Why Do Repairs Require Multiple Surgeries?

[NikosHair]

Anyone interested in learning more can have a look at a post I made in @RTC transplant journey.

Quote

 

There have been studies into hair transplants into scar tissue. Now we are talking significant disfiguring scars from burn, trauma and surgery. Upto 95% growth was observed. 100% of the sample got growth. The patient with lowest growth getting 64% of transplanted hair.

https://www.pulsus.com/scholarly-articles/follicular-unit-transplantation-for-the-treatment-of-secondary-cicatricial-alopecia.pdf

 

 

[Melvin- Admin]

10 minutes ago, NikosHair said:

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).

 

Grafts require blood supply to survive. This is a fact, the article I shared discusses blood flow in scar tissue. I’m extrapolating the information. There’s nothing bro science about it. 

[NikosHair]

1 minute ago, Melvin- Moderator said:

I’m extrapolating the information

That's the problem. 

[Melvin- Admin]

3 minutes ago, NikosHair said:

That's the problem. 

Isn’t that the point of asking a question on a forum?  You don’t have to like the answer or agree. 

@HappyMan2021 

This provides you with a good scientific reason why repairs should be done in sessions.
 

https://www.sciencedirect.com/topics/nursing-and-health-professions/hair-transplantation

 

[NikosHair]

5 minutes ago, Melvin- Moderator said:

Isn’t that the point of asking a question on a forum?  You don’t have to like the answer or agree. 

I haven't expressed a view either way. It isn't about like or dislike.

10 minutes ago, NikosHair said:

That's the problem. 

The problem with extrapolation as evidence is seen in the definition.

[HappyMan2021]

11 minutes ago, Melvin- Moderator said:

@HappyMan2021 

This provides you with a good scientific reason why repairs should be done in sessions.

thanks 🙌

[WhereIsMyMind]

This forum lately seems like arguing for the sake of it. Blood supply problems on scar tissue is known and proven literally for decades... Obviously, if follicles attach and feed from the blood supply, this will affect their health. I cant rly believe this is being up for debate in 2022 or called "bro science".

Here are a few scientific studies that demonstrate that scar tissue has reduced blood supply compared to normal tissue (and trust me, there's many more):

1. "Scar tissue has a reduced vascular supply compared with normal skin, leading to impaired wound healing." (Garg, S., & Kim, H. (2009). Scar management. American family physician, 80(3), 265-272.)

2. "Scar tissue has a lower density of blood vessels compared to normal tissue, which can lead to impaired healing and functional impairment." (Sarul, S., & Ozer, H. (2013). Evaluation of the blood supply of scar tissue using laser Doppler flowmetry. Plastic and reconstructive surgery, 131(1), 25e-33e.)

3. "Scar tissue has a reduced density of blood vessels compared to normal skin, which can contribute to impaired healing and functional impairment." (Broughton, G., & Janis, J. E. (2008). Scar management. Dermatologic therapy, 21(4), 308-318.)

4. "Scar tissue has a reduced blood supply compared to normal tissue, which can contribute to impaired healing and functional impairment." (Neligan, P. C. (2013). Plastic surgery. Elsevier Health Sciences.)

5. "Scar tissue has a reduced vascular supply which can contribute to functional impairment." (Rao, J. S., & Bell, S. (2003). Scar management. The Journal of the American Academy of Dermatology, 48(3), 389-399.)

Edited December 28, 2022 by WhereIsMyMind

[WhereIsMyMind]

Studies that address it directly:

1. Study published in the Journal of the American Academy of Dermatology found that hair transplantation into scar tissue resulted in lower survival rates of transplanted follicles compared to transplantation into normal skin. The study included 37 patients who underwent hair transplantation into scar tissue, and found that the survival rate of transplanted follicles was significantly lower in scar tissue compared to normal skin (68% vs. 88%).

2. Study published in the Journal of Plastic, Reconstructive & Aesthetic Surgery also found that hair transplantation into scar tissue had lower survival rates compared to transplantation into normal skin. This study included 33 patients who underwent hair transplantation into scar tissue and found that the survival rate of transplanted follicles was lower in scar tissue compared to normal skin (71% vs. 89%).

Edited December 28, 2022 by WhereIsMyMind

[WhereIsMyMind]

Also cant find the source, but one study observed that implanting hairs on scars, increased blood supply after few months on old scar tissue.

In short we can confidently say that it is clinically proven that the best approach for a repair surgery is a multi-stepped one, preferably with grafts in scars that regain blood supply over time, and that graft survival is expected to be lower (around 70%).

... Turns out that top repair surgeons know a thing or two about what they doing (surprise!)

Edited December 28, 2022 by WhereIsMyMind

[NikosHair]

You present a bunch of studies on scars. The characteristics of scars isn't being questioned. It's the extrapolation to a lower yield, that's the problem.

You provided two relevant studies:

6 hours ago, WhereIsMyMind said:

Studies that address it directly:

1. Study published in the Journal of the American Academy of Dermatology found that hair transplantation into scar tissue resulted in lower survival rates of transplanted follicles compared to transplantation into normal skin. The study included 37 patients who underwent hair transplantation into scar tissue, and found that the survival rate of transplanted follicles was significantly lower in scar tissue compared to normal skin (68% vs. 88%).

2. Study published in the Journal of Plastic, Reconstructive & Aesthetic Surgery also found that hair transplantation into scar tissue had lower survival rates compared to transplantation into normal skin. This study included 33 patients who underwent hair transplantation into scar tissue and found that the survival rate of transplanted follicles was lower in scar tissue compared to normal skin (71% vs. 89%).

Can you provide links to the studies?

[Al - Moderator]

Just because someone can't give you scientific information on why or how something happens, doesn't mean they don't know it happens. With many things in life, if you spend enough time on something with all different scenarios, eventually you will have a good idea of what works and what doesn't even if you don't know anything about the science behind it all. A 10 year old can sit at an airport all day watching airplanes take off and land. At the end of the day he will be 100% sure that planes can fly even if he has no idea how or why.

 

 

 

[WhereIsMyMind]

8 hours ago, NikosHair said:

You present a bunch of studies on scars. The characteristics of scars isn't being questioned. It's the extrapolation to a lower yield, that's the problem.

You provided two relevant studies:

Can you provide links to the studies?

The extrapolation is self-evident. Follicles attach to blood supply for growth, scar tissue reduces blood supply. 1+1 = 2.

I don't have access to AAD journals (they are behind a paywall and im not an american researcher). I have summaries from my research of several studies. You can pay the journal or ask them directly to give you a quote of the sources if you are interested.

 

[mister_25]

15 hours ago, WhereIsMyMind said:

Also cant find the source, but one study observed that implanting hairs on scars, increased blood supply after few months on old scar tissue.

In short we can confidently say that it is clinically proven that the best approach for a repair surgery is a multi-stepped one, preferably with grafts in scars that regain blood supply over time, and that graft survival is expected to be lower (around 70%).

... Turns out that top repair surgeons know a thing or two about what they doing (surprise!)

Not really relevant but there was a case recently that a patient had a small amount of hair transplanted into a vitiligo patch to restore pigment, I can’t see the thread anymore since the user was banned but it’s interesting to know that a hair transplant can have other effects rather than a Improved cosmetic appearance.

Edited December 28, 2022 by mister_25
Posted before I finished the post oops

[WhereIsMyMind]

17 hours ago, NikosHair said:

Anyone interested in learning more can have a look at a post I made in @RTC transplant journey.

 

"Up to 95% was observed" doesnt mean 95% survivality, that's the outlier from the results. The other end had people below 70% survival. The same study you are quoting has a mean result survivailty of 78% for transplanted grafts. This study is done on patients with cicatrical alopecia which is not the same scar damage than a hair transplant. Even so, the results in terms of survivavility are very similar.

Quoting about transplanting in burnt skin scars -- it has been shown that they survive better than old FUE scars aswell.

"Hair follicle transplantation on scar tissue" (https://pubmed.ncbi.nlm.nih.gov/23851778/)

Quote

Conclusions: The hair follicle transplantation on the scar tissue is more difficult than grafting on normal tissue because the scar is accompanied by poor blood circulation and stiffness of tissue. The patients with burned scar achieved more favorable result than did others. Incision scars are deeper than burned scars, and their success rates are poor. We should recommend the patients that hair follicle transplantation on the scar may need secondary or more operations for the aesthetically better result.

 

Edited December 28, 2022 by WhereIsMyMind

[NikosHair]

23 minutes ago, WhereIsMyMind said:

I don't have access to AAD journals (they are behind a paywall and im not an american researcher). I have summaries from my research of several studies. You can pay the journal or ask them directly to give you a quote of the sources if you are interested.

So you haven't even read the studies🙄

You don't need access behind a paywall to provide the title of the studies, dates and authors.

Where did you get your summaries?

To support your argument you need to cite your source, pretty basic stuff.

[NikosHair]

If there's anyone left that hasn't lost the will to live🙃

It might be good to remind ourselves why survivability of grafts is especially important in repair cases.

A repair patient has already been through enough trauma.

They're putting huge faith in the repair doctor.

All they want upfront is realistic expectations. If I'm paying double or triple the price per graft I want to know the failure rate.

If it take me 2 or 3 passes to get a natural hairline - tell me - upfront.

It would be really good if we could get the input of an expert @DrTBarghouthi

Edited December 28, 2022 by NikosHair

[WhereIsMyMind]

^ communication is another topic which everyone agrees can be improved from doctors and Mwamba case, has nothing to do with all the wrong things you have claimed

Edited December 29, 2022 by WhereIsMyMind
.

[WhereIsMyMind]

7 hours ago, NikosHair said:

So you haven't even read the studies🙄

You don't need access behind a paywall to provide the title of the studies, dates and authors.

Where did you get your summaries?

To support your argument you need to cite your source, pretty basic stuff.

You tell me I havent even read the studies? You quoted one study and didn't even interpret it correctly (or lied on purpose) which actually proved that scar tissue is <75% survival 😄. Then call people on their "broscience" and accuse people of "extrapolating" wrong information. I already gave you a link to a pubilcly available study (https://pubmed.ncbi.nlm.nih.gov/23851778/) where they explicitly recommend several surgeries on scar tissue "We should recommend the patients that hair follicle transplantation on the scar may need secondary or more operations for the aesthetically better result."

Also, every study I mentioned has the citation of where it comes from, some journals are not accesible pulbicly and only for researchers or behind a paywall. I had temporary access to them and made summaries when I was researching this topic. I can't believe you are serious at this point. I guess you are just a troll. Have fun derailing every thread I dont think im gonna get baited anymore, too much energy spent!

Edited December 29, 2022 by WhereIsMyMind

[NikosHair]

More words but still no details on the two reports you describe (in your words) as 'Studies that address it directly:'

You highlight the problem with personal summaries/interpretations. You disagreed with my conclusion on the study I provided.

That's fine, it's part of normal discussion.

The difference is, you could only arrive at your own interpretation because you were afforded the courtesy of the citation. 

It is what it is ... if you ever locate them, then post them up.

Until then, I know at the early stages of your HT. Exciting times for 2023, Happy growing!