What do you think of this repair case? - Dr Arshad hairline repair, hairline grafts punched out and re-implanted! From Jan 2022 (10 months)

[Adam Hair Dr Clinic Leeds]

Hi, 

I would like to share this case with you. This 26 year old male had an FUE hair transplant (not in UK) several years ago. Since then he had further male pattern hair loss and developed a large recessed area between the hairline that had been implanted and his native hairline (which had moved further back, particularly in the frontal temporal areas). 

He was quite distressed with the unnatural appearance, he struggled to cover the receding areas and found the new hairline to be unnatural (with poorly directed hairs). After multiple consults he spoke to Dr Arshad on several occasions and options to repair his hairline were discussed in depth. He then underwent punch extraction of the previous hairline and FUE from scalp donor to reconstruct a more natural hairline. 

Some points to note about this case are: 

• the hairline that was previously implanted was too low and into the region of the frontalis muscle, these can be removed through various means, punching out these grafts has certain risks for example scarring, and regrowth of hairs. The patient was keen to punch out all of the previous hairline so these same grafts could be used further back. 
• the punch extractions was difficult as the hairs were very misdirected
• the patient has some regrowth of the punched out grafts which he plucks and trims, he has some scarring and induration in this area 
• because of the regrowth of some of the previous grafts in the hairline, the options of further punch out extractions was discussed with the patient. But he is worried about further scarring in this area. Also the option of excising this area and raising/advancing a forehead flap was also discussed with the patient, as he is now happy with the density at the front of his new hairline and is on finasteride, therefore after a period of observation (to ensure stability of his male pattern hair loss) such a forehead reduction procedure with Dr Arshad is an option for him in the future. 

Graft breakdown:

- Punch outs from previous hairline 395

- Singles - 110, doubles 40, triples 1,139

Total number of grafts implanted = 1684

I hope you enjoy reviewing this case. 

Regards

Adam 

__________________

PRE OPERATIVE

 

 

 

 

 

 

 

AFTER EXTRACTION OF PREVIOUS GRAFTS AND IMPLANTATION OF NEW HAIRLINE

 

 

 

AFTER 10 MONTHS

 

 

 

 

 

 

 

 

 

 

 

Edited November 9, 2022 by Adam Hair Dr Clinic Leeds

[Berba11]

54 minutes ago, Adam Hair Dr Clinic Leeds said:

Hi, 

I would like to share this case with you. This 26 year old male had an FUE hair transplant (not in UK) several years ago. Since then he had further male pattern hair loss and developed a large recessed area between the hairline that had been implanted and his native hairline (which had moved further back, particularly in the frontal temporal areas). 

He was quite distressed with the unnatural appearance, he struggled to cover the receding areas and found the new hairline to be unnatural (with poorly directed hairs). After multiple consults he spoke to Dr Arshad on several occasions and options to repair his hairline were discussed in depth. He then underwent punch extraction of the previous hairline and FUE from scalp donor to reconstruct a more natural hairline. 

Some points to note about this case are: 

• the hairline that was previously implanted was too low and into the region of the frontalis muscle, these can be removed through various means, punching out these grafts has certain risks for example scarring, and regrowth of hairs. The patient was keen to punch out all of the previous hairline so these same grafts could be used further back. 
• the punch extractions was difficult as the hairs were very misdirected
• the patient has some regrowth of the punched out grafts which he plucks and trims, he has some scarring and induration in this area 
• because of the regrowth of some of the previous grafts in the hairline, the options of further punch out extractions was discussed with the patient. But he is worried about further scarring in this area. Also the option of excising this area and raising/advancing a forehead flap was also discussed with the patient, as he is now happy with the density at the front of his new hairline and is on finasteride, therefore after a period of observation (to ensure stability of his male pattern hair loss) such a forehead reduction procedure with Dr Arshad is an option for him in the future. 

Graft breakdown:

- Punch outs from previous hairline 395

- Singles - 110, doubles 40, triples 1,139

Total number of grafts implanted = 1684

I hope you enjoy reviewing this case. 

Regards

Adam 

__________________

PRE OPERATIVE

 

 

 

 

 

 

 

AFTER EXTRACTION OF PREVIOUS GRAFTS AND IMPLANTATION OF NEW HAIRLINE

 

 

 

AFTER 10 MONTHS

 

 

 

 

 

 

 

 

 

 

 

Lovely repair case - looks a 1000x better now.

Is there anything further the patient can do to minimise scarring in the extraction sites along the old hairline?

[WhiteyUK]

1 million times better… that 1st hairline is shocking 

[MKE 1968]

wow - looks great

 

[follically challenged]

This is such an improvement, great job! Anything that can be done about those scars though...?

[Melvin- Admin]

This is an INCREDIBLE repair, well done Dr. Arshad 👏 

[ClinicAudit]

From a nightmare to a daydream. What an amazing repair job! Very brave to take this on, congratulations to everyone - surgeons and patient!

[Steeeve]

🔥🔥 Amazing repair! Congratulations!

[mrmane85]

Hairline looks 100x better now. 

Interesting to see this patient get so much scarring.

I've seen a number of cases where grafts were removed from the hairline without any scarring (mainly by Konior and Feriduni) 

[GAT]

Amazing work.

[Gatsby]

Incredible results and should serve as a sticky for every young man wishing to race off to Turkey for a low hairline. Those scars will improve over time and the patient does have the option of styling his hair forward to cover this if he feels self conscious. Personally I would just pass it off as bad acne, etc, if anyone asked. But the hairline design is perfect and no grafts were wasted. I think I would have serious hesitations (from my own experience with this) about moving forward to have a forehead reduction excision. He runs a very real risk of ending up where he started from re: scars. Thanks for sharing!

[drawdownfx]

unbelievable you changed that man's life well done Dr Arshad.

[Steeeve]

8 hours ago, Gatsby said:

 I think I would have serious hesitations (from my own experience with this) about moving forward to have a forehead reduction excision. He runs a very real risk of ending up where he started from re: scars. Thanks for sharing!

Well said.

[Berba11]

8 hours ago, Gatsby said:

Incredible results and should serve as a sticky for every young man wishing to race off to Turkey for a low hairline. Those scars will improve over time and the patient does have the option of styling his hair forward to cover this if he feels self conscious. Personally I would just pass it off as bad acne, etc, if anyone asked. But the hairline design is perfect and no grafts were wasted. I think I would have serious hesitations (from my own experience with this) about moving forward to have a forehead reduction excision. He runs a very real risk of ending up where he started from re: scars. Thanks for sharing!

Absolutely this. The only thing this guy might want to do from here is consider options for reducing lingering scarring from the graft removal in the most non-invasive way possible; maybe laser treatment, some decent creams or just the passing of more time. Looking at the amazing progress @DrTBarghouthiis making with Verteporfin, another option this patient might have is to have some of those extraction sites reopened, treated with Verteporfin and then left to heal without/with significantly less scarring.

There are certainly far, far better options than an excision along the forehead.

Would be good to hear from @Adam Hair Dr Clinic Leedsabout the options this patient or future patients might have regarding the forehead scarring.

[Adam Hair Dr Clinic Leeds]

Thank you for all the feedback, it is appreciated.

I have had a chance to discuss this with Dr Arshad. 

@Gatsby totally agree that over time the scarring can get less. Obviously this is dependent on the individuals biology and ability to heal. At the moment the patient is just relieved he can go out in public again and move on with his life. Continuing to apply bio-oil may improve the appearance further and he can always apply some concealer/foundation on the scarred skin. 

In terms of scalp advancement flap/forehead reduction surgery, Dr Arshad stated that this would only be an option if his male pattern hair loss was stable over a number of years and as a last resort if the scarring was an issue that persisted over time. 

In terms of the details of forehead reduction surgery, essentially the zone of scarring (shown in black) from the extracted grafts would be excised as per the picture below. This would involve making a zig-zag incision in the hairline, raising the scalp flap, advancing the scalp and anchoring to were the forehead skin has less scarring (lower line of the zone coloured in black). The closer of this linear wound would be using a trichophytic technique so hair follicles can grow through the scar.  Essentially, the larger black area zone of punch scars would be exchanged for a finer linear scar hidden within the hairline. As a result of this, of course, the hairline would move around 1.5cm lower (depending on scalp laxity). Prior to doing the punch extractions across the full region of the botched previous hairline (in order to salvage as many grafts as possible) these future options were discussed by Dr Arshad in depth with the patient. 

In any case the patient is now enjoying his new hairline and further intervention can be considered only if and when required. 

I hope this information is useful, thanks again.  

Regards

Adam 

 

 

[Pbaird98]

Huge improvement, Certainly changed this guys appearance for the better 🤜🏿

[bigmistake]

Can the induration and scarring be minimised if the extraction is done during multiple sittings ?

[Zinedine]

Just AMAZING 🤩

[A Fue Good Men]

Huge improvement from baseline. My only critiques are the punch size and pattern. The punch looks to be very large. So large that some of the punch outs are coalescing which has likely contributed to the scarring. Maybe this should have been staggered over a couple surgeries.

[Speoj]

Brilliant repair work. That previous hairline work was crazy low and sparse. Hopefully the scaring from the punched out grafts reduces over time 

[SoSoz]

This is good example to not rush into surgery..

[Pmk1]

On 11/10/2022 at 7:46 AM, Gatsby said:

Incredible results and should serve as a sticky for every young man wishing to race off to Turkey for a low hairline. Those scars will improve over time and the patient does have the option of styling his hair forward to cover this if he feels self conscious. Personally I would just pass it off as bad acne, etc, if anyone asked. But the hairline design is perfect and no grafts were wasted. I think I would have serious hesitations (from my own experience with this) about moving forward to have a forehead reduction excision. He runs a very real risk of ending up where he started from re: scars. Thanks for sharing!

He could maybe get a skin peel for his scars and laser work.

[Rafael Manelli]

Always impressed at the lack of visible scarring on such a visible part of the body. Hairline looks very natural and soft now, but one wonders what on earth the previous surgeon was thinking…

[RTC]

Amazing repair

[Gatsby]

@Adam Hair Dr Clinic Leeds this result is one that is very close to my heart. Totally agree that his MPB would have to be incredibly stable before going ahead with a forehead lift.

This was me at around 21 after a scalp excision to remove unsightly punch grafts that ran the entire width of the hairline before hand. The second photo is the same scalp excision only with further smaller scalp excisions over a six year period photographed at around 45. Linear scars are incredibly challenging to improve upon. I think this patient looks fantastic and from my own anecdotal experience small micro scars do improve over the years which is in this patient's favour with tiny FUE scars. Thanks for sharing!