the WTF Scar!

[redhusky]

thanks for nice words, its just one of those things u become obsessed about. I know I might take some flack for coming to a bald forum (like showing up for a testicular cancer support group and there's nothing wrong with me, ala "fight club") but we are here because how we perceive ourselves and how we deal with it. some people bald and take it fine, some bald and its leads them depressed and mental, what does the one guy have that the other one doesn't? u got me! I think this whole thing runs deeper than we imagine! sorry to go all Dr Phil on you.

[redhusky]

The last post was made on ambien,

[Jerry Cooley, MD]

Gill,

It is only my opinion based on the 2 patients i have met in person who were highly disappointed with acell as had left them an expanse of bald flesh opposed to scar tissue. One of these patients was a veteran repair patient and due to his unsatisfactory result had been in contact with several others privately regarding their acell results too whom were also unsatisfied as acell had far from met their expectations supposedly.

Maybe acell is great when used correctly, time will tell i suppose.
Dr Feller doesnt use it and has no plans to either. I do not know what method the acell was used and do not know which docs are using it or their methods.

Best
Spex

Both Spex and Gillenator are right...ACell use can be associated with results that are either awesome or disappointing, and everything in between. One of the mistakes I made early in my work with ACell was assuming that because I saw awesome results in donor excisions with no tension, that it would cause awesome results in all excisions. When there is tension, all that ACell will do is reduces dense scar tissue. The skin will be soft and natural feeling but it will be hairless and white so it may look the same from a distance. It will however be much more receptive to grafts.

The vertical scar in this case is not too surprising and would be about what I would expect from an excision of a nevus sebaceus. Usually, I would excise this first to reduce the scar tissue and then graft what is left. For the past 9 months, we've been using an enzyme called hyaluronidase, injected into the skin around what is being excised. This softens the skin and significantly reduces closing tension. I would use ACell for the above mentioned benefits and also use a permanent buried subcutaneous stitch to ward off stretching post op. The trichophytic doesn't work in a vertical incision because the hair is not shingling over itself. Doing the excision like this first will reduce the number of grafts needed, and would result in excellent improvement in my opinion.

best regards

Dr Cooley

[gillenator]

Gill,

It is only my opinion based on the 2 patients i have met in person who were highly disappointed with acell as had left them an expanse of bald flesh opposed to scar tissue. One of these patients was a veteran repair patient and due to his unsatisfactory result had been in contact with several others privately regarding their acell results too whom were also unsatisfied as acell had far from met their expectations supposedly.

Maybe acell is great when used correctly, time will tell i suppose.
Dr Feller doesnt use it and has no plans to either. I do not know what method the acell was used and do not know which docs are using it or their methods.

Best
Spex

That's why I asked for further clarification from you. I can hardly understand why you would make such a profound statement and judgement based on only two examples! And then we have no idea exactly how the Acell was applied in the cases you did see in person.

The delivery of Acell is being applied with enhancing compounds that Drs. Cooley, Hitzig, and Cole continue to explain. Dr. Cole went into elaborate explanations of the potential complications of the efficacy of Acell when delivered in powder form only.

I have seen some promising and not so promising results in scar repair using Acell. And as you said, time will tell. We need more cases tried as it is more refined in delivery and application including the use of enzymes.

I am still in the observation stage with no final conclusions. I do believe in the right hands with continued research and applications, Acell will benefit patients.

[Alan Bauman, MD]

@redhusky,
I can certainly appreciate your desire to try to camouflage or improve the appearance of a scar. We see a number of patients from across the U.S. and elsewhere with similar concerns. Vertical scars are the most difficult to improve. I would not recommend excision and trichophytic closure as this may distort the surrounding hair and still leave a substantial defect.

However, the FUE hair transplant approach is well suited to address this kind of scar. In my practice, we have had an excellent track record of success with scar camouflage using this technique to repair old linear strip scars, other surgical scars (craniotomy/plastic surgery) as well as traumatic scars from injuries.

With appropriate technique, there seem to be no issue with growth of FUE grafts into the scar tissue in our hands. I've also developed a process which uses a careful combination of recipient sites that harvests out some of the 'abnormal' scar tissue and replaces it with normal skin, in addition to traditional implantation of the grafts into small sites. The careful use of this combination technique cannot be overstated--if done incorrectly this can cause skin necrosis (not a good thing).

The NeoGraft tool with the suction activated is particularly good at one of the types of RECIPIENT site-creation for the removal of abnormal tissue. Be aware that this approach may take more than one procedure to achieve the results you seek, depending on the size and shape of the scar as well as other factors like hairstyle, color/curl/thickness of your hair.

The use of ECMs, like ACell (micronized) and Humatrix with wound-healing adjuncts like hyperbaric oxygen, LLLT, PRP at physiologic concentrations, etc. help with the regeneration of normal looking tissue and camouflage, although I've yet to see any 'autocloning' to date.

This detailed, combination approach helps improve skin tone while at the same time adding hair, providing better coverage than just the addition of hair alone. Micropigmentation (tattoo) of the scalp should be done with caution, as the black ink often has a tendency to fade to blue.

A young patient (Chris) of ours with a birth defect was a pro-bono case we did recently. His enthusiasm about the results caught the attention of the local news. You can see his video here:


6-month photos of Chris show some nice improvement:

http://www.flickr.com/photos/alanbau...5006/lightbox/
He no longer wears a huge amount of Toppik to school/camp every day.

Another patient who had FUE scar-repair on a crainiotomy scar left from the treatment of a childhood injury is seen here immediately post-op and one year later:

http://www.flickr.com/photos/alanbauman/375843853/

http://www.flickr.com/photos/alanbauman/4050495714/
Good improvement seen with the single FUE transplant session could be further improved with additional FUE if desired.

We perform these kinds of repair procedures and others at no charge to patients at least once a month. The Operation Restore Pro-Bono program of the ISHRS may be able to help you reduce or eliminate the cost of the procedure in addition to the cost of travel, etc. For more information on how to qualify for this program, feel free to contact me privately or my office directly.