Dr. Bisanga - Inside the Op-Room - Steps of a Repair Surgery

[Raphael84hair]

Like many, this patient has fallen fowl to*marketing*and*hype*over*real education*and*proven records,*and having no surgery is better than a poor one, as shown here. The good news is that in the*right hands*it can be rectified, but in today’s fast paced world, we now need patience.


Analysis of this patient.

Hair line repair needed due to height, structure, closure and “pluggy" look. This is*5cm from eyebrows and should be 7cm for this patient measuring from the glabella*upwards to be natural and fitting with bone structure.

We need to remove and*punch out*the grafts and*not leave a linear scar*so need to jump/miss*units*to not*make a resulting line from co-joined removals and to assist healing.

Minimise scarring,*remove unwanted hair in a*two step*approach

The donor had been*compromised*so it is a case of*careful harvesting*also for repair patients. Repair patients aside from poor hair lines often suffer from donor issues with poor harvesting and planning and so it is two sides of the same coin.


Hair line removal,*tumescence to lift the skin and*shave and expose the area to work in, 1.5 to 2cm, the hair is evident here and we need to remove the 3 , 4, 5 haired units*and*pitting*is also evident which means*grafts*were placed too deep*and the angles are also like telephone poles with them being too perpendicular to the scalp. *This is more evident when we compare to existing hair that is 40 degrees, so removal of the*larger units*and then leave the smaller ones for now, so it is a question to*prioritise and plan.*

Here we can use a guard to 3mm to*limit the depth*and see how that goes as with transplanted hair it is not at natural depth and angles.


D.Trivellini and Dr.Cole are the punches utilised*here.


A*well lit*and good*field of vision*are needed to then*punch*and then see if the depth is okay for the extractions.

Here the grafts were then removable*intact*so then they will*not regrow*and this is an issue for*repair cases*and removed with forceps that resemble a crocodile’s mouth, so nice flat and easy grip.


These*grafts*will then go back into the*donor to restock*it and we see the holes here from the extractions we have used a*small punch*and also*spaced*the removal.*

Healing cream*is applied and we schedule the next*step*in around 8 weeks to allow healing and we are completed for stage one and removed a significant amount of those*large units.


There will be some "mopping up"*of smaller grafts on the*next step*and then the*final step*will be to rebuild the hair line in the proper manner, which we intend to present*a subsequent video at the appropriate time, so please watch this space to ensure that is not missed.