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Everything posted by HDC

  1. Sounds like a good deal....let me think Well, we can probably fit you in March 31st....in about three years, quality comes at a price..., but thanks for the offer.
  2. Yep.Only a crown for HDC-No one.I repeat No one is touching my front third/Hairline except for Leo di Armani and his Techies Johnny, well, what can I say; it would be a privilage to touch your sacred scalp.
  3. You can see from this image that by placing the equivalent of 50 FU cm2 you start to reach the maximum without compromising the surrounding skin tissue and existing hair.
  4. Surprisingly there has been a few, amazing how the thought of a freebie wakes people up.
  5. I think you need to give somebody from the forum a free HT so that they can post their pics here... That way we can follow the results of a known patient and your clinic would get valuable publicity Now that's an idea, not saying yes right now..........but any takers?, terms and conditions apply as they say. philip@hdc.com.cy
  6. 45/sq cm... seeing as you mentioned earlier that your clinic usually does 40 - 50 and the average is 45 Did I win a free HT?? Spot on PB_, free HT....sorry my friend we're not that generous. Hopefully it demonstrates you do not need 80+ density to create a strong look.
  7. Ok People, Why don't we guess the density of this patient
  8. Thanks Johnny, a moment of madness set in. You may like these pics...I know how much you love agressive dense packing
  9. Sorry for the multiple post with no data, I'm having problems downloading .
  10. To achieve a density greater than 50 per square centimeter, you must trim the grafts very tight during the hair transplant. The grafts must have little excess fatty tissue surrounding them, which may compromise regrowth and a higher than average laxity maybe needed. It may not be possible to reach a density over 50 per square cm in all cases. Certainly, it is possible to reach a higher density with single hair grafts than with two or four hair grafts because the single hair grafts are smaller. If the patient has pre-existing hair, the risk of shock loss will increase during dense packing. You might take three steps forward and fall back one step or two steps. It’s better to take only one or two steps forward. The real question about dense packing is will it all grow. Certainly, it would be better to achieve a single pass result that meets all expectations - patient and physician. Up to now nobody has documented with unquestionable video or photo microscope imaging the number they claim to put in a square cm. Dr Bisanga and I have seen patients who have recieved 80 per sq. cm grafted that yielded less than 50 per sq. cm. Dr Bisanga's sqcm density is between 40 and 50 per sq. cm. 45 per sq. cm is an average, achieving better than good density. Most patients can not see or appreciate the difference between a 40 FU/sqcm and a 65 FU/cm so it is easy to fall in the trap. The density is not the primary factor in determining coverage when treating hair loss. The primary factor is the diameter of the hair shaft and the number of hairs per follicular unit. Hair caliber or diameter is more important than density. The appearance of baldness is due to light penetrating the thin hair and reflecting upon the scalp. At this stage the balding hair is not totally gone, it has miniaturized and lost diameter. The hair is so thin that the person looks bald. The patient didn’t lose density he has lost caliber. Hair is a cylinder: Surface Area of a Cylinder = 2 pi r 2 + 2 pi r h, with the formula if you lose half of your Diameter, your volume is affected by an r 2 On this Microscopic picture we can roughly count 24 sites with or without grafts because you can see where the sites were made. That a density of 88 (surface here is 27 sqmm). But when you count healthy hair the count is 8 on the image that a density around 30 FU. The regrowth ratio is around 35 to 40 % max. You can turn this image upside down and find two or three hairs more but statically he will not make a difference. So, the question and argument will I am sure continue, whether it is right and medically/ethically sound to dense pack over 60 FU percm2.
  11. In this case the surface area was mapped out to ascertain the total yield amount from FUE and Strip. Total FU’s available to be harvested by FUE without over-harvesting donor: 3592.25 if 25% rule respected (this includes the Norwood 6 area) 4311 grafts if 30% of grafts taken (this number doesn’t include the transection rate). This compared with the 6000-8000 FU available via Strip. A 1 mm FUE punch is the most widely used, only a few surgeons are using a 0.75 mm punch without increasing % of transection, larger follicular units (i.e. 4 hair grafts) can’t be extracted with a 0.75 punch. The reasons for variants in punch size (inner and outer diameter) - Hair shaft diameter and spacing between hair follicles in a follicular units - Ethnic origin (including skin variations) - Hair direction A 1 mm punch has enough space to extract a 2 hair FU without damaging surrounding units and maintaining the integrity of the surrounding tissue; this is assuming the density is only 75 FU’s/cm2. Patient needs to be informed; - They may get some scarring, although small and individual due to the cumulative affect of open wounds - It can reduce the yield for future FUE procedures, and requires more donor area than Strip - FUE and Strip can be combined for the optimum yield - FUE does not create a larger donor area, just maximises when both techniques are used. - FUE can be used to harvest grafts outside of the strip donor area to maximize yield and provide additional grafts not available via strip surgery - Some patients may be better suited to Strip whilst some may benefit more from FUE - Norwood classes 5 and 6 may easily require around 7000 grafts to achieve a decent coverage, taking 7000 grafts from the scalp via FUE may thin out the donor area to the point it becomes over harvested or “moth eaten.” One or two Strip surgeries on a virgin scalp can harvest 6000 grafts without risk of scar stretching in the donor area even with low density and mediocre laxity. Taking into consideration the pros and cons to each procedure it is fair to say that FUE and Strip can yield more grafts than either could alone.
  12. Thanks Spex, Although it is not necessary to come close to the patient’s original density when creating the hair line, there is a certain minimum required to obtain coverage; also, the hairline placement must be somewhat random, with single hair FU making up the front line and multiples behind, to give the illusion of graded density. Small incisions simply heal more quickly than larger ones, and the grafts placed are less likely to suffer from blood-flow and oxygen deprivation. Any incision can damage the circulation of the scalp and effect wound healing, hair growth, and even the potential for subsequent transplantation. In addition, small recipient sites, made with needles or micro blades, conserve the normal matrix structure of the scalp’s connective tissue. This allows the FU’s to fit snugly within the created sites, avoiding dislodgement, and promoting quicker healing and immediate nourishment of the grafts from local blood supply.
  13. The frontal hairline is arguably the most important feature of the entire head of hair. Why is the hairline of such significance? It frames the face. This simple statement belies the artistic and cosmetic impact of this all-important frontal zone. Often, hairline planning is a compromise between the patient and the surgeon. What this implies is that people have a tendency to want the hairline too high or too low. The low, rounded adolescent hairline will look inappropriate on a 40 year-old man and younger men still remember quite vividly their own low hair line. This is where the ethical hair restoration surgeon must explain for the patient’s benefit. A middle-aged man seeking hair restoration may fear that a hairline that is not adequately receded at the temples may seem unnaturally low for his age. A hairline placed too high accentuates the balding, by focusing attention on the wide, high expanse of the forehead and frontal area. The front region will never really extend beyond 90 sq cm. The original density of follicular groups in this region prior to hair loss most likely was between 70 and 110 groups per square centimetre. The typical donor region will yield between 7000 and 8000 follicular groups. In theory it is possible to nearly match or exceed the original density of hair you had in the frontal region, assuming you could dense pack to that degree without compromising the skin tissue and the growth rate. The problem would then arise if the person suffered from further hair loss, and we attempt to treat areas of hair loss in the back, as well as the front; the donor area would be exhausted. Fortunately, we find that we do not need to match the density you were originally born with to give you the illusion of coverage and density. For these reasons it is important to understand that hair line placement and density is not just a surgical procedure of technical placement, but an art form that in some respects cannot be learnt but is down to the artistic temperament of the doctor, an aspect that can make the difference between a good transplant and a great transplant.
  14. HDC Medical Trichological Centre are offering personal consultations in London early April. Your consultation is without obligation, with a detailed presentation on Hair Transplant Techniques, diagnostic examination of your hair and scalp and demonstration of results of patients similar to your hair loss pattern, with before and after pictures. If you wish to attend please email me directly or follow the Consultation link below, Consultation Request FUE Non Scarring Strip Closure Philip Bell International Patient Coordinator HDC Medical Trichological Centre philip@hdc.com.cy Home Page
  15. For a procedure of that size, relatively small, the Strip should be no more than 10mm high, this helps when closing the line to create the smallest scar possible; assuming good laxity and you take care not to stretch the donor tissue.
  16. The front region will never extend beyond 90 sq cm. The original density of follicular groups in this region prior to hair loss most likely was between 65 and 110 groups per square centimetre. The typical donor region will easily yield between 7000 and 8000 follicular groups. In theory it is possible to nearly match or exceed the original density of hair you had in the frontal region. You then have to look at the number of hairs per Follicular Unit (groups), anything from one to four hairs per FU. This will affect the density of the result and ultimately the coverage. For example if say 1400 FU are placed but your hairs per FU are mainly ones and twos you will require more FU than a patient who has mainly three to four hairs per FU. Also you have to take into account the area of placement, a front hair line has to be made up of singles with multiples further in to increase density.
  17. The only sure way is to have a skin biopsy, recommended to be 4mm in diameter.
  18. George, He's in contact with us and a few others, I believe spex as well. We are not prepared to carry out any work until we see him in person, not just an on-line diagnosis, because of the severity of the previous work. This is only the beginning, the laxity of the donor area will have been massively compromised and any scar recision made exstremely difficult. The recipient area has poor placment of the FU as well, so it's a big project, and as it's very likely to be his last chance we have recommended who ever he decides on he must meet the doctor first. You have to also be aware that we do not want to compromise our standards, it has to be on the understanding that we can meet our standards and improve on his condition, not just proceed for the sake of it. Sorry, he's not said who carried out his previous work.
  19. Hi Sagg, For the record, this is "butchered"
  20. The major difference between Follicular Unit Extraction (FUE) and the Strip Harvesting Technique (Strip) is the method of extracting the follicular units. With FUE, a specialised punch less than 1mm diameter is used to extract the hair from the scalp. The main advantage of this technique is that follicular units are extracted directly from the scalp rather than in larger groups, which expels the need for scalpels and stitching. It is concidedered to be non invasive, enabling you to keep your hair short or shaved with no visible signs of harvesting. For patients who have exstensive Strip work before it also maximises the donor area surface area. With Strip harvesting a approx. 1cm to 1.3cm wide by "X" cm long hair bearing strip is removed from the back of the scalp. The tissue is carefully dissected into follicular units and the donor area sutured to leave a very fine scar line that your surrounding hair grow over or through to cover. Strip procedures of up to 3000-4000 grafts can be performed in a day, whereas the FUE procedure over 1000 grafts will be performed over two or three days dependent on the quantity of grafts, this is because the method of extraction with FUE is much slower.
  21. Thanks PB_, They went well thanks, busy and a wirlwind visit, but good hair educated people. Good to come back to the cold for a few days!
  22. Donor Area Location If you take a man with Class VII you will see the limits of the donor area. The boundaries of this zone extend from in front of the ears, around the temples, and to the back of the head. The hair at the temples may recede back toward the ear, and the balding area of the crown may dip quite low into the occipital area, at the back of the head. Visible scarring may be revealed if the thinning advances, and donor tissue has been taken too high, too low, or too far in front of the ears. Scarring in the Donor Zone Another problem involving scarring in the donor area is that of the widened scar. In a patient without a systemic disease or drug use that retards healing, a well-closed, non-infected incision should eventually appear as a thin white line, well camouflaged by the hair, even possible now to be made almost invisible with the new closure methods being utilised. Sometimes, however, this is not the case; if the donor strip is taken too low in the back of the head (toward the top if the neck), a widened scar can result. Often, as men get older, the inferior hairline (at the neck) will move higher. If this is the case, a low, widened scar can be a cosmetic liability. In addition, certain patients with an inborn weakness of collagen or defects in the building of new collagen (collagen is the connective tissue protein of which ligaments, tendons and scars are made) may develop wider than normal scars regardless of how well the incision is closed. Surgical wisdom has always taught us that closure of any wound under tension (such as a wide incision or in taut tissues) can lead to a widened scar. Therefore the donor strip should be made as narrow as possible, based on the tightness or laxity of the patient’s scalp. This is a problem seen after multiple transplant procedures: a tight, unyielding, fibrotic donor area. This is why surgeons like patients with lax scalps. Occasionally, though, a paradox exists; when patients who have laxity heal with widened scars. It is possible that these patients may have suffer from a collagen defect. In short, careful evaluation and planning can result in fine, cosmetic scars in almost all cases; When the outmoded harvesting techniques of punch grafting with open donor healing were used, the result was a "shotgun" or "moth-eaten" appearance that is cosmetically quite displeasing. This type of scarring also renders further strip harvesting difficult as it complicates the estimation of needed strip size for a given number of grafts. Similar problems arise when the patient’s donor area has been subjected to multiple small strip harvests, with a "stairstep" pattern of linear scars. Strip harvesting as a technique is widly deemed the most expedient and efficient method of harvesting. If these techniques are properly utilised, then the fewest hairs will be damaged at the time of harvesting. Furthermore, the integrity of the donor area will be preserved, scarring will be minimized, and preservation of donor reserves will be maximized for possible use in the future. This is an integral part of the essential long term planning process.
  23. Is she going to have HT surgery now with your clinic? Possibly, that's what she wants; but we want to do a few more tests first, blood test and a scalp biopsy, for possible inflamation. If all's ok then we'll see, I'm seeing her tomorrow when I'm in London.
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