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  1. #1
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    Question Question about Trychophytic closure

    I'm reading more and more about a new techniques for closing the hair transplant wound called Trichophytic closure. Can some explain how this works in layman terms for me and does it really leave no scar? If this is true then why consider FUE?

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    To me it's a little bit over hyped. It seem that if you cut one edge to be so thin that hair can grow through it that there would be more chance of the skin stretching. I would think the best way to close the skin would be edge to edge with all the skin in tacked.

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    Quote Originally Posted by amadeus View Post
    To me it's a little bit over hyped. It seem that if you cut one edge to be so thin that hair can grow through it that there would be more chance of the skin stretching. I would think the best way to close the skin would be edge to edge with all the skin in tacked.
    I don’t think it’s cracked up to what it claims to be. I’ve seen a couple of complaints on other sites about the scars being even wider that usual. I think it might be a good thing in the right hands, but mostly I think it’s a sales gimmick. But what do I know I got scammed out of thousands of $$$ because I bought a bill of goods from the laser scammers.

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    Quote Originally Posted by Laserhead View Post
    I don’t think it’s cracked up to what it claims to be. I’ve seen a couple of complaints on other sites about the scars being even wider that usual. I think it might be a good thing in the right hands, but mostly I think it’s a sales gimmick. But what do I know I got scammed out of thousands of $$$ because I bought a bill of goods from the laser scammers.
    Why do you think it’s not so good? Any doctors out therr want to respond?

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    Quote Originally Posted by Jkel View Post
    I'm reading more and more about a new techniques for closing the hair transplant wound called Trichophytic closure. Can some explain how this works in layman terms for me and does it really leave no scar? If this is true then why consider FUE?
    Dear Jkel:

    I would like to give you some information about trichophytic closure and FUE that may be helpful.

    The purpose of the trichophytic closure is to close the surgical wound from strip surgery in such a way that allows the hairs along the margins of one side of the incision to grow through the scar. It is this way that the visibility of the scar is decreased as the hair will break up the appearance of a linear scar with no hair. A closure of this type is accomplished by creating a small ledge on one side or the other of the incision (which side is best remains open for debate) which will by necessity remove a small amount of skin overlying the follicles on the margin. The opposite side of the incision is then brought to the side of the ledge and the wound is then sutured closed. The side with no ledge is pulled up over the ledge to create a closure that appears exactly like a non-trichophytic closure. The ledge is only about 1/16 of an inch so there is no tension on the wound that would contribute to a wider scar. If that 1/16th of an inch creates tension on the wound then the surgeon took to wide of a strip to begin with.

    In fact, there is a scar with a trichophytic closure and it is likely just as wide as a non-trichophytic scar, but the difference is that it has hair growing through it making it less visible. The downside of a trichophytic closure is that not all scars are completely camouflaged and there may be areas of slightly wider scar formation (maybe only a millimeter or so).

    FUE graft production also produces minimally visible scars, but it trades a linear scar for many small dot-like scars. One of the principle advantages of FUE is that the patient will have more rapid healing and less post operative pain. The downside of FUE is the longer procedure and higher cost of surgery.

    There is no single “best” way to obtain grafts. The patient has to consider the options and the advantages and disadvantages of each and with the help of the physician decide which is best for their particular situation.

  6. #6
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    Quote Originally Posted by James Harris, MD View Post
    Dear Jkel:

    I would like to give you some information about trichophytic closure and FUE that may be helpful.

    The purpose of the trichophytic closure is to close the surgical wound from strip surgery in such a way that allows the hairs along the margins of one side of the incision to grow through the scar. It is this way that the visibility of the scar is decreased as the hair will break up the appearance of a linear scar with no hair. A closure of this type is accomplished by creating a small ledge on one side or the other of the incision (which side is best remains open for debate) which will by necessity remove a small amount of skin overlying the follicles on the margin. The opposite side of the incision is then brought to the side of the ledge and the wound is then sutured closed. The side with no ledge is pulled up over the ledge to create a closure that appears exactly like a non-trichophytic closure. The ledge is only about 1/16 of an inch so there is no tension on the wound that would contribute to a wider scar. If that 1/16th of an inch creates tension on the wound then the surgeon took to wide of a strip to begin with.

    In fact, there is a scar with a trichophytic closure and it is likely just as wide as a non-trichophytic scar, but the difference is that it has hair growing through it making it less visible. The downside of a trichophytic closure is that not all scars are completely camouflaged and there may be areas of slightly wider scar formation (maybe only a millimeter or so).

    FUE graft production also produces minimally visible scars, but it trades a linear scar for many small dot-like scars. One of the principle advantages of FUE is that the patient will have more rapid healing and less post operative pain. The downside of FUE is the longer procedure and higher cost of surgery.

    There is no single “best” way to obtain grafts. The patient has to consider the options and the advantages and disadvantages of each and with the help of the physician decide which is best for their particular situation.
    Thank you for your response Dr. Harris I appreciate you taking the time to post such a thorough answer to my questions.
    For me having strip scar would be fine. It would be a trade off for having much more hair where I need it most, the top and front of my head. I read so much about strip vs. Fue, types of donor closures and such on other sites. It’s can make a person crazy. Just when I think I know what I want, I read about something else, or about the next great thing. I’m happy I’ve found this hair transplant forum where I can get answers from professionals and not from people like myself who really don't know anything except for what they read on the web.

    Amadeus: As I do my research it seems that much is over hyped as you say.
    Laserhead: How Dr. Harris explained it I don't think it’s a Gimmick, but some doctors might be marketing it in a gimmkie way, espcially on the internet.

    One more question Dr. Harris. I have been trying find out what exactly FUE2 is. Can you exlaine how this differs from FUE?

    Thanks!

  7. #7
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    Thanks for the answer Dr. Harris. The one flaw I see, if I understand the technique is that the hair does not always grow through the ledge, so unless the closer if performed perfectly it doesn’t make a difference. Either way you will have a scar so I still feel that it is over hyped as scarless.

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    Quote Originally Posted by Jkel View Post
    Thank you for your response Dr. Harris I appreciate you taking the time to post such a thorough answer to my questions.
    For me having strip scar would be fine. It would be a trade off for having much more hair where I need it most, the top and front of my head. I read so much about strip vs. Fue, types of donor closures and such on other sites. It’s can make a person crazy. Just when I think I know what I want, I read about something else, or about the next great thing. I’m happy I’ve found this hair transplant forum where I can get answers from professionals and not from people like myself who really don't know anything except for what they read on the web.

    Amadeus: As I do my research it seems that much is over hyped as you say.
    Laserhead: How Dr. Harris explained it I don't think it’s a Gimmick, but some doctors might be marketing it in a gimmkie way, espcially on the internet.

    One more question Dr. Harris. I have been trying find out what exactly FUE2 is. Can you exlaine how this differs from FUE?

    Thanks!
    Dear Jkel:

    FUE2 is simply a designation for a change in the technique or instrumentation by a particular doctor. The end result is essentially the same follicular unit graft but hopefully the advances in the technique results in lower transection rates, better quality graft, or faster harvest (which may translate to lower cost). It is more to catch your eye or alert the potential patient of a change in technique.

  9. #9
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    Hi Dr. Harris--It is great to see you adding your experienced voice to this forum!

    From a patient standpoint, I see the Trico closure as the evolution of the standard strip hair transplant surgery. I believe this method of closure was around for some time, but adapted to hair transplantation by Frechet and Marzola (each deciding to use either the upper or lower lip of the incision) that in the optimal setting would help produce a scar that had some hair growing through it, or in essence producing a "scarless look"

    It is sad that many have over-marketed a wonderful advancement in the field which results in some unrealistic expectations. I have seen Trico closures where the hair growing through the scar is at an odd angle, resulting in a noticeable line around the donor region and I have also seen some amazing results where a patient's scar is almost rendered invisible.

    Obviously, if the closure is not over-tensioned, and the incision edges are prepped properly, the patient has a great chance of getting a "better than standard closure" result--just how good depends on a couple of factors, the patients own physiology being one of them.

    I believe if a patient settles within themselves the fact that they will have a 1-2.5mm wide scar that will be hidden by keeping the hair in the donor region at a 3-4 guard or higher post hair transplant, then a Trico closure that helps disguise the scar is positive.

    However, if a patient is being led to believe that he or she will not have a visible scar due to a trico closure, that is advertisement puffery and should not be believed.

    Finally, if the strip scar is something the patient decides is not an option, then FUE, Hair System, and the option of doing nothing still exist.

    Take Care,
    Jason
    Patient Advocate/FUE Coordinator for Shapiro Medical Group. My advice and opinions are my own and is not medical advice. I am a Cubs fan.

  10. #10
    IAHRS Recommended Hair Transplant Surgeon Scott Alexander, MD's Avatar
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    Trichophytic closures have been around for many many years being used by the plastic surgeons. You just never heard of the name “Tricophytic” except for the hair transplant industry. I like to relay my experience with using this closure. First, I never attempt this closure unless I have the elasticity to do it without applying any unnecessary tension to the wound. Sometimes the patient will have to make the choice of either more grafts or a Tricophytic closure. When I perform this technique, I will first score the inferior line with my scalpel blade just going through the dermis. After which I will then remove the strip, making my inferior incision 2 rows of hair above the scored line. After the strip is out, I will trim off the scored dermis with my scissors leaving a perfectly straight line with 2 rows of hair follicles remaining without any dermis on them. This becomes what Dr. Harris calls my inferior ledge. The amount of dermis removed is about 0.7mm. As you can see, this is very tiny. Then I suture the tissue closed with the superior boarder being closed up and over the exposed tissue. I have never had a worse scar by using the Tricophytic closure. Most of the time, I have a difficult time even finding the remaining scar. If used properly, this becomes a great technique. You can go to my website and look at our results at http://biltmoresurgical.com/. They are much better than a standard closure.
    Scott Alexander, MD www.drscottalexander.com
    Member, International Alliance of Hair Restoration Surgeons
    View my IAHRS Profile

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