Trichophytic closures

[NW4recession]

Are Trichophytic closures the gold standard or is there a debate about what the best technique is. Also, If I have a Trichophytic closure performed now and have another procedure in 5 years, will it affect how many grafts that can be harvested since some of the hairs will be embedded in the scar?

[NW4recession]

Are Trichophytic closures the gold standard or is there a debate about what the best technique is. Also, If I have a Trichophytic closure performed now and have another procedure in 5 years, will it affect how many grafts that can be harvested since some of the hairs will be embedded in the scar?

[MrJobi]

Yes, it is the gold standard although there may be a bit of varience in the detail by the doc. As far a the hairs, I do not think it is that much of an issue regarding the hairs in the scar but others will comment

[bverotti]

I believe it makes more sense to use the tricho closure when going for maximum numbers.

During tricho closure more tissue is cut and thrown away than during a normal closure. This might haunt you in 5 years when you might be faced with less laxity ... and thus less grafts.

[Bill - Seemiller]

Bart,

 

I'm not clear on what you mean.

 

What do you mean more tissue is cut and thrown away with a trichophytic closure?

 

A tricophytic closure is performed by overlapping one side of the wound over the other. Therefore a bit more elasticity is needed to perform this closure technique successfully which may result in less grafts being taken.

 

Most physicians I've talked to about this however, seem to feel that there will be very minimal impact on the number of grafts able to be extracted and feel that this closure technique is superior.

 

Scalp elasticity however, in general, is an important factor in determining how many grafts can be excised verses minimizing the risk of scar stretching, etc.

 

Bill

[TheHairLossCure]

Also, If I have a Trichophytic closure performed now and have another procedure in 5 years, will it affect how many grafts that can be harvested since some of the hairs will be embedded in the scar?

 

The short answer is no(t really). The hair that grows through the scar can be harvested and transplanted if/when you have another surgery. So the hair is not "lost."

[bverotti]

Bill,

I was attenting the advanced surgical course at the Ishrs in San Diego last year when exactly this subject was debated among the surgeons (I was the only non surgeon in the room).

I am sure coalition doc can put some more info here about the technical side of it.

[Bill - Seemiller]

Bart,

 

So in other words, you are not sure .

 

That's ok but in all honesty, it is in your best interest to avoid answering questions where you are not certain of the answer OR preface with "it has been said that" or "I am not sure but, I believe" or something to that effect.

 

I'm not picking on you - only trying to help you and our members.

 

Bill

[bverotti]

There was no discussion among the docs wether or not more tissue had to be cut out using tricho closure, that is an accepted fact since it is part of the tricho procedure to bevel the edges.

This extra tissue is just a few mm, but again these couple of mm could make a major difference for the next session.

 

The discussion was about wheter or not the tricho closure should always be used. As far as I remember there was no consensus about this question.

[Bill - Seemiller]

Bart,

 

Thanks for the clarification. Perhaps a doctor will add their input on this thread.

 

Bill

[chucky]

in my opinion trico is the best option as once the hairs grow through there should be no need for further work to disguise the scar.

[Dr. Michael Beehner]

I think it is best to reserve the use of the trichophytic closure for the LAST donor closure that patient has. As we all know, it is very rare that someone is filled in and totally satisfied with a single session. Most patients come two or three times in those early years to get the hair they want.

Each time you perform a trichophytic closure, you have to extend the width of the donor tissue taken by an extra 1.5-2mm. in order to obtain the area of partially transected follicles that will grow through the scar. Thus, if a man and his hair surgeon both know that three sessions over a period of 3-5 years are needed to obtain the final result they want, by doing a trichophytic closure each time, 3mm of extra donor tissue width will be excised, which isn't necessary to do and sets the table for more tension on the final closure, which is when you want the least tension possible, so the "slide-over" of the lower trichophytic edge will set in place with no stretchback.

The only exception I make to this general approach is when a man plans to have a several year gap between sessions. Then I think it makes sense for optimal cosmesis to have the trichophytic closure done.

Mike Beehner, M.D.

[Bill - Seemiller]

Dr. Beehner,

 

Thank you for your professional medical opinion on this. I think this helps bring clarificaiton to what Bart was attempting to say above.

 

Bill

[Dr. Ricardo Mejia]

Dr. Beener has made some excellent observations. While many consider trichophytic closures the gold standard, there are many examples of great or lack of visible scars without trichophytic closure. This may be perhaps the reason for the debate. Consequently, trichophytic closures has been more popularized lately to mask the appearance of the scar whether it is done in the first or last procedure. It is important to assure you are doing the best for the patient whether you do or do not do a trichophytic closure. Unfortunately, it is very easy for others on this site to label a physician as doing subpar work if a trichophytic closure is not done yet still obtaining superior results without it. Some physicians have also reported increased cysts formation in the donor area following trichophytic closures. I have in my experience found tricophytic closuresto be useful and do use them in my practice. However, there are clinical cases where I preferred not to use it and still obtained great results comparable to trichophytic closures. I am also sure several of the coalition docs have files of excellent donor site scars prior to trichophytic closures that if posted on this website, you could not tell the difference.