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Everything posted by HDC

  1. HDC

    Fue Or Strip

    Hi crabb, At 25, and only needing 1500 grafts I assume you are late Norwood 2, early 3; and therefore it is hair line work that you would undergo. You obvioulsy appreciate hair loss is progressive and at 25 you could have potentially a long way to go before it begins to plateau. With this in mind donor management and looking to the future is vital to ensure you are not just happy today but like you say in your 40 & 50's. Each technique has it's pros and cons; but it is safe to say that long term you will harvest more hair with Strip than you will with FUE. This is assuming you do not over harvest the donor area with FUE and stick to approx. 25-30% harvesting per cm2. This will ensure that there is no percieved density change in the donor. I know this is easy to say, and money is invariably always part of the issue, but do not base your choice on money. Money comes and goes, but your decision will live with you for a lifetime. Phil
  2. Here are two and three hair follicular units in their natural groupings, extracted with a .8 mil. punch. You can see some of the FU's contain white or transparent hair; making the extraction and placement that much harder. Phil
  3. Hi AJG, In this case there was no choice but to remove and redistribute; hair line design and angulation was so bad. The exisitng grafts were removed by FUE, no suturing. There is still some pitting visible below the hair line and he has laser therapy to help the skin heal better and make the pitting less visible. It's unrealistic to expect them to disappear totally, but it has made a large improvement. The removal and placement of a further 2000 FUE was done in one session. He has recently had the scar revision and a few more FUE to give more density. Phil
  4. Updated pictures of the scar revision Scar Line 5 Days Post Op 10 Days Post Op 1 Month Post Op Phil
  5. HDC


    The area at the back of his head shaved is where the strip will be removed from. FU, meaning Follicular Units, or grafts. Phil
  6. HDC


    Most pics taken by the patient. Dr Bisanga Pre Op Immediately Post Op 15 Days Post Op 44 Days Post Op 6 Months Post Op Phil
  7. HDC


    Spuraman, Here is a picture of the scar line immediatly post op; I'll have an updated picture later. Gasman, I'm not aware he had any prolonged redness; do you mean the 14 day pictures? We generally give minox 2% to start approx 12 days after; If you want to read his thread you can go to his forum, it has an easy language translator. Phil
  8. HDC


    Pictures taken by the patient. Immediatley post op 4 days post op 14 days post op 1 month post op Pre & 4 months post op Pre & 5 months post op Phil
  9. 4115 FU by Dr Bisanga; Latter pictures taken by the patient. Pre Op 30 days post op with donor healing 75 days post op 3 months post op 4 months post op 4 months post op donor healing 5 months post op Phil
  10. Updated pictures 5 months post op. The pics were taken by the client. Phil
  11. Hi Gasman, The arguement about punch size is alive a kicking on other sites; smaller the better? not necessarily; there is an increased chance of transection and damage to the surrounding follicular units. Two reasons why punches should be custom to the scalp are the size of the follicular unit and the density of FU in the donor area. 1mm_punch_scarring.bmp FUE is not scar free; this is with a .75mm tool, used to avoid transection in this case. Scarring can vary from non visible to 1-2sqmm. 25__harvesting.bmp Over harvesting of the donor can be a problem with FUE, to avoid this stick to approx. 25%-30% harvesting rule. This will avoid a cosmetic density change in the donor and prevent shock loss to the donor due to over harvesting. Variables to be concidered by the doctor performing FUE include: Punch Size, inner & outer diameter Hair shaft diameter and spacing between hairs and follicular units Ethnic skin variations Punch sharpness- renewed reguarly during the procedure Hair direction 1_mm_punch.bmp This person's density is 75FU sqcm; a 1mm punch has enough room to remove the FU without damaging the surrounding units. FUE_variables.bmp Here you can see the variations in punch size and the effects to the surrounding FU. Phil
  12. BH is used to reconstruct and repair previous hair transplants when, and only when there is no option but to look at other areas of the body to harvest from because the scalp donor has been exausted; and each case is looked at on it's merits. We have a protocol that we follow. Body hair is a last resort and only considered if all avenues have been exhausted. I believe donor management and the use of BH is only undertaken after extensive education of the patient. It is ethical to always patch test a small amount of BH and look at the yield potential at about six months before any decision is made to continue. We do not charge for the BH test. "If one were asked to find 20 successful strip cases, it would be a breeze. If asked to do the same for FUE, same thing - no problem. Why is it not similarly easy to do the same for BHT? Because it does not work." This stands to reason because BH is a last resort; fortunately we do not find many cases where the scalp donor has been compromised to the extent that BH has to become a topic for discussion. This is not a question of does it work or doesn't it; this is medicine; it is not an exact science; and in this case you are never dealing with virgin scalps; The patient has gone through great traumas to the skin tissue, his donor has been so seriosuly compromised to the extent any substantial amount of hair is impossible to harvest. So, what would you suggest, call it a day; do not try to help; do not look at every avenue to reconstruct or repair. If the medical world lived by this philosophy no progress would ever be made. Is it fair not to give a person the chance to improve on their condition, when they are in possession of all the facts; a cancer patient given a 20% chance of recovery still undergo therapy (chemo & radio - therapy) is this ethical, or should they be given no chance or choice. Psychological trauma is relative to the condition, I am not comparing the stress caused by a life threatening disease, but that in no way detracts from the emotional stress that occurs through hair loss, especially in severe repair cases. Progress has to be made, it is not always beautiful or politically correct, try to be objective as to medical developments. I seem to remember such debates about FUE a few years ago. For the record, we charge less for BH than many charge for scalp FUE. Phil
  13. Your questions are answred and all you can pick up on a Feller statement, sad. What is this about, spin or a debate on a hair transplant procedure. I would have more respect if you picked holes in the BH question rather than veering it off on "resentment claim" and ignoring the points made. Martin, do you have a problem with me "giving it some on this forum"? To date, I have posted pictures, answered questions, I believe informatively, never ducked an issue asked of me. If this is what you call giving it some, providing variety, an option, possibly a different opinion, that can be contested for the benefit of educating. Sorry my friend, you are way off the mark; and as for Mike, here or not, I would still be here. Phil
  14. BAL, I wouldn't argue with you; All other avenues must be exhausted. It's only relatively recently FUE scalp are being placed in scar tissue with some success; and I've not seen any documented cases of Triclosure on repairing old strip scars; so all being equal there's a long way to go. Phil
  15. Pictures of the donor area. You can see that it has been massivley compromised; know as an "open donor"; the entire area has been over harvested. Phil
  16. Martin, I appreciate your comments, and will answer them objectively. It is not a case of being defensive but being objective and looking at the bigger picture. The general feeling about BH on this forum is that it is not a viable option ethically or technically. Do not become defensive but I would suggest the reasoning is that the forum is predominately pro Feller, and as he does not recommend it as an option that is obviously going to be the consensus of those who have dealt with him. No different to your comment to Mike, your doc becomes God if you're happy. If you read my post to gappy guy, I made no claims, but pointed out the basics of BH transplanting from a technical point of view. We do not claim to be a BH clinic, on the contrary if you read Dr Bisanga's protocol you will note that we have a strict basis for concidering BH as an option. Each case is looked at on it's merits, the patient correctly educated, patch test performed, a waiting period and then and only then is a decision is made. We do not necessarily extol the virtues of BH; but we do not flattly dismiss it as an option to patients' either. We have perofrmed approx. 14 BH cases; all documented for research purposes and the patient; but I can not always publish results; not everyone gives permission and some it is not worth at this satge because it is too early to document objectively. In the same vien those Dr's who have performed BH tests and achieved poor results, why are these cases not more readily available for discussion? If we are in the business of probity and transparency it would be beneficial to understand all sides; and then and only then will we be totally informed, and you, the patient able to make an objective decision. I was asked to publish a case, well 10 cases, I did, well one; not to convince people BH is great, but to show the results. If I had not been asked I would probably have never bothered. That said the 50 BH test yielded almost 50% growth at six months; I do not concider this poor growth at this stage. To suggest that the six months 1500 BH had little growth in my opinion is flat wrong. For you personally it may appear to be little growth; and a waste of time but to the patient concerned it is the difference between a bald head and the semblance of hair. I will in the future post more BH cases when I feel they give a fair reflection and can be argued objectively from both sides. I would like to raise a point to the cynics; just remember guys. If the first transplant was not performed some fifty years ago to mass critism then this and every forum regarding hair transplants would not exist and you guys would not be walking about with good heads of hair. Progress has to be made, it is not always beautiful or politically correct, and time will tell if it is viable in a big way; but try to be objective as to medical developments. All the best Phil
  17. HDC


    Martin, Heh, no offence taken; this is a valid dabate. It is not that we don't shave I put this argument, because we do shave too. I am saying it is not always to the detriment of detering shock loss. Honestly, yes I do believe that the patient can achieve just a good result; not just during the post op healing but long term. And I feel we are in a position to argue this because we offer both; to shave or not to shave. Many top docs don't shave, or at least give the option; some charge extra for not shaving because it is technically harder. You have to assume that if they are charging more not to shave they are saying the placement is slower and harder, but results will be no different. I am not saying one technique is better than the other; they both have benefits to the doctor and patient alike; but (and this is assuming we are talking about competent doc) from the patients point of view I do not see the problem given the option. The ultimate decision is the doctors'; if the doctor feels comforatble with the density he is working in the size of the FU's being placed and the wellbeing of the patient, then I think the patient should be given the option......and at no extra charge, I may add. Phil
  18. HDC


    This issue of shockloss keeps coming up. The issue of shaving or not shaving; I have said in the past is mainly due to the doctor's preference. Shaving certainly makes it easier to make the placement sites and place the FU; but does not necessarily reduce the potential of shock loss. If the sites are made parrellel to the adjacent hair then the doctor has countered the problem. Whether the hair is long or shaved will not make a difference if the sites are slightly off ; you just don't notice the shock loss if the hair is shaved; but the phenomenon is still there. If the doctor is working with long hair it does become technically harder, the hair has to be parted under microscopic loops; more concentration and time is required; but surley this is all part of the artistry that makes a hair transplant so special. Shaving is not always a option for a patient; timing, work, social commitments can collide and make the option to shave a non option. So I see no reason why the patient not be given the option.
  19. Hi Garageland, I will post pictures of his donor tomorrow; basically it had been massively compromised, "open donor area", and although you could argue there was more to be taken; you could also argue the reasons for not.....pictures tomorrow. The plug redistribution was aided by approximately 200 FUE' but mainly plug redistribution. The BH yield agreed is approximately 50%; but remember these were taken at the six months mark; we do not predict much more than that with scalp hair. I think it is realistic to assume that scalp hair responds more favourably to transplanting than body hair. Does it scalp grow quicker and mature faster...I think the answer must be yes. We have recently worked on two very interesting cases; one with poor yield from two strips; placing more FUE and BH in inflamed skin tissue; and the second on a scalp that had gone through 17! yes 17! ops over about 25 years. Unfortunately way to early to post about those yet. I'll update tomorrow Phil
  20. 50 BH patch test six months post op Donor Healing post test 6 months Body Donor Area Recipient Area pre BH Op 1500 BH placement in recipient area Extraction of BH 1500 BH 6 months post op 8 months post op, distribution of plugs using FUE Phil
  21. Thanks spex; You're right this is FUE, not BH. He has recently had a repair to the 1cm scar line from the first op; we closed with Triclosure. As soon as I can I'll show this also. This should be interesting because there are not many case studies of the triclosure on impaired skin. Phil
  22. Thanks, I would like to take the credit...but it was all down to Dr B. Phil
  23. Hi Gappy guy, Sincerely all the best in your quest. Keep a level head, sorry for the pun, and research. Phil
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