FUE vs scar revision

[amadeus]

Here’s what I think and I have been on these forums for 13 years, originally researching my hair transplant options on another forum that I still have an account on but much prefer the atmosphere of this forum.

Surgeons will only post their best results and unhappy patients show and complain about the bad results. I have seem too many hair transplant pictures and videos to count and as popular as this forum is, only a very small percentage of hair transplant results can be found on this and other forums compared to the thousands of hair transplants performed every year. No one who just reads these forums or who has had a couple of bad hair transplants has the knowledge of people who are actually doing the surgery. There are good doctors, bad doctors and doctors who have been so hyped on these forums that everyone just believes they are great, even when they might just be mediocre at best.

Dr. Karadeniz responded to the OP’s question and everyone else’s replies based on his personal experience. He can just as easily fill in scars with FUE grafts as do a scar revision, but if a doctor with far more experience performing surgery than any typical poster on this forum, believes that in his hands this might be the best approach, depending on the case, then personally I would trust his advice over any of yours.

Joe Tillman is also in a much better position to give advice than most people on these forums. As someone who enjoys posting his opinion on this forum also, I can understand that we all have our biases, but anyone who cannot voice their opinion in a civil, logical manner is someone who should just be ignored. The lack of common courtesy and disrespect displayed on some of these forums is disgusting and only interferes with the ability for people to do real research.

If I were the OP I would be grateful that Dr. Karadeniz took the time to give such an in-depth response. As for the people who spend so much time trying to act like experts or be nasty on these forums, they should just be ignored and seen as the trolls that they are.

I also have to say that I am disappointed that a representative of a doctor would post such a dogmatic response like “Don’t attempt to have a typical ‘revision’ because this will only likely result in ‘stretch back’ and make matters worsen.” without even seeing pictures of the scar. Perhaps Dr. Mwamba himself should post his opinion once he has the chance to actually see what this person is working with?

[doinmyheadin]

Hi, I have seen a few of Dr Mwambas cases online. My scar is about 3 years old. I dont want to go through a revision, it was bad enough having to be a hermit for 5 months following my first two FUT transplants. I fell for the graft survival rate and the scar will only be 1mm wide (with my dark hair and dense donar I thought I would be a good case) at a number 4 to 5 clipper in good sunlight you can see a light patch along the length of the scar.

As I said earlier I have been to probably the most popular doctors in the industry, so I dont think a scar revision will improve my situation much. And I dont want to be cut up again and have to go through all the healing and paranoia again.

With fue into the scar do you think it will be possible for me to cut down to a number 3 clipper and the scar not be noticeable at this length? And also when the hair is saturated wet will it be camouflaged? Again thanks for the reply

[ejj]

Yes, I would always advise against having a hair transplant. It is without doubt the worst decision I have ever made. I am sure that many others
would agree with this but do not post due to the legal waivers, that are more common than most would like to admit, that exist between Dr and client.
Regards
ejj

[jamesst11]

With todays refined techniques and knowledge on how wounds heal favourably, a strip scar should be 1mm or less in width.

Having said that, unfortunately the most frequent cause for a bad strip scar is poor surgical technique. Unfavourable healing characteristics of the patient is a rare cause.

When a patient enquires with a bad strip scar the first thing I do is to ask who did the procedure. If the surgeon isn't someone that I know with an excellent surgical technique I will assume the cause is poor technique. In this case the most effective surgical treatment is a scar revision that involves a direct excision of the scar and closure with the best possible technique.

FUE grafting and SMP have limited efficiency in these situations as they do nothing to remove the existing scar. They only camouflage the scar to some extent. I will consider these methods only when I know the previous procedure was done by an expert and I suspect that the patient has unfavourable tissue healing characteristics, or when a proper scar revision is done with success and I still want to improve the camouflage.

In my experience, there hasn't been a single case when I did a scar revision and the scar didn't improve. The results ranged between complete disappearance of the scar to a significant improvement. There were a couple of cases where the scar improved but with less effect than I expected. I diagnosed that these patients had unfavourable tissue healing characteristics. I had an interesting case where both a body hair transplant and SMP on the scar done by reputable surgeons were not effective and a scar revision done by myself that removed all of these with the scar led to a significant improvement. The previous interventions had actually increased scarring and made it more difficult to do the repair.

Very well put. I must ask, however, in which of the repair cases you performed, did the scar completely disappear?? how is this even possible? Did hair actually grow through the scar tissue? Thank you.

[HairTransplantOops]

Thanks

Until now I was sharing general advice on how to approach strip scars based on my experience. I did not advice you on a certain method yet since I did not have the chance to evaluate your scar. Nor did we see any close up photos of the scar. Without the chance of seeing the state of your scar, without considering who did the procedure and without evaluating donor skin laxity I don't think any surgeon should give you advice on which treatment method is best for you.

2-3mm width is a critical number. It may deserve either of the three options: Not doing anything if it is camouflaged well, doing a scar revision or FUE grafting.

If you asked me to deal with the scar, I would give you these general information and advice you to make the final decision when I have the chance to examine you live.

I hope me chiming into the thread that was silent for 2 weeks has generated a fruitful discussion to help you.

Dr. Karadeniz,

I would like to thank you personally for your input in regards to my situation. As you can tell many of us can get bent out of shape when your opinion/experience does not coincide with ours. Yes, I am sure that surgical technique has a lot to do with it and am glad that you are having great results with your FUT procedures. Here is a pic of the back portion of my scar which I likely should have included earlier to further facilitate your input. Again, thank you for giving me advice.

Regards,

HTO

[HairTransplantOops]

Hairtransplantoops, I will not make a conclusive evaluation by just looking at a single photo. Please don't mention the surgeons name anymore, since I will be making comments. It looks like the scar is about 3mm wide. The scar also appears to be too short (longer but thinner strips heal better) and too straight (it should be lower at the midline and higher at the sides). I would be very dissatisfied if I had caused that scar, unless I knew you had unlucky healing characteristics, which of course we can not rule out. There are many other parameters I need to know before I can tell you what I recommend. For instance, you mentioned earlier that your are 32 and you have an advanced Norwood. It means you may need more surgery. In this case why are we looking at repairing the scar instead of trying to get the most grafts out of it first? If you are deciding to be done with strip surgery and then use only FUE later then it may be a reason to try and repair it, but just that single photo tells me that you may be a candidate for more by utilising both strip and FUE while improving the scar. Only after a detailed examination, explanation of surgical options and and outcomes, hearing what you prioritise, could I come to a final conclusion. I hope these were helpful.

Dr. Karadeniz,

I could use more surgery but the fact of the matter is that I am ready to accept my destiny. I fear that more transplants will only increase the risk of stretching the scar in the back of my head. Makes sense that more grafts out will cause more tension on the wound. Also, my scalp laxity may not be ideal but I will need to see subsequent HT doctors to fully determine this (have had one thus far state that I was tight). The photo I submitted may not tell the entire story. It is a long scar from the tops of my ears and then across the back of my head and it is crescent shaped. Measures at 2 mm in the center (immediately superior to occipital protuberance) and closer to 3 mm toward the ends. My main priority is NOT to keep going down the transplant road. I am in high hopes that I can fix this the best possible and move on with life. It is not about the money, not about the time but about the ability to move on.

Thanks again,

HTO

[ejj]

Ejj, I understand your situation and I am seeing a lot of members who didn't get the best results and are advising others against going for hair surgery. I can't criticise you for that, but when we discuss a scientific topic we are looking for general rules derived from the most advanced surgical techniques available. Advising others against having hair surgery due to a bad experience is not something we can talk over. Besides, it is frequently the choice of surgeon, the timing or the surgical plan that is the mistake; not the decision of going for surgical hair restoration.

Thanks for your reply Dr Karadeniz. My view is that if you decided otherwise, then you are not exposed to the risks (details above) of a poor result, and therefore are better off

What concerned me when I was 22 years old seems laughable now that I am a lot older. It is unfortunate that mpb strikes a lot of young men at this tender age, when desperation often overrides common sense. Many in time with other more pressing responsibilities that life throws at us would not give hair loss a second thought.

As a repair client, the best approach is to not make your situation any worse.

Artas is currently considered an `advanced surgical technique` and is widely available. From my research the extraction punch was 1.4 mm in size, I am unaware if this has now changed, however I would assume that clients who had this procedure performed on them may now be classed as repair cases, with little donor or options available to them.

Cell therapy (mentioned earlier in this thread) is considered advanced however as yet there appears to be no evidence to back it up, all very confusing for the newcomer

Choice of surgeon is obviously important. This is immensely difficult for potential clients as most pre- op waivers restrict what one can say publically, and this seems to be far worse for repair clients who may have costs returned to them for poor results, if they agree to release the physician from all responsibility for their disfigurement. So more often than not the newcomer only sees the doctors best results, and can make a poor decision based on this.

What are we really seeing on forums? If ten doctors perform a procedure daily then this is 50 per week, no forum provides this amount of results, we see cherry picked results with high hair counts per graft, so we have to accept that we probably see less than 1% of results and only then, the better ones. It takes time to meet with ten patients of a particular doctor who are willing to give their time and have a chat over a coffee, however I believe this is critical when considering this procedure. Representatives and employees of a physician are another good source, as they see other doctors work on a daily basis. Again they are restricted to what they can or cannot say, however I take `no comment` as a good indicator.

If you are to proceed with this procedure my advice would be to work out your own donor availability and use it wisely. More often than not the donor will only cover so much bare scalp. For me I would go fue and graft into the frontal forelock, this is the safest way to go and future loss means you maintain a normal appearance, this area can be expanded upon later, donor permitting.

Regarding scar revision, I found with my scars that grafting into them also improved the appearance of the scar tissue, the area became warmer, and pinker due to the improved blood supply, this improves the appearance significantly, you really do lose that horrible bone white colour.

Fue into scar gave me a significant improvement, my doctor implemented a low risk surgical plan that has improved my quality of life immensely and enabled me to move on with my life, much like the op wishes to do, however my earlier attempts at repair can only be described as a disaster as the claims of advanced surgical techniques and therapies that are still promoted today, left me in a much worse position than I was already in, this cost me years in time, money, and heartache.

I hope this helps

Regards

ej

[HairTransplantOops]

Good advice

Ejj, I understand your situation and I am seeing a lot of members who didn't get the best results and are advising others against going for hair surgery. I can't criticise you for that, but when we discuss a scientific topic we are looking for general rules derived from the most advanced surgical techniques available. Advising others against having hair surgery due to a bad experience is not something we can talk over. Besides, it is frequently the choice of surgeon, the timing or the surgical plan that is the mistake; not the decision of going for surgical hair restoration.

Thanks for your reply Dr Karadeniz. My view is that if you decided otherwise, then you are not exposed to the risks (details above) of a poor result, and therefore are better off

What concerned me when I was 22 years old seems laughable now that I am a lot older. It is unfortunate that mpb strikes a lot of young men at this tender age, when desperation often overrides common sense. Many in time with other more pressing responsibilities that life throws at us would not give hair loss a second thought.

As a repair client, the best approach is to not make your situation any worse.

Artas is currently considered an `advanced surgical technique` and is widely available. From my research the extraction punch was 1.4 mm in size, I am unaware if this has now changed, however I would assume that clients who had this procedure performed on them may now be classed as repair cases, with little donor or options available to them.

Cell therapy (mentioned earlier in this thread) is considered advanced however as yet there appears to be no evidence to back it up, all very confusing for the newcomer

Choice of surgeon is obviously important. This is immensely difficult for potential clients as most pre- op waivers restrict what one can say publically, and this seems to be far worse for repair clients who may have costs returned to them for poor results, if they agree to release the physician from all responsibility for their disfigurement. So more often than not the newcomer only sees the doctors best results, and can make a poor decision based on this.

What are we really seeing on forums? If ten doctors perform a procedure daily then this is 50 per week, no forum provides this amount of results, we see cherry picked results with high hair counts per graft, so we have to accept that we probably see less than 1% of results and only then, the better ones. It takes time to meet with ten patients of a particular doctor who are willing to give their time and have a chat over a coffee, however I believe this is critical when considering this procedure. Representatives and employees of a physician are another good source, as they see other doctors work on a daily basis. Again they are restricted to what they can or cannot say, however I take `no comment` as a good indicator.

If you are to proceed with this procedure my advice would be to work out your own donor availability and use it wisely. More often than not the donor will only cover so much bare scalp. For me I would go fue and graft into the frontal forelock, this is the safest way to go and future loss means you maintain a normal appearance, this area can be expanded upon later, donor permitting.

Regarding scar revision, I found with my scars that grafting into them also improved the appearance of the scar tissue, the area became warmer, and pinker due to the improved blood supply, this improves the appearance significantly, you really do lose that horrible bone white colour.

Fue into scar gave me a significant improvement, my doctor implemented a low risk surgical plan that has improved my quality of life immensely and enabled me to move on with my life, much like the op wishes to do, however my earlier attempts at repair can only be described as a disaster as the claims of advanced surgical techniques and therapies that are still promoted today, left me in a much worse position than I was already in, this cost me years in time, money, and heartache.

I hope this helps

Regards

ej

Ejj,

It is interesting how quickly we can see mistakes after they are done. Hindsigh trulyt is 20/20. But I can bet if we had never done it in the first place there is a good chance we would long for hair .

This is a truly a daunting task. How wide of a scar did you graft ejj? How were your results?

I for one plan to take my time with this decision, considering my hair is currently relatively stable. If I would have done this initially I would not be in this predicament. But the world was "crumbling" and needed to control my situation.

May try some dermarolling, fraxel or whatever research supports to reduce my current scar.


HTO

[ejj]

Ejj,

It is interesting how quickly we can see mistakes after they are done. Hindsigh trulyt is 20/20. But I can bet if we had never done it in the first place there is a good chance we would long for hair .

This is a truly a daunting task. How wide of a scar did you graft ejj? How were your results?

I for one plan to take my time with this decision, considering my hair is currently relatively stable. If I would have done this initially I would not be in this predicament. But the world was "crumbling" and needed to control my situation.

May try some dermarolling, fraxel or whatever research supports to reduce my current scar.


HTO

Attached is a before and after. The slow, least risk approach is the way to go in my opinion

All the best

ej

[HairTransplantOops]

Recommendation

Hairtransplantoops,
We all have to respect your decision on what to do with your own hair. My contributions are not aimed at convincing patients to go for surgery, but they are rather to inform members about surgical options and expected outcomes when properly performed.

Dr Karadeniz,

What would be your vote on my scar out of curiousity?

HTO

[HairTransplantOops]

Decisions

What are the chances of you wanting another hair transplant later in your life?
If you may want another one, what are the chances you accept having another FUSS procedure if you were convinced that the scar even improved after it?
What are the chances of you having another FUSS procedure if you were convinced that the scar wouldn't get worse, but could stay about the same?
What are the chances of you having another FUSS if you knew that the scar improved or stayed the same and your surgeon told you that he could do a scar revision if it didn't improve with the FUSS he did?
Are you done with hair transplants, or are you done with just strip surgery or are both options open?
Do you want to improve the scar as much as possible, be done with FUSS and consider only FUE for later?

There may be other things that I would like to discuss to give a conclusive opinion. This is why my consultations take at least an hour, sometimes longer than how much time some surgeons spend on a patient during the whole surgery.

These are all good questions. I think the main reason I am done with strip is because I don't want to have a scar stretch out further and impact my ability to conceal it in the future (there are absolutely no guarantees this will not happen with another procedure). I am far more concerned about the scar than the front/crown. I can't get my hair at all wet without my scar showing. This effects my ability to go swimming and run long distances (when my hair gets sweaty it shows through). It impacts my well being and my ability to enjoy life.

Can't thank you enough for your help,


HTO

[LogicalBald068]

Hi, Talking about Scar revision a strip scar at least should varies in the range of 1-2 mm approximately or may be some lesser number. There are several causes for bad strip scar is like poor surgeries for hair transplantation. And as you have mentioned FUE well FUE grafting and SMP have limited efficiency in this situation as they do nothing matters with existing scar. And according to me there are very rare case where you will found scar revision and the improvisation does not occurred. Results can be varies in disappearance of scar to a significant improvement.

[HairTransplantOops]

I finally prepared my first video to present how a strip scar may look like in my hands. I am hoping to keep posting on the below thread to explain more what I have been trying to say.

https://www.baldtruthtalk.com/thread...343#post222343

Hey Dr. Karadeniz,

That is a decent scar but I suspect the criticism you will get is that it a good example and that not all examples can be that good. I will say that it is hard to pick up in the comb through but the patient's hair is quite long. Either, nice job on this young man's incision/scar.

HTO

[GNX]

Hey Joe ur a representative of his I wud expect nothing less from you as far as defending him but the fact still remains EVERY single patient that has had a HT bases their decision from either LOOKING at the final result of patients and reading wat other patients experiences were so me looking at pictures vs. wat HIS personal experience is is not irrevelant. its wat every patient uses to determine which HT doctor their gonna chose. so yes based on wat I have seen over the last 15 years I disagree with him.

maybe he is not arrogant in person but he sure is on the HT forums. Joe, his work is so-so. sorry if that offends you but he's no Erdogan and anyone going to Turkey to get a HT Erdogan is best choice hands down and your well aware that. you can try ur best to defend his work but Erdogan is the starting player on the All-Star team. Karadeniz is the guy wishing he made the team period.

and FUT is simply barbaric and it won't be long before it goes like the dinosaurs did so closure techniques are pretty irrelevant imo. ppl are finally realizing that they can get just as many grafts from FUE that they do FUT. at least from world class HT surgeons that is.

there are no FUE threads created asking how FUT is gonna repair or hide their poorly healed FUE surgery.

and I don't see Dr. Karadeniz performing any LARGE FUE procedures. like 5000+ grafts. I see plenty of large procedures from Erdogan and many others from Turkey but not ur guy. whether u want to admit it or not a tell-tale sign of a Dr's skill level is being able to transplant as many grafts via FUE that he can FUT (meaning 5000-7000 grafts on average) and ur guy can't do that which makes his skill level average.

Hi GNX,

I don't understand how looking at pictures of different results from different clinics disqualifies what Dr. Karadeniz has said he has experienced in his own clinic. I also don't understand how his statements about his OPINION on donor wound closure is justification for you to say that you don't like his results. What does your opinion about his results have to do with his opinion on donor wound closure? Dr. K does have a waiting list but what does any of this have to do with anything?



Actually, it should. You looking at pictures is irrelevant to the experience that a surgeon has in his own OR. Let's be honest here, the comparison is silly. I've read for several years how patients have had sexual side effects and other sorts of side effects from Propecia. I've met them in person in the various clinics I've worked in and I've spoken to them live on the show (The Bald Truth). I've been taking it myself for thirteen years. Does this mean that my own personal experience, side effect free, is null and void because these other people have a different experience?



You're putting words in his mouth. Dr. K didn't say that his patients are not subject to having a widened scar. He said that he's had cases where the scar wasn't as it was hoped or predicted and he notched them up to having healing characteristics that didn't allow for the intended result. He has also said that while some of the "top" doctors do not have the best surgical technique there are some that do but he doesn't want to start rattling off names because it is irrelevant.

One of the things you are completely mistaken about is that Dr. K is arrogant. I can attest it is abslutely the opposite. The man has very little ego when it comes to his abilities. He is as black & white as they come. And I'll say this; I too have been on the forums for 15 years but instead of looking at pictures the whole time, I've been in the OR studying how donor wound closure is done. I know about as much as anyone can possibly know without having actually performed the surgery with my own hands. I've been speaking face to face with patients that have great experiences and those with horrible experiences and on top of it all I have been looking at the same photos that you have been looking at online. I've seen many doctors perform their own procedures and I've seen the best and the worst of EVERY top name in the business. I can say with ABSOLUTE authority that Dr. Karadeniz has a donor wound closure technique that will rival ANY hair transplant doctor on the planet and will in fact surpass most. He doesn't take big risks by taking 3cm donor strips and he doesn't try to set new records. Is he perfect? No, but he is no less perfect than anyone else out there and it is his qualities as a surgeon AND his ethics that tell me he's a doctor to keep an eye on. I'm a free agent and I can work with most anyone I want to work with. I choose to work with Dr. K because I believe in him, his ethics and his abilities and I'm here to say that he's damned good with a donor wound closure. I've seen it first hand.

[JoeTillman]

Hey Joe ur a representative of his I wud expect nothing less from you as far as defending him but the fact still remains EVERY single patient that has had a HT bases their decision from either LOOKING at the final result of patients and reading wat other patients experiences were so me looking at pictures vs. wat HIS personal experience is is not irrevelant. its wat every patient uses to determine which HT doctor their gonna chose. so yes based on wat I have seen over the last 15 years I disagree with him.

maybe he is not arrogant in person but he sure is on the HT forums. Joe, his work is so-so. sorry if that offends you but he's no Erdogan and anyone going to Turkey to get a HT Erdogan is best choice hands down and your well aware that. you can try ur best to defend his work but Erdogan is the starting player on the All-Star team. Karadeniz is the guy wishing he made the team period.

and FUT is simply barbaric and it won't be long before it goes like the dinosaurs did so closure techniques are pretty irrelevant imo. ppl are finally realizing that they can get just as many grafts from FUE that they do FUT. at least from world class HT surgeons that is.

there are no FUE threads created asking how FUT is gonna repair or hide their poorly healed FUE surgery.

and I don't see Dr. Karadeniz performing any LARGE FUE procedures. like 5000+ grafts. I see plenty of large procedures from Erdogan and many others from Turkey but not ur guy. whether u want to admit it or not a tell-tale sign of a Dr's skill level is being able to transplant as many grafts via FUE that he can FUT (meaning 5000-7000 grafts on average) and ur guy can't do that which makes his skill level average.

GNX,

You appear to have a hard time differentiating between talking about donor closure abilities vs. opinions of one's work. They are not synonymous which is why I called into question your attack. I don't care if you like Dr. K's work. I do. My point is that your opinion of the work is irrelevant to the dicussion yet you feel obliged to change the tone of the dicsusions to being a personal attack. There is so much wrong with your post that I won't bother dissecting it entirely but there are a few things of note to consider.

Removing 7000 grafts via FUE does not require skill. It requires multiple sessions. Nothing more, nothing less. Prove this to be otherwise if you disagree. If you believe this then do you think Dr. Erdogan is so much better than Dr. Lorenzo? You have applied numbers as being a qualifier of greatness so let us see if you can argue this. Dr. Lorenzo keeps his numbers to 2500 grafts per day, sometimes 3000. So does Dr. Bisanga, Dr. Lupanzula, and almost every other recognized doctor. Dr. K also limits his sessions to 2500 to 3000 grafts. Do you think that when a clinic says 7000 grafts that it was done in one day?

Furthermore, contrary to your beliefs, there are situations where strip is better, especially in cases where there is already extensive donor scarring. Yes, FUE can get just as many grafts as FUSS. In fact, it can get more. FUE can move every single hair from the entire donor zone so that the scalp is plucked clean. Does this mean it should be done? I'll let you decided that one.

Revision is, in many cases, better because it's better to have less scar than to have more scar, regardless of camouflage technique. I think of my own case where I had two donor scars stacked, one above the other. My crown and the back of my head were numb for nine years. The first strip I had with Dr. Wong allowed the feeling to return and each subsequent surgery I had with the man the nerves regenerated and I still have nearly full sensation throughout the back and crown. I witnessed the same happen for a patient of Dr. K's that I've been in contact with. He too had a wide scar, had it revised by Dr. K, and he has told me that six months later he has full feeling. He's a former FUE only proponent and now he understands. FUE cannot restore lost feeling in the donor zone created by previously poor FUSS surgery. Only FUSS can restore this damage and then once the scar is improved and the feeling is restored THEN one can consider FUE into scar for further camouflage.

Finally...

there are no FUE threads created asking how FUT is gonna repair or hide their poorly healed FUE surgery.

No, but there are threads asking how their FUE donor zones can be repaired in general. If FUE was so flawless, why would this be asked to begin with?

If you want to argue about which is better, FUE or FUSS, you're barking up the wrong tree. I am a huge proponent of FUE and now it is the only surgery I can have personally as I'm tapped out for FUSS. I still have laxity but I don't want to risk any more strips but when someone tells me that FUSS is a dinosaur and just as many grafts can be taken with FUE as with FUSS (without causing visual deficits) I use my own case as an example. Do you think I could have had the same degree of repair with FUE only?