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775 grafts FIT in black patient w/ WHTC (Dr Mwamba )

D

drmwamba

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#1
This young black patient (23yo),NW3 came to us to seek help .He was under medication and his family pattern seems to be NW3 to 4.As most of the black he was concern about short hair cut and scar visibility.He had a donor density of 50 Fu /110 hairs on average.

He is young ,he is black :what technique to propose?

I had to recommend a technique that have the possibility of reversibility.This hair transplant must be natural and undetectable (recipient and donor area ) and the first choice was FIT.

Strip with tricho still have the risk of visible linear scar.

What about white spots?In black so far ,I never see white dots .What about cheloids ,hypertrophic scar (it's possible but rare).

Because he had a low density in the donor (which is normal in black patient),I decided to try a new product ,the A Cell ,which is Matrix that seems to regenerate live tissue from wound bed.

If this A cell test works ,this patient will keep the same density and could have an infinite donor area.That's the purpose of my study .Right now ,I am selecting candidates .

In this toppic we can discuss a lot of issues we are facing today in hair transplant such as age to do surgery,punch size in FIT/FUE,donor area management ,and of course future solutions such as Acell ,cloning ,etc...

I don't have the answers and I am counting on each one of you to throw some ideas or create new topics.

I will present several pictures from before the surgery up to 5 months (last pictures sent by the patient himself).
 
D

drmwamba

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#2




This illustrates the hair line design which vary a lot from one ethnic group to the other.Black hair line is usually close to classic caucasian woman hair line design.





Intact grafts which illustrates the big size of hairs grafts in black and the notion of splay grafts.Is a 0.75 or 0.8mm punch can get them intact???




 
D

drmwamba

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#3
Now I will continue with progress pictures 6days,15 days,1month and half,3 months until the last one at 5 months .

DAY 6 POST OP



Presence of crusts .We recommend our patient to wash their hairs every day by just pouring water on it and use hair cycle biotin spray to keep them wet and fight the inflammation and free radicals.From now on they can start to wash with gentle massage to get rid of the scabs for another week.This bring us to

DAY 15 POST OP



At this time you can notice the scabs have gone ;but still you have grafts on the recipient area.This one is still inflammed.We therefore recommend to start an agressive hair shampooing to get rid of all the dead shaft that could stick to your scalp and are better off.Because your body will recognise them as foreign bodies and will try to eat them(risk of folliculitis).

And I allow my patient to use a shaver at this point to harmonize their hair cut.I discourage them to do wet shaving as it might irritate the scalp (which is already inflammed as said before).

1 MONTH AND HALF



Skin is red and all the hairs shed.We believe that some products such as rogaine may allow some grafts to stay and continue to grow.

I didn't say anything about donor area but since day 6 it was healed and looks OK.We are monitoring it for our Acell study and hope we will get promising results for the future.

3 MONTHS (WE SHOULD EXPECT THE FIRST SIGNS OF GROWTH)


No comments

5 MONTHS POST OP



These pictures were provided by the patient himself.I loved the negative because it really shows hair growth in those temples.Of course we are expecting more hairs in the future ;at 5 months , we should be at 50 % of hair yield.

The next step will be 6 months ,9 months and one year before we draw conclusions about Acell .So far the patient is happy and I will add the last two pictures before to get your inputs.








 
Nervousnelly

Nervousnelly

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#4
I think that this might be the most interesting case that I have witnessed in the couple of years on forums. I applaud you Dr. for the choice of technique. Great to see attempts to stimulate the donor area. Wow this is awesome.

The work is very refined and natural. Looks absolutely great. The patient must be thrilled. The beauty of a HT on a black patient that will have down is that density in the recipient area is less of a concern as contrast is not a factor. I believe that is why a procedure of this size was such an impact.

Question: Is it true that donor density is often less in blacks or is it just that it appears this way because the hair tends to "clump" together leaving spaces?

NN
 
janna

janna

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#5
I think your patient is very fortunate and his results will be tremendous. This is indeed an extremely educational thread and the pictures are superb!!! Thanks so much Dr. Mwamba.

Thomas has told me all about you and your work - as much as he talked you up, I'd say so far he's understated your skills.
 
the B spot

the B spot

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#6
Black patients on average have low density.

However, the individual follicle and graft from a black person is huge compared to a Caucasian/Asian.

Notice also the radical curve/splay to the grafts which makes the entire procedure very difficult.

I don't know about a .8mm punch--I would have a hard time believing anything less than a .9mm was used and more likely a 1.0 would be perfect---because of the curvature of the grafts.

Another issue in black patients is cysts forming in the donor with transected follicles/trapped hairs which can cause issues as well.

All in all, I think this is a great case and one that will look great at 9-10 months---interested in the Acell use as well.

Congrats Dr. M!
Jason
 
timuk

timuk

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#7
Great work Dr Mwamba


all I can say is that its amazing work and the patient case is very interesting... as NN states.....

The Acell part .. would be great to know more.



Tim

 
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Bigmac

Bigmac

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#8
Dr Mwamba, thanks for a great thread.

The work looks top notch with good quality pictures.

I`d be very interested to hear your approach on overcoming the difficulties of extracting the curly hair grafts as i`ve heard they are difficult to sliver after a strip procedure.

Also interested to hear your views on Acell.

Thanks bm.


 
D

drmwamba

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#9
Thank you everybody for your comments.

Skin texture ,hair shaft texture and tissue around the grafts are different in consistancy.Feeling and knowing those textures may help you to lead your hand motion and follow the curvature of your grafts.Let the tool work at your place and don't try to push or cut through the skin.This implies your punch much be very sharp so it can slide through the less hard tissue which is the tissue around the hair shaft.And adapt your punch size to the graft size.

Yesterday I was following Oprah's show and the man who cut his finger came to show how the Acell Matrix regenrates all the parts ,including the nail.And this is Oprah'scomments:"This could be great for bald man.They will have to apply it and rub it on their scalp and new hairs will grow.This could really help the stimulus package ...".Same reaction I had when i first read about it .It seems utopic so decided to try it .I choosed to try it in FIT (and not in Strip Patient for one reason).In FIT we know that the scar is non visible at naked eye.With strip ,if the Acell doesn't work,you will end up with a huge uggly scar.But A cell seems to stimulate and regenerate new cells from the wound bed.So let's try it because if it works ,it will be the awesome for patients with limited donor density and we can attack NW6 and 7 more aggressively.

Acell is a matrix from pork bladder .It seems that this cells are multipotent such as germinal cells.It means they can become everything else according to the signal they will receive.They have that capacity ;therefore they are multipotent .It works in animal ,why not exploring it in our field?

In the first patient we applied it in one side (right ) and the left side were treated as usual.We observed a little delay in healing and at 1 month and half we saw some new hairs.It could be a transected hairs???But we had a lot of them and my Trate during the surgery was very low.We keep following the patient ...

We therefore adjust our protocole .With the second patient we recorded the total number of follicles and hairs ,the t rate so we can do a precise count of new hairs if it does occur.Because what is important is to know what percentage will grow at the end.If it is only 5 % ,then it won't be worthy .If it is 50 %,our interest in this product will grow .To get significant data statistically ,we need a large sample of patients.


 
janna

janna

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#10
The A-cell could be an amazing thing. Let's hope you get enough patients to do the study sufficiently.
 
timuk

timuk

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#11
Dr Mwanba.

Thank you again for your information. Very interesting and informative.

Tim
 
B

biancolone

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#13
Great pictures and impressive first experience with acell! :)
Just one thing that maybe I have lost in the reading: how many applications of powder/sheet did you do? Just one at the beginning, or someone else?

Regards, Davide
 
D

drmwamba

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#14
In the first patient I did 1 at the beginning ,1 at 2 days and 1 at 4 days post op.

But right now we changed the protocole and we are applying it one at the beginning .Healing is very fast in FIT/FUE.(And in the A cell protocole for other wounds they do replace the bandage every week ).

Thttp://www.mywhtc.com/index.php?option=com_jfusion&view=wrapper&Itemid=11his is the link where you can see the first pictures on our Acell study .


 
Bigmac

Bigmac

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#15
Thanks Dr Mwamba for the additional info,very interesting/educational reading.

bm
 
N

NW5a

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#16
Hi Dr.Mwamba,

do u have any updates in this case ?

Do u worked only at the temple points or in zone2 behind the front hairline, too ?

Thx, looks great so far for the patient