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Subject: "Hair war (a repair case) - choices & decisions." First topic | Last topic
Dr. ArvindThu Aug-03-06 03:04 PM
Member since Jun 23rd 2004
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"Hair war (a repair case) - choices & decisions."


          

Dear forum readers,
Hairwar is the net name of a poster on various hairloss related discussion forums.
He is a Caucasian from Europe.
His journey through hair transplants as well as his experiences may help other HT aspirants to plan their hair restoration procedure.
His is also a case where the delimma in front of the patient and the doctor is revealed.

A brief history -
Hairwar is presently in his mid thirties.
He first noticed hair loss in 1993.

In 1995, he had 2 strip hair transplant surgeries (about 300 grafts in each session), in Switzerland.

In 1996, he had 2 more strip surgeries within 2 weeks gap at another clinic in Switzerland (again about 300 grafts in each session).

In 1997, he had 1 more strip surgery (600 grafts) in Switzerland.

In 2004, hairwar had a FUE surgery in a clinic in Turkey. Total 1150 FUE grafts. 600 of them placed in crown & 550 placed in hairline.
Hairwar feels that his FUE surgery in Turkey led to shock loss in the transplanted hairline and a %age of the transplanted FUE grafts in the hairline did not grow.

That amounts to a total of 5 strip surgeries and 1 FUE surgery before coming to us.
If hair war had not got any hair transplants, today he would be a NW5.
Hair war has average scalp laxity in the donor area.


Following is a picture of his scalp donor area.
The first issue in front of the doctor and the patient is over the choice of the procedure. Should the surgery be another strip or another FUE or a combination of both.
Hairwar does not have much robust body hair.
Please let me know your views and choice along with reasons for the same.



Dr.(Capt) Arvind Poswal
Dr. A's Clinic,
A-9,First Floor,
C.R. Park, (Near Nehru Place),
New Delhi-110019, India. www.fusehair.com
e-mail: poswalarvind@yahoo.co.in
Ph- 91-011-26274368,91-098-101-78062
Timings-10a.m.to 5p.m
Scalp & Body hair transplants.

Attachment #1, (jpg file)

  

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Replies to this topic
Subject Author Message Date ID
Some donor area pictures
Aug 03rd 2006
1
5 scars?
Aug 03rd 2006
2
RE: Some donor area pictures
Aug 03rd 2006
3
RE: Some donor area pictures
Aug 03rd 2006
5
Butchers
Aug 03rd 2006
4
      RE: Butchers
Aug 03rd 2006
6
RE: Hair war (a repair case) - choices & decisions...
Aug 03rd 2006
7
Marco
Aug 04th 2006
10
RE: Hair war (a repair case) - choices & decisions...
Aug 04th 2006
8
RE: Hair war (a repair case) - choices & decisions...
Aug 04th 2006
9
      RE: Hair war (a repair case) - choices & decisions...
Aug 04th 2006
11
donor area pictures with hair cut further short
Aug 04th 2006
12
Some recipient area pictures
Aug 04th 2006
13
hairwar's recipient area plan
Aug 04th 2006
14
Very Difficult case
Aug 04th 2006
15
RE: Very Difficult case
Aug 04th 2006
16
RE: Very Difficult case
Aug 04th 2006
17
      DENS1...
Aug 05th 2006
20
      RE: DENS1...
Aug 05th 2006
25
      RE: Very Difficult case
Aug 05th 2006
23
Plan B
Aug 05th 2006
18
Dr C, no offense but..
Aug 05th 2006
19
Well read this then...
Aug 05th 2006
21
RE: Plan B
Aug 05th 2006
22
      RE: Plan B revisited
Aug 05th 2006
24
RE: Temple Point question
Aug 05th 2006
31
      RE: Temple Point question
Aug 06th 2006
32
      RE: Temple Point question
Aug 06th 2006
33
           RE: Temple Point question
Aug 06th 2006
34
                RE: Temple Point question
Aug 06th 2006
35
                RE: Temple Point question
Aug 07th 2006
41
                The look
Aug 06th 2006
36
RE: Hair war (a repair case) - choices & decisions...
Aug 05th 2006
26
Recipient area
Aug 05th 2006
27
      RE: Recipient area
Aug 05th 2006
28
           RE: Recipient area
Aug 05th 2006
29
                What about the donor ?
Aug 05th 2006
30
                     RE: What about the donor ?
Aug 06th 2006
37
                          Patient's decision
Aug 06th 2006
38
                               Hairy Tale please read..
Aug 06th 2006
39
                                    Tempest in a teapot
Aug 07th 2006
40
                                         Hairy..
Aug 07th 2006
42
                                              RE: Hairy..
Aug 07th 2006
44
RE: Hair war (a repair case) - choices & decisions...
Aug 07th 2006
43
RE: Hair war (a repair case) - choices & decisions...
Aug 10th 2006
45

Dr. ArvindThu Aug-03-06 03:17 PM
Member since Jun 23rd 2004
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#1. "Some donor area pictures"
In response to Reply # 0


          

Following are some pictures of the donor area with the hair trimmed down to 4 mm.

The picture is taken in flourescent, soft lighting and no flashes.




The next picture is taken with using flash + the same flourescent lighting.

Dr.(Capt) Arvind Poswal
Dr. A's Clinic,
A-9,First Floor,
C.R. Park, (Near Nehru Place),
New Delhi-110019, India. www.fusehair.com
e-mail: poswalarvind@yahoo.co.in
Ph- 91-011-26274368,91-098-101-78062
Timings-10a.m.to 5p.m
Scalp & Body hair transplants.

Attachment #1, (jpg file)
Attachment #2, (jpg file)

  

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pcguyThu Aug-03-06 04:50 PM
Member since Jul 09th 2006
143 posts
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#2. "5 scars?"
In response to Reply # 1


          

i dont think that s normal for s strips. that too when they totalled 300 a strip.

  

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bennstuThu Aug-03-06 05:42 PM
Member since Feb 01st 2006
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#3. "RE: Some donor area pictures"
In response to Reply # 1


  

          

Just what were the doctors thinking?
Making a race course of a person's scalp. Sorry, hairwar. Its just not something I will expect of any self respecting doctor.
BTW, whats with the long strips if it was just 300 grafts a strip?
Seems like they wasted a lot of your grafts. At 100 grfts per sq cm the strips should have been just 3-4 cms long. Why do you have 5 long strips?

  

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fourheadThu Aug-03-06 06:14 PM
Member since Jul 07th 2006
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#5. "RE: Some donor area pictures"
In response to Reply # 3
Thu Aug-03-06 06:22 PM by fourhead

  

          

Why did they go in and do strip and keep using different donor areas?
As someone posted earlier, 300 grafts would never take that much and the donor area would only go across half of his head at most. They must have wasted a lot of grafts.

BTW my doc put another strip in my head, but the reason is that my first strip was taken was down, more in the neck, instead of the scalp. The hair there is not nearly as good, so I opted to have the previous scar filled in with grafts. There doesnt seem to be a good reason for those strips in Hairwars head..

He has barely any donor area left in the back, perhaps some could be taken from the sides and if he has any body hair at all, they do a BHT to fill in some of those strip scars. But, if there really is no Body hair and only a limited amount of side donor, he does have a dilemna. I would rather repair any problems, go for as natural look as possible and live with it, than do anything risky. The two lower scars might be close enough together to use those grafts and excise the previous scars, making it one scar, but I dont know since I am not a doc. Anyway, utilizing any side donor hair may be his only option.

  

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SKThu Aug-03-06 06:07 PM
Member since Oct 27th 2005
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#4. "Butchers"
In response to Reply # 1


  

          

How could they do this?

  

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topcat611Thu Aug-03-06 07:05 PM
Member since Oct 21st 2005
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#6. "RE: Butchers"
In response to Reply # 4


          

That's a pretty simple question to answer. It's about making money, as much as you can, and as fast as you can. I do not blame doctors for this, it's just the way things are and will always be. I guess one could argue the point that doctors should be held to a higher ethical standard. When you have too many doctors that standard goes out the window. If there is a opportunity to perform surgery or use the expensive equipment, that still needs to be paid for, that opportunity will not be passed up.

Speaking for myself, I learned a valuable lesson from my own experience. I am thankful I have pursued a life that will lessen my chances of having a heart attack, cancer, diabetes and other diseases. Imagine the posistion these people find themselves. They are literally at the mercy of the doctors. They will be forced into unnecessary surgery, and poisoned with drugs and bizarre therapies, like chemo.

Like I said, I'm not picking on doctors, the same goes for lawyers, car repair shop, realtors, on and on. People just need to wise up a bit and remember this dark side of capitalism. Sometimes we get caught up in the hype.

I am not a doctor, I am not a surgical tech, I am a hair transplant victim.

http://hairsite.com/serendipity/authors/19-Topcat611

  

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marcoThu Aug-03-06 07:07 PM
Member since Feb 27th 2003
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#7. "RE: Hair war (a repair case) - choices & decisions."
In response to Reply # 0


          

Dear Dr. Arvind,

I am confused by your list of choices. In a recent post you suggested that FUSe could make available more scalp donor hair than strip. Therefore (with the exception of price issues) why would you suggest strip as an option. I am not being confrontational here, but I am genuinely confused about your opinion of the comparative advantages of FUSE over strip in this context.

My thought regarding your question are that the fu's above the ear have not been used and would be suitable for FUSE. The rest of the operation would need to be body hair in order not to risk further damage to the occipital donor area. I would also NOT place any grafts into the strip scars until the desired frontal coverage is achieved just to preserve what donor is left for now.

Thanks in advance for your reply to the first question.

  

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Dr. ArvindFri Aug-04-06 05:28 AM
Member since Jun 23rd 2004
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#10. "Marco"
In response to Reply # 7


          

>Dear Dr. Arvind,
>
>I am confused by your list of choices. In a recent post you
>suggested that FUSe could make available more scalp donor hair
>than strip. Therefore (with the exception of price issues) why
>would you suggest strip as an option. I am not being
>confrontational here, but I am genuinely confused about your
>opinion of the comparative advantages of FUSE over strip in
>this context.
>

Dear Marco,
I understand your view.
There are numerous techniques available today.
Advances in each ensure that they complement each other.

As a doctor, I have to customize my repair plan based on many factors, not the least of them being the patient's preference.
As long as the patient is well aware of the various techniques, I think doctors should not be dogmatic. They need to be versatile in different methods - strip, FUSE, BHT - to be able to help the patient.

This is the delimma I was referring to earlier.
Do you turn away a patient who honestly has had a bad experience with fue, and does not feel comfortable going for more of the same?

Hair war has had bad experiences with both strip and fue. He was not aware of the forums till his last surgery. Since then, he has, as per his admission, researched extensively.

I feel the input of the patient, especially the well researched and aware one, should not be disregarded.

Regards,
Dr. A

Dr.(Capt) Arvind Poswal
Dr. A's Clinic,
A-9,First Floor,
C.R. Park, (Near Nehru Place),
New Delhi-110019, India. www.fusehair.com
e-mail: poswalarvind@yahoo.co.in
Ph- 91-011-26274368,91-098-101-78062
Timings-10a.m.to 5p.m
Scalp & Body hair transplants.

  

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topcat611Fri Aug-04-06 12:05 AM
Member since Oct 21st 2005
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#8. "RE: Hair war (a repair case) - choices & decisions."
In response to Reply # 0


          

It's hard to determine a strategy without seeing the transplanted area.

Depending on how the transplanted area looks and how much more hair I would be likely to lose, I would conserve any and all body hair for the frontal area to make sure I would look as normal as possible when interacting with people. The crown and back would be the last of my worries. If I believed I had a bit more body hair to spare, including pubic and underarm hair, I would try to fill in the scar area as much as possible, starting with the scar closest to the crown.

It's a better strategy to look normal and balding then to look abnormal, I should know.

I am not a doctor, I am not a surgical tech, I am a hair transplant victim.

http://hairsite.com/serendipity/authors/19-Topcat611

  

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fourheadFri Aug-04-06 12:41 AM
Member since Jul 07th 2006
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#9. "RE: Hair war (a repair case) - choices & decisions."
In response to Reply # 8


  

          

>It's hard to determine a strategy without seeing the
>transplanted area.
>
>Depending on how the transplanted area looks and how much more
>hair I would be likely to lose, I would conserve any and all
>body hair for the frontal area to make sure I would look as
>normal as possible when interacting with people. The crown and
>back would be the last of my worries. If I believed I had a
>bit more body hair to spare, including pubic and underarm
>hair, I would try to fill in the scar area as much as
>possible, starting with the scar closest to the crown.
>
>It's a better strategy to look normal and balding then to look
>abnormal, I should know.


Top,

Yeah, I would have to agree. I am assuming there is very little donor left except on the sides and maybe a few artistically pulled grafts using fue from the back donor. Even then, if he has low body hair he is also low on options.

Does anyone think they can get anything else out of the rear donor using fue or strip??:

  

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hairy taleFri Aug-04-06 08:22 AM
Member since Nov 08th 2005
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#11. "RE: Hair war (a repair case) - choices & decisions."
In response to Reply # 9


          

Even though the patient hasn't got a lot of robust body hair, it still foots the bill in term or DEM to fill into the previous 5 strip scars and therefore somehow enhance them.
Thus one would save the precious last scalp donor follicles for hairline and crown only purposes, carefully cherrypicking them all over between the 5 scars plus as low as possible in the nape by extrafine expanding needle type FUSE.
Trying to harvest further strips between the existing strip scars would yield less scalp donor follicles, since one would have to strictly adhere to the erratic serrated patterns of said scars. It would be messy, and furthermore definitely deplete the entire scalp donor.
The resulting combined scar could not be but extra large, all the worse because of the only average laxity precluding significant scar width reduction.
It would all end up with a massive bare neck region for a rather low yield of transplantable follicles.
Thus my strategy reads :
- as many extractable extrafine scalp FUSE as decently possible for HT purposes
- any body hair to fill in the old scars + old fue as much as possible, no matter how many "weak" body hair are needed, to achieve a "better than nothing" donor look.
- possibly additional BHT all over the newly to be transplanted areas, if scalp donor turns out to be wanting in spite of all. Weak body hair involving more of it, preferably paired wherever possible.
- no fantasy of any further buzz cut, anyway, since too much damage has been done.
Sad to say, Hairwar is sentenced to a mid length neck haircut for the rest of his life.
But I believe his current scalp aspect can be vastly improved by the proper strategy and use of techniques.
Best luck to him !

hairy tale

Attachment #1, ( file)

  

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Dr. ArvindFri Aug-04-06 10:22 AM
Member since Jun 23rd 2004
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#12. "donor area pictures with hair cut further short"
In response to Reply # 0


          


Without Flash






With Flash

Dr.(Capt) Arvind Poswal
Dr. A's Clinic,
A-9,First Floor,
C.R. Park, (Near Nehru Place),
New Delhi-110019, India. www.fusehair.com
e-mail: poswalarvind@yahoo.co.in
Ph- 91-011-26274368,91-098-101-78062
Timings-10a.m.to 5p.m
Scalp & Body hair transplants.

Attachment #1, (jpg file)
Attachment #2, (jpg file)
Attachment #3, (jpg file)

  

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Dr. ArvindFri Aug-04-06 10:26 AM
Member since Jun 23rd 2004
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#13. "Some recipient area pictures"
In response to Reply # 12


          


Side view before trimming hair


Top view after the hair have been trimmed

Dr.(Capt) Arvind Poswal
Dr. A's Clinic,
A-9,First Floor,
C.R. Park, (Near Nehru Place),
New Delhi-110019, India. www.fusehair.com
e-mail: poswalarvind@yahoo.co.in
Ph- 91-011-26274368,91-098-101-78062
Timings-10a.m.to 5p.m
Scalp & Body hair transplants.

Attachment #1, (jpg file)
Attachment #2, (jpg file)

  

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Dr. ArvindFri Aug-04-06 10:37 AM
Member since Jun 23rd 2004
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#14. "hairwar's recipient area plan"
In response to Reply # 0
Fri Aug-04-06 10:41 AM by Dr. Arvind

          

Hairwar wishes the recipient area to be addressed in the following order of priorities.

1. The top and the hairline area needs to be thickened.
2. The temple points need to be constructed.
3. If any grafts are left, they should be placed in the crown area.


Temple point reconstruction will be very helpful to give a more balanced look in hairwar's case.






Thank you for all the suggestions till now.
They are very insightful for the doctors as well as other readers of the forums.
Regards,
Dr. A

Dr.(Capt) Arvind Poswal
Dr. A's Clinic,
A-9,First Floor,
C.R. Park, (Near Nehru Place),
New Delhi-110019, India. www.fusehair.com
e-mail: poswalarvind@yahoo.co.in
Ph- 91-011-26274368,91-098-101-78062
Timings-10a.m.to 5p.m
Scalp & Body hair transplants.

Attachment #1, (jpg file)
Attachment #2, (jpg file)

  

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notanewbieFri Aug-04-06 02:49 PM
Member since Jan 11th 2005
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#15. "Very Difficult case"
In response to Reply # 14


          

I will once again take a different path for Hairwar and one that I think will give him the best results and most benefit.

Dr A Stated "Hair war has average scalp laxity in the donor area"

Since the laxity after 5 strips is still average and the amount of grafts yielded from these 5 strips is low, I am prone to believe that the strip Dr was not only incompetent but took very thin strips from the donor. I have come to that conclusion because the amount of grafts Hairwar netted was low, the scarring is quite bad but the laxity is still average to good.

Because of these factors I feel the Dr should do a single strip revision, most likely in the lower scars where they are the worst. This will give HW 2000 strip grafts (potentially) and combine both bad scars into a single and hopefully better one. Dr A clearly has better closure technique than the hack who did this and can improve on the scarring if the patient has the laxity to do so.

There is also ample SCALP for FUE and Dr A should utilize this scalp hair before venturing into body hair which may be better served for planting into the remaining strip scars to improve them.

Obviously the recipient area is also quite bad and planting around those pluggy grafts, lowering the hairline a bit and adding density to the frontal 2/3rds is critical.

  

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notanewbieFri Aug-04-06 02:54 PM
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#16. "RE: Very Difficult case"
In response to Reply # 15
Sat Aug-05-06 02:05 AM by HairSite

          

This poor guy has gone from one bad Dr to another and hopefully Dr A will be the last stop for him

Please help him Dr A, this guy is in a bad spot.

  

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Dens1Fri Aug-04-06 11:32 PM
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#17. "RE: Very Difficult case"
In response to Reply # 15


  

          

absolutely right "hairwar" went for another strip procedure and got over 3000 grafts, that will make a great cosmetic improvement

200 grown out minis/micros from strip session in the 90s
500 FUEs with Dr Gho in two sessions
July 11th, 2005: 2500+ stripFUs with Dr A in India

check the details of my ht-procedure with Dr A under "Dens1":
http://hairsite.com/serendipity/authors/21-De

  

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notanewbieSat Aug-05-06 01:04 AM
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#20. "DENS1..."
In response to Reply # 17


          

How do you know that was the route taken? I am happy that my suggestion was ultimately the same as the one chosen but, how do you know? Dr A has not yet responded AND I am curious if the strip was done primarily to harvest grafts or to revise scars?

Certainly they work hand in hand but, I would like to know if in fact he had a DOUBLE revision as Dr C had suggested and if NOT then which scars did Dr A choose to revise.

I love these types of cases, very interesting and challenging and much respect goes out to Dr A for even accepting such a case, most US Dr's would certainly pass due to the liability and probability of failure.

  

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Dens1Sat Aug-05-06 01:32 PM
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#25. "RE: DENS1..."
In response to Reply # 20
Sat Aug-05-06 06:30 PM by HairSite

  

          

I just read through his post

200 grown out minis/micros from strip session in the 90s
500 FUEs with Dr Gho in two sessions
July 11th, 2005: 2500+ stripFUs with Dr A in India

check the details of my ht-procedure with Dr A under "Dens1":
http://hairsite.com/serendipity/authors/21-De

  

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pcguySat Aug-05-06 06:36 AM
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#23. "RE: Very Difficult case"
In response to Reply # 17


          

>absolutely right "hairwar" went for another strip procedure
>and got over 3000 grafts, that will make a great cosmetic
>improvement

3000 grafts from that donor seems a large #. is that true.

  

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DrCSat Aug-05-06 12:52 AM
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#18. "Plan B"
In response to Reply # 14


  

          

Hairwar is full of scars now.

That being a fact, my opinion is to do a double scar revision FIRST, making the very top scar and the second top scar into ONE single scar.

Simultaneously unite the two bottom scars into one scar.

Such double maneuver can easily yield 9,000 (low guess) very good hairs that can be readily transplanted to give density midscalp and over the sides. Besides it will almost reduce the scarring by 50%, in one inexpensive shot.

Once healed, say 6 months, then finely FUE for hairline (fine) hair and strongly camouflage the remaining scars with noble (thicker)hair.

Truly,


DrC



Dr. Carl Bazan, MD, MTTS
www.itzan.com
doctor@itzan.com
------------------------
1-866-828-0710 Toll Free
from Canada and the U.S.
------------------------

  

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notanewbieSat Aug-05-06 01:00 AM
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#19. "Dr C, no offense but.."
In response to Reply # 18


          

Dr C no offense but, the laxity was average not exceptional and in MY years of study, I have found that a scar revision has a 50/50 shot of being successful the first time around and the percentages decrease after each failed revision.

To suggest a DOUBLE scar revision without sufficient laxity to do so would jeapordize the success of BOTH scars rather than increase the likelihood of improving the worst two lower ones.

Furthermore, the higher of the 2 scars are perhaps "too high" and any attempt to revise them could yield not only to a far worse result, but a more visible one due to the location high on the skull.

There is no way on earth YOU or any other Dr in the world can show me a single photo of a successful Double scar revision. I do not beleive teh scalp laxity is such that it could sustain such trauma with FOUR major lacerations in one sitting removing significant tissue without tremendous tension on the suture line.

I apologise but I think that may be the very worst advice I had ever heard from ANYONE let alone a Dr.

  

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DrCSat Aug-05-06 01:15 AM
Member since Jun 24th 2004
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#21. "Well read this then..."
In response to Reply # 19
Sat Aug-05-06 01:17 AM by DrC

  

          

Don't get excited.

I seen many bad and abnormally huge linear scar due to HTs.

Scars revisions are successfull if and ONLY if the sutured lines run according to the low tension vectors AND the lips of the wound sustain zero tension. That is indeed achievable with the correct surgical technique. Seems extreme by just looking at a picture, but if the scalp shows good laxity (as described) he is a very good candidate, indeed.

Yet, you are right (meaning I understand your point) in saying that attempting the double repair in one sitting is risky.

I proposed the double repair at once because the guy is in India (and that looks far away for most of us) so it would save Hairwar precious time and money. And I am sure good DrA can revise those lines easily.

So if you want to the the revision + transplant while running in "safe mode", then one revision at the time should be attempted.

The top two scars are there already ! by revising you diminish and not enlarge the problem.

Besides, it was just Plan B. Let's wait for DrA to show us Plan A.

I wrote before what in my experience is viable, doable and in my opinion the best shot for Hairwars (aesthetically and yield wise).

Cheers!



DrC


Dr. Carl Bazan, MD, MTTS
www.itzan.com
doctor@itzan.com

  

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jotronicSat Aug-05-06 01:32 AM
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#22. "RE: Plan B"
In response to Reply # 18


  

          

Double scar revision? One word for that. Necrosis.

Joe Tillman
aka, Jotronic
Hasson & Wong
www.hassonandwong.com
www.hairtransplantmentor.com
Joe@HassonandWong.com

1.800.859.2266

The Truth Is In The Results

7917 FU Grafts

  

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DrCSat Aug-05-06 09:25 AM
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#24. "RE: Plan B revisited"
In response to Reply # 22


  

          

>Double scar revision? One word for that. Necrosis.

Jotronic, no need to panic since the occipital aspect of the scalp is greatly vascularized. A well done double revision should bring no fear when done according to tension lines, with a zero tension suture protocol and observing all care needed.

And it was a proposed way of action only, not a done surgery, remember we do not have the patient at hand to be examined.

As I told your peer, if the idea os a double revision seems scary to some, then just think about one revision at the time (top first!).

Reasons:

(a) Patient temporarily lost some confidence on FUEs

(b) Patient can gain in a fast procedure 6000 hairs from the top revision, and that only with the top. 6000 thousand hairs in 7 hours or so is not a bad idea, given his circumstances.

(c) Patient may gain 3000 hairs from the bottom revision, which is actually uniting line #3 with line #4 (counting from top to bottom), sparing line #5 which can be easily covered with FUE's when the patient feels more confident again with FUE's.

(d) We are not making scars while revising. We are reducing their number.

(e) Scar are there already. I can not find a reason WHY they gave him 5 huge scars. But the scars are there, so lets just repair them.

(f) 8 to 9 thousand hairs can bring him closer to his #1 objective which is more density on top and front.

(g) Then we would strongly advise him to choose FUE's (by DrA) in order to fine tune the hairline, cover all 3 remaining scars and (perhaps) fill some of the crown.


DrC




--------------------------
Dr. Carl Bazan, MD, MTTS
www.itzan.com
doctor@itzan.com
---------------------------
Toll Free from Canada / USA
1 (866) 828-0710
---------------------------
+52 (449) 122-1128 (world)

  

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checkinginSat Aug-05-06 08:08 PM
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#31. "RE: Temple Point question"
In response to Reply # 14


          

Aren't these temple points awfully high?

Hoping for BHT results!

http://bhtadventresults.blogspot.com/

  

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DrCSun Aug-06-06 04:20 AM
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#32. "RE: Temple Point question"
In response to Reply # 31


  

          

>Aren't these temple points awfully high?

IMHO, yes.


DrC



Dr. Carl Bazan, MD, MTTS
www.itzan.com
doctor@itzan.com
----------------

  

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Dr. ArvindSun Aug-06-06 05:05 AM
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#33. "RE: Temple Point question"
In response to Reply # 31
Sun Aug-06-06 05:06 AM by Dr. Arvind

          

>Aren't these temple points awfully high?

Dear Checkingin,
As listed in Hairwar's priorities, the #1 priority was filling in the top and the hairline areas densely.

That leaves very little grafts to use for temple areas. Thus, the limitation.

Regards,
Dr. A

Dr.(Capt) Arvind Poswal
Dr. A's Clinic,
A-9,First Floor,
C.R. Park, (Near Nehru Place),
New Delhi-110019, India. www.fusehair.com
e-mail: poswalarvind@yahoo.co.in
Ph- 91-011-26274368,91-098-101-78062
Timings-10a.m.to 5p.m
Scalp & Body hair transplants.

  

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checkinginSun Aug-06-06 05:30 AM
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#34. "RE: Temple Point question"
In response to Reply # 33


          

Dr. A, as you are my doctor and I know your skills and capabilities, it always feels a little funny asking questions in your threads.

However, if it looks wrong or funny, I will.

As a doctor it is hard to find the balance between what you know is right and an individual patient's wishes. I remember reading a thread once where I thought you articulated about the placement of the temple points and I had never thought about it in that fashion. That the line should map closely to the eyebrow angle.

It is very obvious to me that they are too high with the drawn out model, but even more so when you look a the faint traces of what is left of the original temple points in this pic. These are mostly vellous hairs, but show up as blond with the angles and the lighting. It looks like it needs to be south of the current location by about an inch or better. Or, at some later date, extended downward.



I think I am seeing this correctly. That is something I am thinking of for my next appt as well, but I don't see the need for a lot and I believe you can use some of the less robust body hair to accomplish this.

Hoping for BHT results!

http://bhtadventresults.blogspot.com/

  

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Dr. ArvindSun Aug-06-06 05:57 AM
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#35. "RE: Temple Point question"
In response to Reply # 34


          

Dear Checkingin,
I am happy to answer to your queries on the threads. You point out things that may be on other reader's minds and it is always helpful to discuss these topics openly as it may benefit many other readers too.

I understand the point you are referring to.
In the picture I have attached, I think you are referring to the temple drawn in yellow. That was the fine vellus hair temple point originally given by nature. Unfortunately, apart from the graft limitation, we also do not have the precise fine hair to recreate this zone when performing strip.

That is why the temple point has, for the time being, been kept where the blue line is.
Ideally, given no limitations, the temple reconstruction should have proceeded on lines of the green line. That would entail a minimal broadening of the hairline zone too.


Please let me know if you have additional queries.
Regards,
Dr. A

P.S.- The brown line refers to the closed temple angle teenage hairline.




Dr.(Capt) Arvind Poswal
Dr. A's Clinic,
A-9,First Floor,
C.R. Park, (Near Nehru Place),
New Delhi-110019, India. www.fusehair.com
e-mail: poswalarvind@yahoo.co.in
Ph- 91-011-26274368,91-098-101-78062
Timings-10a.m.to 5p.m
Scalp & Body hair transplants.

Attachment #1, (jpg file)

  

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checkinginMon Aug-07-06 01:21 AM
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#41. "RE: Temple Point question"
In response to Reply # 35


          

Dr A right on the money. That is exactly what I was talking about!!

Hoping for BHT results!

http://bhtadventresults.blogspot.com/

  

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Dr. ArvindSun Aug-06-06 06:14 AM
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#36. "The look"
In response to Reply # 34


          

Dear Checking in,
I located a thread where the temple point was reconstructed in a similar manner. The grown out result may help give a better understanding of the plan we decided to go ahead with when making the temples.

http://www.hairsite4.com/dc/dcboard.php?az=show_topic&forum=12&topic_id=22535&mode=full

The actual nature given temple point in this patient was near the mole.
However, since only scalp hair were used, we did not proceed that far ahead.







Dr.(Capt) Arvind Poswal
Dr. A's Clinic,
A-9,First Floor,
C.R. Park, (Near Nehru Place),
New Delhi-110019, India. www.fusehair.com
e-mail: poswalarvind@yahoo.co.in
Ph- 91-011-26274368,91-098-101-78062
Timings-10a.m.to 5p.m
Scalp & Body hair transplants.

Attachment #1, (gif file)
Attachment #2, (gif file)

  

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Dr. ArvindSat Aug-05-06 05:02 PM
Member since Jun 23rd 2004
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#26. "RE: Hair war (a repair case) - choices & decisions."
In response to Reply # 0


          

Thank you for all the inputs.
Various options for the repair procedure were discussed along the lines as outlined by various forum members.
Due to Hairwar's previous bad experience with fue, he opted for a strip FUHT.
In the strip FUHT, we aimed to excise some strip scars while still managing to get grafts to perform the repair procedure in the recipient area.

A total of 3080 grafts were extracted and transplanted.
The grafts were used to recreate the temple areas and to fill up the front, the hairline and the top areas.
No grafts were transplanted into the crown area.




Dr.(Capt) Arvind Poswal
Dr. A's Clinic,
A-9,First Floor,
C.R. Park, (Near Nehru Place),
New Delhi-110019, India. www.fusehair.com
e-mail: poswalarvind@yahoo.co.in
Ph- 91-011-26274368,91-098-101-78062
Timings-10a.m.to 5p.m
Scalp & Body hair transplants.

Attachment #1, (jpg file)

  

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Dr. ArvindSat Aug-05-06 05:18 PM
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#27. "Recipient area"
In response to Reply # 26


          

Dear Forum readers,
Following are some of the pictures of Hairwar's recipient area.











Regards,
Dr. A

Dr.(Capt) Arvind Poswal
Dr. A's Clinic,
A-9,First Floor,
C.R. Park, (Near Nehru Place),
New Delhi-110019, India. www.fusehair.com
e-mail: poswalarvind@yahoo.co.in
Ph- 91-011-26274368,91-098-101-78062
Timings-10a.m.to 5p.m
Scalp & Body hair transplants.

Attachment #1, (jpg file)
Attachment #2, (jpg file)
Attachment #3, (jpg file)

  

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SKSat Aug-05-06 05:39 PM
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#28. "RE: Recipient area"
In response to Reply # 27


  

          

I am no fan of stripn but 3080 grafts fron a strip revision?! That's a big number.
I guess the one thing in favor of strip is the large number of grafts one can get.

  

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Dens1Sat Aug-05-06 05:57 PM
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#29. "RE: Recipient area"
In response to Reply # 28


  

          

over 3K grafts plus an improved scar: absolutely awesome! I bet this is going to be another A+ result

200 grown out minis/micros from strip session in the 90s
500 FUEs with Dr Gho in two sessions
July 11th, 2005: 2500+ stripFUs with Dr A in India

check the details of my ht-procedure with Dr A under "Dens1":
http://hairsite.com/serendipity/authors/21-De

  

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ipodSat Aug-05-06 06:51 PM
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#30. "What about the donor ?"
In response to Reply # 29
Sat Aug-05-06 06:53 PM by ipod

          

What about pics of the donor site ?


hey dens1, your hair looks really good , got more pics ?

  

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Dens1Sun Aug-06-06 05:55 PM
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#37. "RE: What about the donor ?"
In response to Reply # 30


  

          

I guess the donor pics are on that other site.

200 grown out minis/micros from strip session in the 90s
500 FUEs with Dr Gho in two sessions
July 11th, 2005: 2500+ stripFUs with Dr A in India

check the details of my ht-procedure with Dr A under "Dens1":
http://hairsite.com/serendipity/authors/21-De

  

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hairy taleSun Aug-06-06 06:00 PM
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#38. "Patient's decision"
In response to Reply # 37


          

I wouldn't have gone for a further strip no matter what, but it all comes down to the patient choice, so in the end best luck to him ! Wait and see...

hairy tale

  

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notanewbieSun Aug-06-06 10:08 PM
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#39. "Hairy Tale please read.."
In response to Reply # 38
Sun Aug-06-06 10:10 PM by notanewbie

          

You commented that you would not have opted for a strip under any case scenario.

I stated that a strip was the best option for this patient and my reasons were discussed in an earlier post in this thread.

There is NO WAY that this patient could have recieved 3000 grafts via FUE. Given the 5 strip scars and density required to cover them in between each scar, if you removed grafts from between the railroad track scarring, you ran the risk of making the strip scars more visible. The sides of the head alone would not yield that number of grafts AND they were previously harvested from already.

He also saved a great deal of time, money and precious scalp grafts by revising 2 scars rather than attempting to FUE them. Now he will have a thin unnoticeable scar in place of 2 3-4mm wide scars.

The patient also declined FUE from Dr A or any other Dr based on the poor yield he got from FUE previously. Even though he is scarred badly from strip, he acknowledged the strip yield was better..for him anyway.

So, my question is..why would you feel that FUE was a better choice for Hairwar then the decision to have a strip like Dr A and myself suggested?

  

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hairy taleMon Aug-07-06 12:00 AM
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#40. "Tempest in a teapot"
In response to Reply # 39


          

Well, I'm only an upcoming Dr A's patient so please be kind enough to just consider my input a layman's one
I already stated my reasons in an earlier post on this thread, for what they're worth, they mightn't have turned up to be the best convincing ones, not an issue for me.
Dr A was the one who publically subjected the case to the boards and asked for opinions, I am still glad I contributed in my own small way, believing in what I wrote, no KJing, flooding, whatsoever.
Besides, I stubbornly keep disagreeing that strip yields more than fue, contrary to one of the popular misconceptions the boards are fraught with. The debate has been already brought up countless times and never led to a definitive, compelling conclusion.
I suppose what prompted Hairwar to opt for a by-strip strip revision and hairline/vertex refill has more to do with his own irrational forebodings of just another likely hapless fue, as his previous experiences alas have instilled him with, than with any cold-blooded educated pondering.
As for me, in the patient's emotional shoes, I would have dreaded the outcome of a sixth further strip much more than that of a third fue session.
But again it's just my feeling and I wish Hairwar all the best in Dr A's expert hands, regardless. Confident that if Dr A consented to follow his patient's preference for strip, no doubt he sincerely assumed it's still a feasible repair option, by which he's currently striving to give him satisfaction.


hairy tale

  

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notanewbieMon Aug-07-06 03:16 AM
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#42. "Hairy.."
In response to Reply # 40


          

There have been countless studies done that PROVED that graft placement higher than 30 grafts per/cm/sq produces significantly less percentage growth and yield. Guess what, I disagree and many Drs have proven that you do not have to scarifice yield with high density transplants. Is there a definitive answer, NO.

I have proven on my own scalp that strip yields better than FUE. There have been countless photos of 2000 FUE grafts patients and they look far thinner than the same number of strip grafts. FUE DR's feel the yield is identical and a "graft is a graft". Is there a definitive answer, NO.

So if you are waiting for a definitive answer as to which method yields better or if high density transplants sacrifice yield then you will be waiting FOREVER.

Speak to 2 different people and you will get 2 different answers so, pick who you respect and listen to them.

  

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HairSiteMon Aug-07-06 07:50 AM
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#44. "RE: Hairy.."
In response to Reply # 42
Mon Aug-07-06 08:06 AM by HairSite

  

          

>There have been countless photos of 2000 FUE grafts
>patients and they look far thinner than the same number of
>strip grafts.

That is so untrue. I am going to ask that you back up everything in your post from now on. Woods patient George, Gary, Blond Guy as well as Wolf's 1800 FUE are all patients with excellent yield.

Show me the "COUNTLESS" examples that you were referring to.

I can say I can find countless bad strip transplants with poor yield too, so what's your point !

HairSite.com
email: hairsite@aol.com
========================
Disclaimer: I am NOT a doctor. Please do not consider anything you read from this website or any of the forums as medical advice.

  

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Dr. ArvindMon Aug-07-06 04:59 AM
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#43. "RE: Hair war (a repair case) - choices & decisions."
In response to Reply # 0


          

Dear forum readers,
The aim of the current patient repair case discussion was not to highlight one technique v/s the other.
Rather it was to help readers gather inputs on the different options available to patients today.
There is no single ONLY correct way.
There are varied approaches possible and the educated patient can go a long way in researching and choosing the road they wish to travel.

I am thankful to all the forum posters who contributed with their suggestions.
That a particular approach was not followed in Hairwar's case does not negate the benefits of that approach.

Regards,
Dr.A

Dr.(Capt) Arvind Poswal
Dr. A's Clinic,
A-9,First Floor,
C.R. Park, (Near Nehru Place),
New Delhi-110019, India. www.fusehair.com
e-mail: poswalarvind@yahoo.co.in
Ph- 91-011-26274368,91-098-101-78062
Timings-10a.m.to 5p.m
Scalp & Body hair transplants.

  

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scarredup5Thu Aug-10-06 10:12 PM
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#45. "RE: Hair war (a repair case) - choices & decisions."
In response to Reply # 43


  

          

i think you must always take into consideration that bht will always take longer to grow and when it does finally come in the hair is always thinner so the outcome may seem less dense and the perception of less yield, therefore more bht is required for a cosmetically acceptable result

  

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