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Dr. Lindsey Stage 2 of a 3 step procedure to repair a failed flap surgery
This fellow is now a year out from 2600 grafts, of his relatively fine donor hair, and returns for step 2—to remove his failed flap procedure from the 1980’s. You may recall that because he had a large flap, which ultimately failed years ago, that his donor region is not terribly dense, and he has moderate quality hair. Step one was to do a hair transplant behind his flap. He’s done quite well this year. These pictures were taken the day before starting step 2. I posted that story separately on the forum.
Step 2 will be to excise the flap and scar, and to place whatever hair we can get, at the back of his first transplant. Step 3, next year will be a second strip case to augment the frontal hairline, touch up any scar issues, and increase density.
The first few pictures are from last year. Preop, intraop, and 1 month scar and recipient site views.
For this procedure, I had the patient do scalp stretching exercises (on his forehead) for 1 month prior to the case. Then, in an upright position, I outlined the flap containing hair, and the hairless scar-flap centrally, for excision. Nerve blocks and only a medium amount of numbing medicine were required and he was awake and talkative throughout the case. Shown are the failed flap being elevated and ultimately being removed. Undermining of the forehead down to just above the eyebrows allowed the forehead to be advanced upward, but by not freeing up the eyebrow musculature—he should be able to avoid that “surprised” appearance sometimes associated with browlifts. On the hair side of the incision, undermining toward the crown allowed the hairline to be advanced a little and a fairly tension free trichophytic style (albeit without hair in this particular incision) was done. He’s staying 5 days and will have suture removal overseas.
We got 1050 grafts out of his failed flap and its “stalk” and these were placed behind his first case. The scalp in this area had excellent blood flow and I’m hopeful that this will grow well over the next year. Unfortunately he bumped his head on the taxi van and dislodged about 35 grafts which we replaced… a tough way to conclude an otherwise excellent and satisfying case.
He’s amenable to coming on and posting his story on occasion so I’d like his thoughts on this quite complex and challenging case.
Dr. Lindsey McLean VA
