View Full Version : Dr. Lindsey 4536 graft frontal case with 1 month scarcheck McLean VA

Dr. Lindsey
09-13-2011, 05:42 AM
This fellow was in yesterday for a scar check. He has been doing a comb-over for years to hide his hairloss. At his initial consultation, I suggested he preserve his comb-over, do a big frontal case, which would take a week off of work, then he could go back to work with his comb-over and hopefully no one would notice. Then a year later we could do a second case but I felt we’d never cover the crown.

We did a large strip case on him, and excised the usual size (1.7cm wide) strip and had a nice 2 layer closure. In fact, I commented during the strip that #1: he had fantastic density—way more than I expected and #2: that we probably could have gone a little wider given how easy he was to close. I expected us to get 3500+ grafts, pretty typical for a big case at my office.

As the day wound on, my techs’ numbers kept growing and by 3 o’clock, we had 4536 grafts, roughly half singles and half doubles and triples. I’d made fewer single slits than that, so in the far back we added some extra one’s to give more bulk. I’ve described my thoughts on this before, and essentially, back in the middle of the head, I think it’s reasonable to add extra singles like this as you really just want density. I’d never do this up front or at the hairline, as the hairs may grow at a bit of an angle and look noticeable, but way back in the middle; again I just want density and more coverage.
Shown are periop pics, 3 day checkup pics, 1 week and 5 week pictures. His scar is virtually undetectable even at 1 month. Assuming this grows in well, I’m guessing we can get 3000 out of another strip and really almost completely give him good coverage. He has thick wavy hair which solves half the battle.

Dr. Lindsey McLean VA

09-13-2011, 07:23 AM
Great stuff Doc - 4500+ BOOM!!!:cool:

Follicle Death Row
09-13-2011, 03:59 PM
Whoa. He must have really good donor. He's going to have a very nice result. The 12 month photos will be impressive. I've heard people mention that a 3.25-3.5cm width of donor area is available to some lucky people with favourable characteristics over a number of procedures. If that's the case he could get close to 9000ish in 3 strips provided a good degree of scalp elasticity returns!

Great work as usual doc. I was wondering whether you generally cut a uniform width strip or whether sometimes you vary the strip width? I've heard Dr. Hasson talking about how graft numbers can be maximised by not cutting a uniform width strip and by varying the width in places where there is greater scalp elasticity. Apparently it results in a uniform tension along the length of the closure which would make sense. However would doing that mess up the hair growth direction in certain places and give that slightly odd appearance where it kind of looks like the patient just took off a tight baseball cap?

Dr. Lindsey
09-20-2011, 06:28 AM
Thanks for the comments. That is a reasonable question.

For virgin heads that have normal laxity, my strips are almost always just about the width a stick of gum, 1.5cm and I vary the length to get the number we are shooting for. For tight scalps,that tends to narrow at the corners, where the strip bends around and up toward the ears, and there is inherently more tension.

For 2nd or later cases, it just depends on the need and what is available, plus whether we are cutting out the old scar, or sewing up to it. The amount of hair depends on that of course as if 3 mm of your strip is hairless scar, there will be less hair to transplant in that case.

I almost never go wider to get more hair. I did a doctor's crown yesterday, and we could have used more hair, but he agreed with getting 2300 and hopefully getting a good scar, and having decent crown coverage, as compared to getting 3000 and having a wider scar with a bit more coverage on his crown.

Its important to discuss all this at the consultation.

For this guy, his hair was just so dog gone dense, that we way exceeded our goal, all for his benefit I believe.

Dr. Lindsey McLean VA