Necrosis - "it just happens sometimes" or an "explicit error made by the surgeon"?

[Mirko nooh]

Hello everyone. What is your stance about the above statement? 

what is considered a 'legitimate' necrosis complications by a surgeon? is is ~20%? 5%?

and if there is such - does it almost certainly reflect an error by the surgeon?

 

 

[shiba1985]

10 minutes ago, Mirko nooh said:

Hello everyone. What is your stance about the above statement? 

what is considered a 'legitimate' necrosis complications by a surgeon? is is ~20%? 5%?

and if there is such - does it almost certainly reflect an error by the surgeon?

 

 

 

I think in a good surgeons hand the necrosis rate is probably 0.5%. 
 

sometimes it can happen even if you do everything right. 
 

some clinics have Terrible techniques and in that case it is the clinics fault. 
 

there is not one single answer. It would depend on the case and the technique used, solutions used. You woild have to know and observe the whole procedure to troubleshoot why it happened. E.g dense packing, too much epinephrine, too big recepient sites, smoker/ diabetic patient etc. 

[BaldReaper]

100% fault of the surgeon

[Mirko nooh]

If that's the case, I really do think that when some users here reply (about cases of necrosis) that "don't worry, that's the difference between hairmills and clinic X/Y/Z. Clinic X/Y/Z will take care of it and fix it for free if needed", fails to address that having a necrosis is by itself a big issue. This is just damage control of something that shouldn't have happen on the first place, and if it happens systematically is shows no critical thinking is being done by the clinic. 
Not only I see, by reading posts here, that this is the approach of a very esteemed spanish surgeon (who some started calling "hairmill"), but as for myself I also had a surgery and necrosis with one of the recommended surgeons here on this website. After searching for some "reviews posted by patients" (and not "results posted by clinics"), it seems there're too many cases of "small necrotic areas" by this surgeon. 

[shiba1985]

28 minutes ago, BaldV said:

100% fault of the surgeon

completely disagree. In 80% of the cases it can be the surgeons (or surgical technique flaw). In some cases you can do everything by the book and still have a case of necrosis. It is just the risks of being operated on. 

[shiba1985]

32 minutes ago, BaldV said:

100% fault of the surgeon

its like saying every bad scar from FUT is the surgeons fault. We know now, that no matter how perfect some techniques will be, some people just scar poorly or form keloids or what not. At the same time there are a lot of surgeons that use poor closing techniqure and cause bad scars. 

[Mirko nooh]

what do you think should the ethical patient do? should he post about his necrosis?

[BaldReaper]

1 minute ago, shiba1985 said:

its like saying every bad scar from FUT is the surgeons fault. We know now, that no matter how perfect some techniques will be, some people just scar poorly or form keloids or what not. At the same time there are a lot of surgeons that use poor closing techniqure and cause bad scars. 

You are comparing a 200x1500 mm strip removal with an 1x1 mm slit? scalp necrosis happens because of the doctor 100% of the times

[shiba1985]

2 minutes ago, BaldV said:

You are comparing a 200x1500 mm strip removal with an 1x1 mm slit? scalp necrosis happens because of the doctor 100% of the times

no i am not comapring the procedures. I am pointing out the genetic difference between individual patients. Necrosis happens cause the blood supply to the scalp is interrupted to that area for a prolonged period of time. Some people have blood vessels that are more vasospastic. They shut down (constrict) with a little bit of epinephrine. Other people have poor circulation due to diabetes, high cholestrol smoking.  There is genetic differences to everything. Saying that it is 100% surgeons fault, is misleading. Every surgeon on the planet if they have done surgery for long enough will have a case of necrosis. 

 

[shiba1985]

6 minutes ago, Mirko nooh said:

what do you think should the ethical patient do? should he post about his necrosis?

There is nothing unethical with posting about your result. Your doctor is not your family or your friend. It is a business after all and if a patient has an unfrotunate incident he should post. Some post op pics can give possible clues as to what may have happened. 

 

[Mirko nooh]

1 minute ago, shiba1985 said:

no i am not comapring the procedures. I am pointing out the genetic difference between individual patients. Necrosis happens cause the blood supply to the scalp is interrupted to that area for a prolonged period of time. Some people have blood vessels that are more vasospastic. They shut down (constrict) with a little bit of epinephrine. Other people have poor circulation due to diabetes, high cholestrol smoking.  There is genetic differences to everything. Saying that it is 100% surgeons fault, is misleading. Every surgeon on the planet if they have done surgery for long enough will have a case of necrosis. 

 

Is there any "documentation" for the numbers/rate of necrosis in different clinics? 

Don't you think (on a wider scope) that this information should be collected for all patients (and potential patients) to be used? This way we could choose more wisely. 

It seems like at the moment, if one clinic produces too many necrosis - there's no 'mechanism' to stop this from happening.

[shiba1985]

4 hours ago, Mirko nooh said:

Is there any "documentation" for the numbers/rate of necrosis in different clinics? 

Don't you think (on a wider scope) that this information should be collected for all patients (and potential patients) to be used? This way we could choose more wisely. 

It seems like at the moment, if one clinic produces too many necrosis - there's no 'mechanism' to stop this from happening.

no this would be impossible to know. U would have to know how many patients from the clinic got necrosis and how many patients got surgery at the clinic. 

the best thing is for patients like yourself to make their complications known publically (but anonymously). If you see a pattern then people can start avoiding the clinic. 

 

[Steeeve]

It is 100% not the doctor’s fault 100% of the time.

Allowing your head to get sunburned post-op.

Issues with blood clotting can cause the necrosis.

If a bacteria is introduced to the surgical site post surgery, say in the car ride/plane ride home, and is not cleaned properly that could cause an infection, which, in turn, can absolutely lead to necrosis if not taken care of in time with antibiotics-there are posts on this forum where the posters dealt with this particular issue.

Necrosis can happen if a person has issues where their bodies can’t produce new cells or tissues.

These are all issues that all have 0% to do with what the doctor does during their surgical procedure and all have to do with either the patient’s genetics or failure to clean properly/follow post-op instructions.

Those are just a few reasons. There are many more.

I’m not saying that a surgeon is never at fault because it can absolutely happen. A surgeon’s failure during their surgical procedure, say the excessive use of anesthesia with vasorestrictions, can absolutely lead to necrosis. It’s probably the most common cause.

There are so many reasons but to say that it is 100% a surgeon’s fault is not only misleading but it’s a completely uniformed opinion. 

Edited January 6, 2023 by Steeeve

[Gatsby]

Necrosis can be due to several factors. Poor sterile clinical hygiene, exctractions placed too close together. This results in the tissue in between being unable to support the surface and blood supply is compromised. Not following the doctors after care instructions to the point where the tissue area becomes infected. 

[Steeeve]

1 hour ago, Steeeve said:

It is 100% not the doctor’s fault 100% of the time.

Allowing your head to get sunburned post-op.

Issues with blood clotting can cause the necrosis.

If a bacteria is introduced to the surgical site post surgery, say in the car ride/plane ride home, and is not cleaned properly that could cause an infection, which, in turn, can absolutely lead to necrosis if not taken care of in time with antibiotics-there are posts on this forum where the posters dealt with this particular issue.

Necrosis can happen if a person has issues where their bodies can’t produce new cells or tissues.

These are all issues that all have 0% to do with what the doctor does during their surgical procedure and all have to do with either the patient’s genetics or failure to clean properly/follow post-op instructions.

Those are just a few reasons. There are many more.

I’m not saying that a surgeon is never at fault because it can absolutely happen. A surgeon’s failure during their surgical procedure, say the excessive use of anesthesia with vasorestrictions, can absolutely lead to necrosis. It’s probably the most common cause.

There are so many reasons but to say that it is 100% a surgeon’s fault is not only misleading but it’s a completely uniformed opinion and not based on fact. 

 

Edited January 6, 2023 by Steeeve
Don’t mind me. Just struggling to edit my post here🤷🏼‍♂️

[Fue3361]

Can be either or.  Both are possible.  You can't foresee everything, no matter how many tests you do.  Sometimes, even if surgeon does everything well, unforeseen circumstances can lead to necrosis.

Sometimes, it's absolutely surgeon's fault for doing crap work as well.

[gillenator]

I developed some necrosis from a result of trying to fix a tattoo on my arm too many times or should I say too many times in the same location…the tattoo is an eagle head and I kept trying to fix how the beak looked…a lot of scar tissue kept building up eventually diminishing the blood supply to that specific spot and as a result, necrosis took over and  left a small crater where the flesh is missing.

[Berba11]

22 hours ago, Mirko nooh said:

If that's the case, I really do think that when some users here reply (about cases of necrosis) that "don't worry, that's the difference between hairmills and clinic X/Y/Z. Clinic X/Y/Z will take care of it and fix it for free if needed", fails to address that having a necrosis is by itself a big issue. This is just damage control of something that shouldn't have happen on the first place, and if it happens systematically is shows no critical thinking is being done by the clinic. 
Not only I see, by reading posts here, that this is the approach of a very esteemed spanish surgeon (who some started calling "hairmill"), but as for myself I also had a surgery and necrosis with one of the recommended surgeons here on this website. After searching for some "reviews posted by patients" (and not "results posted by clinics"), it seems there're too many cases of "small necrotic areas" by this surgeon. 

You should absolutely be sharing some photos and information about your own case, especially if you have found evidence that a particular surgeon - a forum recommended one no less - seems to have issues with causing necrosis in their patients.

[Parasol]

Interesting topic.

Even though I have a result I am very happy with, I dealt with some rough scabbing (have no clue if it was necrosis) and to this day still wonder what caused it and how it could have been prevented.

I don’t often see topics such as this one here and like seeing it. It’s an unfortunate possibility from hair restoration surgery, and I think it’s important for all potential patients to be aware of it (and for all surgeons to continue to work to be better at avoiding it).

Edited January 7, 2023 by Parasol

[JayLDD]

On 1/6/2023 at 4:45 AM, BaldV said:

100% fault of the surgeon

I think its plausible to suggest that it is surgeon error, however I have seen multitudes of necrosis cases even for the absolute top end of surgeons.  Plausible that even top end surgeons will make mistakes 1/200 cases, for a fine detail surgery such as this human error is absolutely something to think about. 

There are certainly cases though such as people who are regular smokers and alcoholics for whom maybe they should not have been admitted to begin with, but you can't entirely blame the surgeon for necrosis occurring. 

Realistically physiology is probably having some impact and there are times where a good surgeon under standard protocols will still have unexpected consequences such as necrosis. 

I would disagree with your post overall as speaking in absolutes for which quite frankly you have no clinical data or medical knowledge to claim isn't helpful. However I would say that all surgeons who have cases with severe complications such as this should be offering refunds on top of any aid they can to rectify cases such as this, even if they aren't entirely to blame for them.

It should be the standard of care in an industry with this much profit to rectify the situation for all patients, particularly instances that are especially negative as necrosis is even if the doctor isn't at fault.

But that doesn't mean you should blame the doctor for what realistically will some percentage of the time occur outside of their control, even if they ought to rectify the negative result.