Why Do Repairs Require Multiple Surgeries?

[HappyMan2021]

Why do repairs universally seem to require a multiple-surgery approach? Why do repairs always seem to have to be broken up? Why is a mega-repair session seemingly unheard of?

Assume a patient has 1k badly angled grafts. Why can't a doctor extract and correctly reimplant these grafts all in one-go? Why does it seem, no matter the doctor, repairs such as this always require multiple procedures? 

This thread is looking for scientific, objective answers why repairs by default seem to require multiple surgeries. 

Not looking for mudslinging or politics. Just rational, logical explanations why repairs seemingly by default require a multiple-surgery approach. 

[mister_25]

I know that a surgeon can’t get rid of every single badly angled graft due to some resting in the telogen phase.

There was a post from a user earlier saying that transplanting into scar tissue has lower survival rate. So if you scarred from your botch job it would make things difficult so I imagine a slow and cautious approach is appropiate

Also what would you constitute a mega repair session? I’ve seen a 5k+ graft repair procedure before.

[HappyMan2021]

8 minutes ago, mister_25 said:

Also what would you constitute a mega repair session? I’ve seen a 5k+ graft repair procedure before.

were these 5k grafts extracted? or more like 5k brand new grafts from the donor area implanted? I would consider extracting/reimplanting 1k+ grafts to be a megasession, which at least I have not heard of. 

what I am thinking about is say you have an area of your scalp with like 1000 badly angled grafts. It seems, literally no matter the surgeon, doctors do not extract all 1000 at once. They have to split up the 1000 grafts into multiple procedures. 

Very frustrating doctors can't repair an area like this all in one go. The scar tissue and lower survival rate makes sense, I suppose. 

 

[mister_25]

9 minutes ago, HappyMan2021 said:

were these 5k grafts extracted? or more like 5k brand new grafts from the donor area implanted? I would consider extracting/reimplanting 1k+ grafts to be a megasession, which at least I have not heard of. 

what I am thinking about is say you have an area of your scalp with like 1000 badly angled grafts. It seems, literally no matter the surgeon, doctors do not extract all 1000 at once. They have to split up the 1000 grafts into multiple procedures. 

Very frustrating doctors can't repair an area like this all in one go. The scar tissue and lower survival rate makes sense, I suppose. 

 

It was 5.7k FUT procedure to cover up a 3k FUE botch job. Looks like the patient went in for a second op to get the last poorly angled grafts out

 

Edited December 27, 2022 by mister_25

[sl]

This video should be helpful in explaining some of the challenges. You also need to take into account healing and if you punch out a lot of grafts together then it can become a linear scar..as in puncturing a piece of paper continually along a line with a pencil tip..the more you put and the closer together then also the more chance of them joining.

Repairs really are far more complex than people imagine, the depth and direction of the grafts also are usually wildly different to native follicles and you may also need more than one attempt to get some. Anyone can break an egg but no one can put it back together and repair work is like that, it takes no talent to ruin someone but a lot to repair and as said the below video from Dr.Bisanga will give some further insight.

Best is to research well and not to become a victim of these clinics because even in the best hands you are going with many issues that are not limited to the recipient area only and the last person to touch the patient becomes responsible for them going forwards and mostly the offending clinics then get off with no problem at all and the patient paid them at times for 5k grafts that were all done and dusted in 4 hours with 9 other patients at times the same day. The repair clinic will be doing far more hours for far less grafts and also then hold the responsibility of the patients outcomes with all of the limitations that are present, combined with far higher expectations and questions that the first clinic never had to deal with at all. So, usually there really is a lot more involved in repairs and it is harder for patient and clinic alike.  

Make sure to get educated well and realistic expectations because at times it really is the last chance to get it right with very real challenges and limitations. We put so many educational vids out there to educate and have done so for over a decade but the problem is worsening exponentially. 

 

Take care.

 

 

 

[jjsrader]

These videos are very satisfying!  You know, like those pimple popper videos & all that jazz!!😆

[Melvin- Admin]

2 hours ago, sl said:

This video should be helpful in explaining some of the challenges. You also need to take into account healing and if you punch out a lot of grafts together then it can become a linear scar..as in puncturing a piece of paper continually along a line with a pencil tip..the more you put and the closer together then also the more chance of them joining.

Repairs really are far more complex than people imagine, the depth and direction of the grafts also are usually wildly different to native follicles and you may also need more than one attempt to get some. Anyone can break an egg but no one can put it back together and repair work is like that, it takes no talent to ruin someone but a lot to repair and as said the below video from Dr.Bisanga will give some further insight.

Best is to research well and not to become a victim of these clinics because even in the best hands you are going with many issues that are not limited to the recipient area only and the last person to touch the patient becomes responsible for them going forwards and mostly the offending clinics then get off with no problem at all and the patient paid them at times for 5k grafts that were all done and dusted in 4 hours with 9 other patients at times the same day. The repair clinic will be doing far more hours for far less grafts and also then hold the responsibility of the patients outcomes with all of the limitations that are present, combined with far higher expectations and questions that the first clinic never had to deal with at all. So, usually there really is a lot more involved in repairs and it is harder for patient and clinic alike.  

Make sure to get educated well and realistic expectations because at times it really is the last chance to get it right with very real challenges and limitations. We put so many educational vids out there to educate and have done so for over a decade but the problem is worsening exponentially. 

 

Take care.

 

 

 

Nothing else to say after this, well done 👏🏼

[NikosHair]

Whether it's a virgin scalp or a repair, multiple HT's often comes down to expectation . 

It's about managing that expectation.

Doctors really need to understand the repair patients expectation and be realistic with them.

Tell them honestly that it may take 2 or 3 passes.

The problem is patients dont want to hear that

An ethical doctor loses the work to someone who says 'no prob, one and done' (knowing they will most likely get the repeat business).

Never forget it's a business.

 

Edited December 27, 2022 by NikosHair

[NikosHair]

4 hours ago, HappyMan2021 said:

This thread is looking for scientific, objective answers why repairs by default seem to require multiple surgeries. 

 

3 hours ago, mister_25 said:

There was a post from a user earlier saying that transplanting into scar tissue has lower survival rate. So if you scarred from your botch job it would make things difficult

That's not very scientific.

Where's the evidence?

[Melvin- Admin]

10 minutes ago, NikosHair said:

 

That's not very scientific.

Where's the evidence?

https://ishrs.org/2006/01/01/hair-restoration-in-the-scarred-scalp/

[NikosHair]

2 minutes ago, Melvin- Moderator said:

https://ishrs.org/2006/01/01/hair-restoration-in-the-scarred-scalp/

That's not scientific evidence.

It's a article by an organisation that represents & promotes doctors.

[Melvin- Admin]

36 minutes ago, NikosHair said:

That's not scientific evidence.

It's a article by an organisation that represents & promotes doctors.

ISHRS is a society of doctors that meet to discuss advancements in the field of hair restoration, they also feature studies conducted by surgeons. You’re asking for studies but I don’t think you understand what it takes to finance a study. It’s common knowledge that blood flow is lower in scar tissue.
 

https://www.mccormick.northwestern.edu/news/articles/2014/11/new-device-reduces-scarring-in-damaged-blood-vessels.html

 

[NikosHair]

4 minutes ago, Melvin- Moderator said:

I don’t think you understand what it takes to finance a study

How do you know what I know?

5 minutes ago, Melvin- Moderator said:

https://www.mccormick.northwestern.edu/news/articles/2014/11/new-device-reduces-scarring-in-damaged-blood-vessels.html

That isn't about transplanting into scar tissue, it about a Surgical membrane.

I'm not busting-your-balls but all this bro-science on HRN is fine if that what you're into but it becomes chinese whispers.

No one know where the info came from.

It gets repeated with all the conviction of fact.

The OP asked for a 'scientific' debate, I think we should respect their request.

 

[Berba11]

If you're punching out 1000 grafts and then trying to re-implant in the same area you'll come across three problems: 

1. You're going to be making a lot of extraction sites close together, probably at or near to the hairline. If those extractions are done with a large punch or are too close together, you could risk creating more trauma and more scarring because the extractions may overlap (eg, two small punch sites too close may become one larger hole, which could cause more visible scarring). It's a bit like getting carried away piercing the film lid on a microwave meal... Pierce it too many times and eventually you'll stag an existing hole and make an even bigger one! Obviously any extractions in the frontal hairline need to be done very carefully so as to keep scarring to a minimum. When done well the scarring is usually not visible at all. So best to do it over a couple of sessions and take things bit by bit, depending on the number being extracted.

2. Some hairs simply won't be visible - they'll be in a shedding phase and will need to be extracted later, or plucked - depends on the patient; whether they're happy to pluck away and how many stragglers there are.

3. In order to re-implant into the same areas you have to create incisions sites amongst the extraction sites. See point one really... Same difference. There's going to be a limit on the space required to punch out and then re-implant into the same areas. But it depends what you're doing really... If you're raising a hairline, most of the new incisions sites will be behind the new hairline, meaning you're not re-implanting into the extraction sites save for a smaller number of single grafts to soften the new hairline. But equally the extraction sites won't be covered by new hair with a hairline raising surgery, so too many extractions too close together all in one go could cause more visible scarring than could be achieved with a multi-stage process.

I'm not sure exactly what you mean by 'scientific' - the reason good doctors will favour a multistep approach really comes down to available space and trauma given that we're talking about extracting and implanting into the same area at the same time. Normally you're taking hair from one area and then implanting it into a totally different area of the head, so these issues don't arise. But in frontal hairline repair cases, you're doing both aspects in the same place (or near enough).

[HappyMan2021]

7 minutes ago, Berba11 said:

I'm not sure exactly what you mean by 'scientific'

I didn't mean to imply like I only want answers from scientific journals (although those are appreciated as well)

Moreso that I am looking for objective, rational, logical answers as opposed to trolling or an answer clearly biased by someone's personal agenda. 

Your answer was good!

[NikosHair]

14 minutes ago, Berba11 said:

so too many extractions too close together all in one go could cause more visible scarring than could be achieved with a multi-stage process.

I agree that is a consideration. 

I also subscribe to the view that HT's are part medicine, part artistry. Now I know that doesn't sound very scientific 😊 but some surgeons either through education, experience or natural talent can create stunning results.

So my point is, we have no problem with a portrait artist making multiple passes to create their masterpiece, why should a HT surgeon be expected to get it done in one hit? (especially with a repair).

Edited December 27, 2022 by NikosHair

[Berba11]

Also OP, I have to ask...

You've had your first round of repair surgery with Dr Mwamba in June, right?

Why did you not just ask him and the other surgeons you consulted with why they suggested a multi-surgery approach? I noticed you post a heck of a lot of question threads, many of which seem easy enough to search for the answer or are better off directed to your surgeon. Genuinely just curious... not having a pop!

[mister_25]

3 minutes ago, Berba11 said:

Also OP, I have to ask...

You've had your first round of repair surgery with Dr Mwamba in June, right?

Why did you not just ask him and the other surgeons you consulted with why they suggested a multi-surgery approach? I noticed you post a heck of a lot of question threads, many of which seem easy enough to search for the answer or are better off directed to your surgeon. Genuinely just curious... not having a pop!

I actually like that OP makes these threads, you get a variety of different answers from members of the community, it creates thought provoking discussions that can lead to new questions and new answers. It also will help people later down the line that have the same question and that search it online and may stumble across this thread.

 

[Gatsby]

I think Dr Bisanga answered this question best by saying the goal is to minimize the scarring and to remove all of the unwanted hair. As a repair patient and can totally agree with his statement. I had more than two rows of 'punch graft plugs' removed over a five year period. The reason it took several surgeries is exactly for the reason stated by Dr Bisanga.

[Berba11]

1 minute ago, mister_25 said:

I actually like that OP makes these threads, you get a variety of different answers from members of the community, it creates thought provoking discussions that can lead to new questions and new answers. It also will help people later down the line that have the same question and that search it online and may stumble across this thread.

 

Fair. Like I said, not having a go... Just seems a strange question to field to a forum 6 months after actually having repair surgery with one of the best around, plus consultations with, among others... Konior!

[HappyMan2021]

19 minutes ago, Berba11 said:

Also OP, I have to ask...

You've had your first round of repair surgery with Dr Mwamba in June, right?

Why did you not just ask him and the other surgeons you consulted with why they suggested a multi-surgery approach? I noticed you post a heck of a lot of question threads, many of which seem easy enough to search for the answer or are better off directed to your surgeon. Genuinely just curious... not having a pop!

correct, the first repair surgery was with Mwamba in June, and I am having a 2nd repair surgery with him in less than 2 weeks 

When I began my repair journey, all the docs I talked to except Mwamba to said this was going to be a multiple-surgery journey. Mwamba was the only one who said he could get it "one-and-done".

I will say that aesthetically, when I have my hair styled in its normal way, without any product it looks completely natural, good, and "passable." But there are clearly significant bad angles that for whatever reason Mwamba did not extract during the first surgery. 

So whether Mwamba's definition of "one-and-done" is a good, natural result that still technically has some flaws, or was just a marketing ploy to get me to become his patient, there is still work to be done. 

I definitely plan on getting firm answers from Mwamba when I see him in person. 

I'm not upset or angry really at Mwamba for telling me I could be a one-and-done repair, because it seems I was always destined for a multiple-surgery repair, whether it was with Mwamba or another surgeon. Plus, Mwamba is indeed great at what he does. He did 100% fix my primary pain point (a super ugly artificially created cowlick in my right side hairline from my 1st HT/botched). I guess he just couldn't fix everything else entirely. 

I ask these questions because I can't be bothered to look up the answers all the docs provided me earlier in the year lol, and I just wanted to get answers from the forum. 

 

Edited December 27, 2022 by HappyMan2021

[NikosHair]

2 minutes ago, Gatsby said:

exactly for the reason stated by Dr Bisanga.

You never go too wrong listening to Dr B. Straight talking, No BS type of guy. All done with humility and humour.

A credit to the HT community.

[HappyMan2021]

8 minutes ago, Berba11 said:

Just seems a strange question to field to a forum 6 months after actually having repair surgery with one of the best around, plus consultations with, among others... Konior!

Even though this upcoming surgery will be my 5th surgery, I am still learning something new about hair transplants all the time. 

A good analogy is going to the dentist/orthodontist. I had braces 2x when I was younger, and have gone to the dentist dozens of time in my life. But no one expects someone to be a subject matter expert in dentistry/orthodontics just because they have visited the specialist in question. 

I think one of the most unique and troublesome aspects of the hair transplant world is patients are somehow expected to know as much about this complex medical procedure as the surgeons themselves lol. 

Plus, its just more convenient, easier, and wanted forum opinions. 

Edited December 27, 2022 by HappyMan2021

[Melvin- Admin]

3 hours ago, NikosHair said:

 

That's not very scientific.

Where's the evidence?

 

1 hour ago, NikosHair said:

How do you know what I know?

That isn't about transplanting into scar tissue, it about a Surgical membrane.

I'm not busting-your-balls but all this bro-science on HRN is fine if that what you're into but it becomes chinese whispers.

No one know where the info came from.

It gets repeated with all the conviction of fact.

The OP asked for a 'scientific' debate, I think we should respect their request.

 

If there’s compromised blood flow, the yield will be lower. Scar tissue has lower blood flow due to potentially damaged blood vessels. This isn’t bro science. 

I listed a credible medical website. But regardless, OP wasn’t looking for scientific medical literature.

[NikosHair]

32 minutes ago, Melvin- Moderator said:

If there’s compromised blood flow, the yield will be lower. Scar tissue has lower blood flow due to potentially damaged blood vessels. This isn’t bro science. 

The bro science is taking a piece of information and making an assumption( lower yield). It fine to have an hypothesis but you need to back it up with evidence. The article you linked was about a paper on:

“Periadventitial atRA citrate-based polyester membranes reduce neointimal hyperplasia and restenosis after carotid injury in rats,”

More to the point in the other article you linked to says  (nothing about lower yield).

Quote

 

Is hair restoration an option to consider for the scarred scalp?

The answer is “Yes” in the majority of cases. The method of hair restoration is usually hair transplantation. Skilled, experienced physician hair restoration specialists have been very successful in transplanting hair to scarred areas of the scalp