View Full Version : I have never seen a case like this...

Limmer HTC
12-31-2009, 08:12 AM
Having been involved in follicular unit micrografting since I was a 3rd year medical student (~19 years), I thought I’d seen it all…good and bad. But on 12/16/09 a patient presented to my office having had a prior transplant in Florida (he did not elaborate further). He was a very pleasant young man who showed me his problem and asked if I could help, but I was almost speechless when he told me his procedure was performed only a year or so ago.
Now I have seen and repaired many cases, however the linearity of his graft placement (perfect row after perfect row) was the most striking I’ve seen. Compounding this problem is the fact he is Asian, has dark coarse hair, had compression of multi hair grafts, some pitting and the angle of placement was off by almost 90 degrees. In addition, his case is complicated by a very extensive/wide donor scar.
So many problems in one case leaves me only to think this could have been done by someone with very limited experience or training in the field of hair restoration. I present it here as I feel this site has helped direct patients to good physicians who not only understand how to perform the surgery, but have the knowledge, experience and artistry to complete the case and avoid the many pitfalls this patient experienced.

Presented today are his preop photos demonstrating the problems we faced:
• linearity of prior graft placement
• compression of muti hair grafts up front
• pitting around some of his grafts
• poor angle of prior grafts
• a wide donor scar

We were able to remove a majority of his old scar by excising ~32 sq cm of donor (~16 sq cm harvest from the right posterior parietal scalp and ~15 sq cm from the left posterior parietal scalp. Part of the old scar had to be left behind in his mid posterior scalp and will be taken care of in ~9 months. From this donor we were able to generate just over 1800 follicular unit grafts (his old scar limiting the graft total).
An extensive number of single hair f.u. grafts we created to use in advance and amongst his old hairline with the goal to drown out the compression problem and old pitting from his prior procedure. The angle was brought down, but because of his prior grafting it was still around 60 degrees. Not as low as I would have liked, but we did not want too great a mismatch of angles between our grafts and his prior work. Also, I wanted to minimize the risk to his prior grafts by making our recipient sites at a sharper angle. We then transferred over to 2 hair f.u. grafts to fill the void between his original rows and finally 3 hair f.u. grafts were placed well behind his frontal tuft to minimize any affect compression of the grafts might have on their cosmetic appearance.
While some additional correction is planned for ~9 months from now, I feel this patient will see a tremendous change in both the donor and recipient zones with what was able to be done.

Brad Limmer, MD/jac