continue to wear his hair very short after the procedure, since I found that UV rays had a positive impact on the skin disease.

The patient was extremely pleased with the results obtained and decided then to perform a second surgery in order to restore the vertex area. In August 2017, we managed to transplant 1437 FUE grafts (because of his limited donor resources). The last pictures sent by the patient show the current situation, nine months after the second surgery. The regrowth appears satisfying, the density acceptable : if he wish to further strengthen it, we could consider a BHT complement in the future. 

 

SURGERIES DETAILS

1st Surgery (TEST) -  July 2015

✓ 78 grafts

✓ Technique: FUE

✓ Incisions: N/A
✓ Grafts Breakdown: N/A
✓ Total number of Hair: N/A
✓ Average Hair/Graft: N/A

 

2nd Surgery (FUE I) - February 2016

✓ 2903 grafts

✓ Technique: FUE

✓ FUE scoring and extractions executed with my WAW system, now widely used in the sphere of FUE. It consists of a very precise pedal that enables to control the movement of the punch, that I also designed myself. The main advantage is to reduce substantially the number of damaged and transected hair, thus to raise the quality of the procedure. The system is now used worldwide and several dozens of surgeons or centres are already using it.

✓ Incisions: 40-45/cm2

✓ Grafts Breakdown:
☞ 1042 Single FUE grafts
☞ 1698 Double FUE grafts
☞ 159 Triple FUE grafts
☞ 4 Quadruple FUE grafts

✓ Total number of Hair: 4931

✓ Average Hair/Graft: 1.70

 

3rd Surgery (FUE II) - August 2017

✓ 1437 grafts

✓ Technique: FUE

✓ FUE scoring and extractions executed with my WAW system.

✓ Incisions: 25-30/cm2

✓ Grafts Breakdown:
☞ 147 Single FUE grafts
☞ 936 Double FUE grafts
☞ 339 Triple FUE grafts
☞ 15 Quadruple FUE grafts

✓ Total number of Hair: 3096

✓ Average Hair/Graft: 2.15

 

Dr. Jean Devroye

 

 

 

 

 

 

 

 

 

 

 

[Melvin- Admin]

Wow great work Dr. Devroye, I see the extraction pattern on the last surgery went fairly high up in to the donor zone. What is your opinion on using these donor hairs that are generally not considered “safe” I feel that my best hair is located in that section. 

[Sean]

Dr. Devroye, Impressive result based on the patient’s skin conditions too.  Really made a big difference.  This is what I am calling/coining a “distinct” change.  Considering the number of grafts used too.  Excellent work!  

[LonelyGraft]

Which corticosteroid was used by this patient?

[Dr. Jean Devroye]

 

On 7/26/2018 at 6:05 PM, Melvin-Moderator said:

Wow great work Dr. Devroye, I see the extraction pattern on the last surgery went fairly high up in to the donor zone. What is your opinion on using these donor hairs that are generally not considered “safe” I feel that my best hair is located in that section. 

This is a very interesting question and I congratulate for your keen sense of observation.

That boundary zone can be treated in accordance with two philosophies : the first is the "prudent", the most orthodox, taught everywhere and which consists in leaving one or two centimetres not exploited between the donor and recipient areas. There are two main reasons to act in this way : to not use hair potentially unstable and, furthermore, to not create scars in a zone potentially balding.

This modus operandi presents however a big inconvenient, mostly when performing a second (or further) FUE : in fact, it creates a no man's land between the donor and recipient areas having an original density - which is often ungraceful, especially when the patient wears his hair very short - that resembles a halo all around the skull, often called fringe.

The second philosophy, which I tend to apply when the patient wears his hair very short and/or it is about a second (or further) surgery, consists in ending the extraction in a progressive way, approaching the recipient area as much as possible. Obviously, it is difficult to be certain about the boundaries between the donor and recipient areas. However, at worst, we will have transferred a limited amount of unstable grafts. In this specific case, we were practically obliged because of the patient's safe donor limitations (more than 5000 FUE grafts already extracted).

I never had the need to treat a scarring issue in that area but, if it happened, it would be simple to solve by transplanting some hairs taken from the lower area.

 

On 8/1/2018 at 8:56 AM, Sean said:

Dr. Devroye, Impressive result based on the patient’s skin conditions too.  Really made a big difference.  This is what I am calling/coining a “distinct” change.  Considering the number of grafts used too.  Excellent work!  

           Thank you for your comments, much appreciated. 

 

On 8/2/2018 at 9:09 AM, jj51702 said:

Which corticosteroid was used by this patient?

          Medrol was prescribed to this patient.

[Melvin- Admin]

Thank you so much Dr. Devroye, for your detailed response. 

[LonelyGraft]

Thank you doctor.

Do you feel it is safe for a patient to use a potent corticosteroid such as clobetasol for two months leading up to the surgery?

[Sean]

30 minutes ago, jj51702 said:

Thank you doctor.

Do you feel it is safe for a patient to use a potent corticosteroid such as clobetasol for two months leading up to the surgery?

That is a great question.  I’d like to know too as clobetasol is some pretty potent stuff.  

[Dr. Jean Devroye]

On 8/8/2018 at 1:01 AM, jj51702 said:

Thank you doctor.

Do you feel it is safe for a patient to use a potent corticosteroid such as clobetasol for two months leading up to the surgery?

 

I've never prescribed this specific medicament to my patients so I would tend to not give a definitive answer about it. 

However, I consider that in general it is always preferable to perform surgery on a less inflamed area - even if the patient is on medical treatment.

[Steeeve]

This is such an interesting case to me. I love reading success stories like this. The patient is already going through so much but was able to achieve so much with Dr Devroye’s help.

Dr Devroye, I see earlier in the thread you mentioned he would use BHT to compliment his current situation. Considering his dermatitis would you also recommend or not that he use SMP to aid in concealment of his scalp? What about other forms of concealers such as Toppik or topical shaders like Dermmatch? Would any of these options be beneficial to the patient or would they only be helpful in inflaming his dermatitis outbreak?

This is not really a question for this patient in particular. I’m more just asking for my own general knowledge. If someone were going through this are other options available to them that we’re less invasive than a hair transplant?

Edited August 18, 2018 by Steeeve

[Dr. Jean Devroye]

I don't have any experience with a SMP treatment on an inflamed area and I wouldn't like to risk a try, but this has probably been tested by others. However, the use of Toppik or any other keratin-containing product is not an issue given the neutral character of the product (which moreover remains external).