Dr. Beehner from Saratoga Hair FUE eyebrow hair transplant

[matx]

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Edited March 26, 2011 by matx

[Manko]

Oh dear lord...you need to settle down. You're only 12 days out, and Dr. Beehner is very well respected. Please, relax, and rest assured that you have a long time to go before you can make an assessment as to whether you're troubled or pleased, I'm guessing that since you've chosen a good doc that you'll be pleased. At this point, your post is alarmist in nature, and unfair to the doctor who was looking to help you. You'll be alright...your pictures show nothing alarming, you just need to settle yourself.

 

Manko

[Manko]

One other thing, you definitely didn't receive strip surgery. Trust me, I've done it. You'd have stitches, bandages, stitch removal, etc. You're fine. relax, you're making me nervous.

[Mike1651]

Matx:

 

As Manko indicated, you definitely did not have strip surgery--I've had both...everything you describe is typical FUE--moth appearance, etc...you couldn't be in any better hands than with Dr. Beehner...hang in there, your recovery will be brief...will a little research you'll quickly realize that your reaction was premature!

[Bill - Seemiller]

matx,

 

I'm not sure how much research you've done prior to surgery however, I can understand how being new to hair transplant surgery and/or FUE and not knowing what to expect can make you feel a little nervous. A quick overview of a procedure found on the internet is typically not enough to know what the actual experience is like. That's why we typically recommend prospective hair transplant patients research patient based communities like ours and talk to real patients.

 

That said, take comfort that everything looks perfectly normal at this extremely early stage post-transplant.

 

Any remaining swelling and pain should dissipate in a short period of time on its own. That said, to discuss your concerns with Dr. Beehner. He may or may not decide to prescribe an anti-biotic to help with any remaining swelling/inflammation.

 

Best wishes and hang in there :-)

 

Bill

[Manko]

matx - I've had both strip and FUE, and yes, the area can still be a little painful a few weeks out. I really wouldn't worry, you'll heal. If you got an infection, that's a different story, but antibiotics will take care of that. I'm sure the doc used .9mm punch's, it would be unethical to lie about that, and Beehner has such a stellar reputation that you should be comforted with his response. I know after my FUE session, I made a point of not looking at the donor area for about a month, and when I did look there was nothing to see. Best of luck, I'm sure you'll be fine.

 

Manko

[Mike1651]

matx:

 

I'm in total agreement with Manko...your picture does show a raised area, but it does not show the punch marks left by the instrument...your scalp could be more sensitive to the procedure than someone else, and hence the irritated area...as you read about other experiences on the forum you'll notice that FUE & strip procedure reactions are different for everyone...I can understand your concern, but I trust Dr. Beehner will "walk" you through this sucessfully.

[phil mascallpen]

matx if you had a punch of 1cm+ there would be no hair and an open wound. What your picture shows is a raised red circle with hair still growing. This would point to ingrown hairs that are possibly infected or the clippers nicked you and those areas got infected.

 

Go see Dr. Beehner or if he is too far go see a local dermatologist. They should be able to pinpoint the cause and put your mind at ease. But it is most definitely not from large punch extractions. I've had them so I have a little experience in what they look like

[Bill - Seemiller]

matx,

 

You are just being paranoid. As others have said, if the area is inflammed and raised, each wound will appear larger than they are.

 

Dr. Beehner isn't going to lie about the instrumentation he used on you. His ethics and character are of the highest standards and there's absolutely no reason he wouldn't be transparent with you and provide you with all the information upfront.

 

In my opinion, contact Dr. Beehner with your concerns and he may be able to prescribe you something for any remaining inflammation and swelling.

 

Best wishes,

 

Bill

[windjc]

I think you will be absolutely fine.

 

Are you going to wear your hair that short? If, not, there is no way any scars will ever bee seen.

 

You probably had a mild infection or immuno irritation. I had a break out on my nape from FUE. I haven't seen anyone on the forums with something similar. I got steriods from the doctor and eventually it went away. And this is an area with very little hair to cover up at all.

 

You'll be fine. How is your eyebrow, btw? That seems the more interesting and pressing topic.

[Bill - Seemiller]

matx,

 

Have you shared your concerns with Dr. Beehner yet like I suggested? What did he say?

 

Bill

[TheEmperor]

Originally posted by matx:

Just wanted to give a 1 month update from when I had the procedure::

 

 

Everything still persists, the shiny red raised painful bumps are still here, and the whole area in general remains inflamed. And I still have the 2 swollen hardened lumps on both sides of the donor area that was harvested. The entirety of the back of my head has been a complete painful and visually disturbing mess since I've had this procedure.

 

I have done everything Dr. Beehner has told me to do (hot compresses, full run of antibiotics) and yet nothing has changed or improved in the slightest.

 

If it is still inflammed one month after surgey, my guess is that it has become infected. Skin wounds noremally heal much faster than that, although there will still be redness for up to months.

 

I am not a doctor, so you should go see Beehner or an emergency room doc. First course of antibiotics dont always work, afaik. It could also be something like a fungal infection. THey could take a culture to find out.

 

Do you sleep on the back of your head or wear a hat? You migh consider sleeping on your side or front and gently cleaning the area a few times a day. Maybe dab some neosporin ointment on it. I think you need to avoid touching it.

 

I am not a doc so you should probably go see a GP and find out for sure.

 

Youve not going to die, and I would say that you probably wont be able to tell you had it done when everything settles down. Good luck.

[Bill - Seemiller]

matx,

 

0.9mm is actually an acceptable size for FUE punches and typically creates minimal scarring. I've talked to some physicians who in their experience have seen similar size scarring with a 0.9mm punch as a 0.7mm punch. Thus, one could argue that there's no real need to use the smaller punches, especially since they'res greater risks of transection. That said, I agree that tools larger than that are potentially problematic in increasing the amount and size of the scarring.

 

I'm sorry you're still seeing signs of infection. Did Dr. Beehner recommend anything to help with that?

 

Best wishes,

 

Bill

[Bill - Seemiller]

matx,

 

I can't say that it's common, but obviously it does and can happen. It appears that you've been emailing Dr. Beehner back and forth. However, what if anything has he said about healing time? In my opinion, ask Dr. Beehner if there's anything you can do to expedite its healing and if not, approximately how long this inflammation and swollenness will last.

 

All the best,

 

Bill

[Bill - Seemiller]

matx,

 

I don't mean to offend you in any way by saying this, but it sounds like your problem is more psychological than physical.

 

From the photos you presented, I only saw minor inflammation and it seems like you're very worked up over this, so much in fact, it's affecting how you function in your every day life. I think you ought to try to do your best to relax and take comfort that both Dr. Beehner and the ER doctor said that this is only temporary and will heal with time.

 

If understand how easy it is to become anxious, but I encourage you to relax and do things that will help take your mind off this, especially given that it's only temporary. Obviously, if it does get worse (take weekly photos and compare rather than letting your mind convince you it's gotten worse), then report your concerns to Dr. Beehner and even your primary care physician if it would be helpful.

 

In the meantime, if there's anything else I can do for you, don't hesitate to send me a private message.

 

Hang in there my friend,

 

Bill

[phil mascallpen]

Matx have you or any of the doctors considered that hair and tissue was pushed down into the extraction site and this swelling/scarring is from that?

[TheEmperor]

matx,

 

I dont want to alarm you, but a single cyst can get quite large. If you are dealing with many cysts, on the order of 50+, then I would advise doing something sooner rather than later.

 

I had a cyst once which started out as you describe as "watery" or "loose". I think there is a pocket of fluid deep in the skin (deeper than a pimple). Over time, the cyst begins to form scar tissue, will get harder, raised, and can quite large.

 

The solution was to have a minor surgery to excise the cyst. (It had grown to the size of a half dollar and was a big raised bump on my lower back, not painful at all). THe fluid trapped in the cyst reeked, which leads me to believe they are not exactly sanitary and may harbor bacteria.

 

My concern for you, if indeed these ingrown hairs have caused cysts, is that they will grow and form a significant amount of lumpy scar tissue. If you are dealing with not one cyst, but with many, you may have a considerable problem on your hands.

 

THat said, I wish I could reassure you that everything will be OK, but I think you need to be proactive in the treatment. Perhaps you can have Dr. Beehner identify the punch sites that are causing problems and do a deep incision/extraction to kill or remove any ingrown hairs. It might be time consuming, but the alternative is to watch the cysts grow and harden over time. Surgery to remove a cyst involves an incision and carving out the scar tissue pocket that has grown under the skin. If you have a large number of cysts, this could be a serious operation.

 

I wish you the best, please try to stay positive.

[TheEmperor]

Drive to Arocha, get an assesment, and if this requires additional surgery, have Beehner fly you out and comp your hotel.

 

This could be serious and a coalition doctor will certainly take responsibility.

[Bill - Seemiller]

Matx,

 

I'm glad to hear that you've already been in touch with Dr. Beehner about this. I too agree that you should consult with a physician sooner or later if you are seeing signs of cysts. Since Dr. Arocha isn't too far away, I'd suggest making an appointment with him sooner than later. Since it is a few hour drive, don't hesitate to consult your primary care physician. While most won't know much about hair transplant surgery, they may be able to recommend helpful treatments.

 

Please do keep us up to date on this.

 

Best wishes,

 

Bill

[Dr. Michael Beehner]

Since this patient's interaction with me has been carried out in public view, I thought I would add a few comments to simply give my perspective on the case and what can be learned from it.

The patient is a nice young man who approximately a year before his surgery with me was the victim of an assault which resulted in some scarring and missing hairs in the left eyebrow (see attached photo), which distressed him quite a bit. He sent me an e-mail in December of 2009, noting that he liked the quality of our eyebrow results, and, due to lack of financial resources, asked if I would do his eyebrow transplant work as a pro-bono case without charging for it. I agreed to do this and set aside one of my days off to do it on. The patient and I communicated back and forth as to how the hair would be harvested. I stated that all of the eyebrows I had done to date (nearly 150 cases) had been done with a strip harvest, as I felt the 1-hair grafts could be better dissected under the microscope than with FUE, and also we could leave the hairs long at around ?? inch, which has two advantages: It helps me see the slight curve to the hair that each person has, so that we could rotate the graft to conform to the 'flow' of the eyebrow contour and to hug the skin; Second, by leaving the hairs longer, I do a slight trim at the end of the case and, by seeing these long hairs in the mirror, the patient at the end of the case gets a good idea of what his eyebrows will look like later when the hairs finally grow out. The hairs we transplant obviously mostly shed and are replaced later by permanent hairs. Just a day or two before he flew out he indicated that he really wanted to preserve the option of keeping his hair very short and asked that I use FUE for harvesting. We have done around 80-100 cases of FUE, mostly for camouflaging donor scars and in chest hair harvesting when someone had no more obtainable scalp donor hair. During that 3-4 year experience doing FUE, we had never had even a minor complication. I use all 1-hair grafts for my eyebrows. From the photos he sent, I estimated 35 grafts might do the job, but at the time of surgery was able to fit in 75 grafts using a tiny 22g needle and a stick-and-place technique, hoping this number might allow for a single session accomplishing our mission.

His occipital donor follicles/hairs were not easy to obtain with the FUE technique. I use the 3-step Harris method, using a sharp punch for the initial 1mm deep impression through the epidermis and dermis, and then the dull punch to strip away the deeper attachments, and then the 'plucking' of the follicle out with the forceps. As any experienced FUE surgeon will attest to, some patients are very easy to extract these grafts and in some it is very difficult. In the early days of FUE, Dr. Bill Rassman advocated doing what he termed the FOX test beforehand and ended up rejecting a fairly large proportion of patients as being FOX-negative and using strip on them instead. I haven't done such a test during consultations, as I felt it was a little 'invasive' from the perspective of the patient. On the day of this patient's surgery, I had already sedated him and felt committed to finishing the job with the FUE technique. A photo is attached showing a lower and slightly higher shaved occipital area in which I did the FUE. I targeted 1-hair bundles and made overall 132 holes to obtain the 75 grafts we used. We did the lower ridge first, which were difficult, and then went to the upper area, which was easier and resulted in a higher percentage yield. When performing FUE, there are 3 things that can happen. Either you pull out a nice FUE graft, or a thing called 'capping' occurs, in which during the forceps pluck, the very top of the graft, namely the epidermis and dermis along with the short hair, are pulled off, leaving the main body of the follicle intact in the skin, which will continue to grow and survive. The 3rd thing that can happen is that the whole graft can bury down in the hole. In most cases I try to retrieve this with a fine-tooth forceps when it occurs, but sometimes they are hard to find. Prior to this case I had never had an FUE patient have a reaction to any left-behind particles down in these holes. It is apparent from the patient's description that some reaction to some buried fragments of the follicle or hair has occurred.

When doing a patient from long-distance, which constitutes nearly one-third of our practice, the one big disadvantage is that it is not easy for the patient to get in his car and come and visit if any small problem arises post-op. We are fortunate that for the most part hair transplantation surgery is virtually complication-free. I felt bad that I couldn't examine and put my fingers and eyeballs on this patient's donor area to assess the problem. The surgery was on January 11 of this year, and the patient and I have exchanged several phone calls and at least 20 e-mails reviewing what could be done. Very early, besides recommending hot packs and an antibiotic, which I called in, I emphasized the over-riding importance of having a physician with some surgical background examine him to make sure there was no abscess present which would require incision and drainage. The first physician he saw apparently didn't know what to think and did not appear to have much surgical background. The ER physician he saw was more helpful and assured him there was no abscess or infection present. Things seemed to be getting a little better, but then the patient remained alarmed, and at that point I personally called Dr. Arocha from Houston and asked if he would be willing to see the patient, and he graciously agreed. The patient was very grateful for this and said he would try to get down to see him in a couple of weeks. After several days, I then decided that the best course was for myself to see what was going on and I called the patient and told him I would cover the cost of travel and airfare to Albany for me to examine him in my office in Saratoga and do whatever needed to be done. He again was very grateful and said that due to pressing college study issues, he couldn't now, but we left off that we would talk in a week, and if things were not better, he would then decide between either coming to my office or seeing Dr. Arocha.

As you can see, the doctor-patient relationship becomes very important when dealing with any post-operative problems. The lions share of my patients have a personal consultation in which I can better assess this aspect. Perhaps in this case the time of our intervening was too close to the emotional trauma of the attack he endured and which had a severe effect on his self-image. I remain confident that the eyebrow transplant we did will improve his looks. He is aware that he will have to trim those hairs the rest of his life and also that in at least half of our eyebrow patients, a second pass of grafts is necessary to achieve the final density, but I am optimistic that one session may be enough now. I remain supportive of the patient and will work with him to get him through this, regardless of what is needed on my part. Patients often ask me if we offer a 'guarantee', as one of your posters recently asked about, and I reply that we don't. I have found them gimmicky and impossible to prove in the past. But what we do promise each patient is that we will stick with them and make sure they are happy when their transplant journey is over. I am pretty sure that if you contacted all of the 2600 patients I have treated over the years, that 99% of them would attest this is true of our practice. Usually the doctor-patient relationship takes place between the doctor and the patient, but in this new era of the internet, I understand that some patients will want the support and input from others. I understand this, but it is a little difficult to get used to, and I hope to be better about it in the future. Thanks for listening.

Mike Beehner, M.D.

[Dr. Michael Beehner]

I was very grateful that the patient was able to be seen by Dr. Limmer to check on his post-operative situation. Dr. Limmer communicated his clinical findings to me and I thought it would be better if I put on the record here what they were, so that anyone judging me based on this case would have a fair picture. Our reputation is the most valuable thing we have. Most hair surgeons, including myself, try to honestly spell out the risks of surgery to each patient before getting their consent to go ahead. We do the best we can and then stick with the patient through any post-op problems, which fortunately in hair transplant surgery are very few and far between. We also learn from each of our cases. My "take-home" from this particular experience will probably be that I will not do FUE on patients that live far away and can't drive to see me, should any problems arise.

Returning to Dr. Limmer's evaluation, in his report to me,he stated that he found no scarring and felt that everything was healing fine. There was one tiny pustule (a small yellowish bump on the skin)which drained without requiring any incision or cut, and there were 2 small scales of skin which fell off with being slightly touched. In the areas where the patient complained of some "aching", Dr. Limmer could not see nor feel with his hands any problem.

I hope this closes the book on this case history, but I just wanted to have the record include these findings It's a pretty helpless feeling as a doctor when you can't personally evaluate a problem one of your patients is having and take care of it. My fervent hopes are that everything settles down for him and that the growth of the 75 1-hair grafts in the scarred area of his eyebrow grow in nicely and with regular trimming give him a normal appearance and a better feeling about himself. I know that this is his hope also.

Mike Beehner, M.D.

[Rachmunas4life]

These pictures speak for themselves, unless this is an April Fools joke. But this problem must be very stressful. I'm sorry you are going through this!

 

What did the surgeon tell you to do now?

[Bill - Seemiller]

Matx,

 

It's a bit surprising to me to hear that Dr. Limmer didn't see any inflammation at the time he evaluated you when its evident in the photos. Even if your hair was longer at th time, clearly he could have seen the inflammation by combing through the hair and magnification. Is it possible that at certain times and under certain conditions, the area appears more inflammed? For instance, for the first 3 to 5 months after surgery, working out would cause my donor scar to appear much redder and feel itchy. Also, if I scratch the area it also looked inflammed.

 

If you emailed Dr. Beehner, I'm sure he'll get back to you. I know he has a standing offer out to you to fly you into his clinic at his expense for an evaluation. Perhaps you may want to consider taking him up on this offer.

 

All the Best,

 

Bill

[ulko]

Hey matx! Any updates? Hope the donor area has improved since your last post. Seeing as you're well into month three now, you should start seeing some growth in that eyebrow as well!

[Sparky]

Just read this whole story. Makes me feel really bad for both the patient and the Doctor, considering he did this surgery for nothing just to make someones life better and this has happened.

 

I really hope that everything turns out ok for both of them.