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MaxMidlander
member
Wow ! Just wow !! Awesome scar cover up
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Failed FUT surgery with major Clinic
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Wow ! Just wow !! Awesome scar cover up
Thanks so much! 
I realise the FUT scar is just too big so when Im outside the scar reflects too much sunlight and it's obvious. So keeping my hair short isnt an option.
I started growing my hair longer and I've found the SMP looks better this way as it fills in all the gaps so to speak - sort of like a permanent dermatch. The SMP artist also said it was about finding the right hair length so it seems you just have to experiment. Nobody has said anything about the scar now and I dont feel so ashamed/self conscious anymore. My GP thought it looked really good.
Thanks again for the positivity, means a lot!!!
I realise the FUT scar is just too big so when Im outside the scar reflects too much sunlight and it's obvious. So keeping my hair short isnt an option.
I started growing my hair longer and I've found the SMP looks better this way as it fills in all the gaps so to speak - sort of like a permanent dermatch. The SMP artist also said it was about finding the right hair length so it seems you just have to experiment. Nobody has said anything about the scar now and I dont feel so ashamed/self conscious anymore. My GP thought it looked really good.
Thanks again for the positivity, means a lot!!!
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JoeTillman
Valued member
When you say that a "tech" operated on you, do you mean they made the incisions to place grafts, or they placed grafts into incisions already made by the doctor?
JoeTillman
Valued member
Unless she was a nurse at the very least there will be no qualifications to be sent.
JoeTillman
Valued member
Unfortunately, industry standards are few and far in between. Regardless of standards, if a second doctor comes in to make incisions, which many clinics consider to be imperative for directing the aesthetic outcome of a result (angle, direction) it is my opinion that the patient should be informed. It could be argued that when one chooses a doctor for their surgery, they’re choosing the entire team. I agree with this, however, the team usually means the technician support structure behind a single doctor, not a trainee or second doctor that’s performing the recipient site creation. As a patient, you have every right to know if a second doctor will be sharing the main duty of your surgery.
the clinic is also arguing that my medical certificate was filled out incorrectly.
The doctor apparently took a 4cm strip which he also confirmed with me over skype, We discussed it for about 5-10 minutes (the size, donor density, closure tension etc) and he said I had one of the biggest donors he's ever seen before.
I then found a medical article that if you take a strip over 2cm it will likely stretch, and so after showing it to the clinic they have now argued the medical certificate was filled out incorrectly and strip was only 1.4cm. And then when I challenged it they argued it was 1.7cm and longer. So I challenged them again and now they are arguing it was 1.9cm.
How am i supposed to interpret this? Aren't medical certificates supposed to mean something?
The doctor apparently took a 4cm strip which he also confirmed with me over skype, We discussed it for about 5-10 minutes (the size, donor density, closure tension etc) and he said I had one of the biggest donors he's ever seen before.
I then found a medical article that if you take a strip over 2cm it will likely stretch, and so after showing it to the clinic they have now argued the medical certificate was filled out incorrectly and strip was only 1.4cm. And then when I challenged it they argued it was 1.7cm and longer. So I challenged them again and now they are arguing it was 1.9cm.
How am i supposed to interpret this? Aren't medical certificates supposed to mean something?
JoeTillman
Valued member
I can’t speak to the varying donor documentation details but I can say that the strip width maximum is directly related to the donor laxity and the implementation of undermining, if so required.. In other words, it’s relative. I’ve seen 3cm wide by 32cm long strips taken with no adverse outcome for the resulting scar. The likelihood of stretch back is dependent on the closure tension and the collagen production of the patient, which decreases with age. In other words, the article is wrong.
the article by Frechet suggested the looser the scalp (mine is really loose), if you have previous scarring and the more aggressive the strip the more likely it will stretch.
my previous FUT scar was less than 1mm and I was told to expect similar
the closure tension was moderate actually. im 40 so im old now brother!
my previous FUT scar was less than 1mm and I was told to expect similar
the closure tension was moderate actually. im 40 so im old now brother!
JoeTillman
Valued member
Well, unfortunately that is the problem with strip in general. Even if everything is done right, things can go wrong and result in stretch back. I’m sorry you’ve had a wide scar as a result of your surgery. I’ve been there myself.
i dont believe things were done correctly for my surgery tbh. The tech involvement/failed growth Ive never been happy with. And given the amount of scalp laxity I had there was never any need to take such a wide strip in the first place. I didnt even need that many grafts.
If your assertion about closure tension is the reason why it stretched then it would have been much smarter to take a far longer strip that was less wide without any tension, right?
EDIT: What would be considered too much tension actually? Isnt it ideal to have none (that's what the doctor is now arguing for when doing the scar revision).
If your assertion about closure tension is the reason why it stretched then it would have been much smarter to take a far longer strip that was less wide without any tension, right?
EDIT: What would be considered too much tension actually? Isnt it ideal to have none (that's what the doctor is now arguing for when doing the scar revision).
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JoeTillman
Valued member
How long was the strip taken? Do you have a copy of your records? It is ideal to have none(tension), but every strip is closed under at least some tension. But “what is too much tension?” does not have a single answer, again, due to varying circumstances. I’ve seen excellent outcomes from tight closures, and wide scars from easy closures and vice versa. I’ll say this, as Devil’s advocate; an experienced surgeon knows what he’s doing and the chances of a major screw up are extremely low, and the issue(s) that you’re presenting represents the perfect storm of what can go wrong, which is like lightning striking twice during a blue moon. Bad growth, bad communication, inconsistent answers to your questions and a wide donor scar? I think excision of the donor scar is not in your best interest. FUE into the scar should be considered. If you legit do not have a lot of scalp donor, beard and body hair can be options.
25 x 4cm was the strip size
closure tension was a 3 out of 5
My first FUT was for 2k grafts and got an ideal scar under 1mm.
I had told the doctor i was expecting around 1800 grafts for this surgery based on my donor density but they ended up taking almost 3k grafts instead. The doctor did the initial incisions and I have perfect growth in those areas, but not so much where the tech operated.
I asked the clinic to confirm the strip size because i wanted to know if a scar excision was worth it; if the strip size was that big with that much tension then it's worth trying again because that would be the reason it stretched. If the strip size was incorrectly listed however then I should do FUE into the scar as you suggested (even if it would use up most of my remaining donor). But the clinic won't tell me what was done.
Other clinics Ive consulted are telling me given the size of the scar that an excision is worth trying just to try and save grafts. My only fear is if a scar excision can make things worse ... so can it? Even if the area they excise is smaller and with no tension this time?
If my surgery was completely mishandled it would explain all the lightning and blue moons.
closure tension was a 3 out of 5
My first FUT was for 2k grafts and got an ideal scar under 1mm.
I had told the doctor i was expecting around 1800 grafts for this surgery based on my donor density but they ended up taking almost 3k grafts instead. The doctor did the initial incisions and I have perfect growth in those areas, but not so much where the tech operated.
I asked the clinic to confirm the strip size because i wanted to know if a scar excision was worth it; if the strip size was that big with that much tension then it's worth trying again because that would be the reason it stretched. If the strip size was incorrectly listed however then I should do FUE into the scar as you suggested (even if it would use up most of my remaining donor). But the clinic won't tell me what was done.
Other clinics Ive consulted are telling me given the size of the scar that an excision is worth trying just to try and save grafts. My only fear is if a scar excision can make things worse ... so can it? Even if the area they excise is smaller and with no tension this time?
If my surgery was completely mishandled it would explain all the lightning and blue moons.
I should have clarified, the article suggests the bigger the strip increases the likelihood the scar will stretch, the same as having a loose scalp or prior scarring. Overall however the determining factor when it comes to scarring appears to be that of surgeon's skill.
If your argument is i might have a physiological predisposition to stretching or poor growth ... no. My previous FUT scar was ideal and I've never had any growth issues in any of my other surgeries. The doctor's own incisions for this surgery all grew, with the only growth issues isolated to that of the tech. The doctor has already excluded any physiological reasons for poor growth like lichen planus, staphylococcus, fibrosis etc.
If your argument is what happened to me is rare and I should avoid another invasive surgery to avoid anymore suffering I might agree with you. The clinic's rep even told me it's the worst scar he's ever seen from the clinic and seemed shocked by it.
All available evidence however suggests my results were due to poor or unnecessary surgical choices;
- The surgeon taking a 25x4cm wide strip with moderate tension when a smaller but longer strip with no tension would have been preferable. Particularly as my side laxity was untouched and those areas are less prone to stretching.
- Extracting 3k grafts when i only needed 1800 was overkill. Most other clinics had quoted me a smaller strip count and that's what I had asked for in our initial consult.
- Having a tech dense pack me and do the incisions for the majority of my surgery without telling me was unethical. Had I been asked I would rejected her involvement, and it was not what i expected nor paid for.
- Suggesting the medical certificate is wrong stops me from figuring out possible reasons why the scar might have stretched and thus prevents me from knowing how to move forward
Based on all this I don't believe my surgery was conducted in my best interests and so the scar likely stretched due to bad surgical choices. A scar excision then, rationally speaking, still might be the best option. At least that is my current thinking ... I just don't know/understand what effect scar tissue plays in terms of predicting whether the scar will stretch again.
JoeTillman
Valued member
I know the article. Logically, yes, the wider the strip the higher likelihood of wider scarring. And yes, surgeon skill is A determining factor, but not THE determining factor. It doesn't take into account patient physiology. I'm not shifting blame, I'm laying down truth. This is getting into a bunch of nuance that is difficult (and time consuming) to break down, but the point is that there are multiple factors at play with every strip surgery, and surgery in general, that are out of the surgeon's control thus the persistent message I've always pushed "surgery is the last resort". This is also why I've advocated for the banning of any and all guarantees save for the guarantee of one's best effort.
This is not something anyone can deny just because a previous surgery yielded a preferred outcome. It is always a factor, for better or for worse, as physiology is not static. It is always changing, but the reason why I said revision (removal) isn't in your best interest, is because as I've always said, there are no guarantees. The safer bet is indeed FUE into scar, and even that is not guaranteed but your scar will not be worse off because of it. It is the lesser of two evils, one might say. This, coming from someone that had a scar similar (but shorter) to your own, but x 2, stacked on top of each other.
However, thinking more about your case this morning, I'm inclined to believe the clinic when they say they mistakenly wrote "4cm" instead of something more sensible. If you do the math, a 4x25cm scar is 100 cm of tissue. With 2900 grafts that comes out to 29 FU per cm2 inside of the excised tissue. If this were your actual donor density, you would be able to see clear into your scalp regardless of hair length and no clinic would touch you for surgery. Assuming your donor density is, for argument's sake, an average of 80 per cm2 (which is considered to be healthy) a 4x25cm strip would have removed 8000 grafts. In truth, your density is most likely lower than this, but you get the idea. Taking the range of widths they've subsequently mentioned to you, 1.4cm wide to 1.9cm wide, the math works out for your donor density being between 61 fu per cm2 (calculating 1.9 cm width) to 82 fu per cm2 (calculating 1.4 cm width). Looking at your donor photo confirms that the truth is probably somewhere in the middle. 4cm is astoundingly wide, so wide, that in all my years in this field I've never seen anything close to that. 3cm was the widest I've ever seen and that was only at the widest point, since wide strips have to be tapered at the ends to prevent "dog ears" from forming. Seeing these 3cm wide strips was also very rare, perhaps less than ten times in my career and they were all well over 30cm long.
Question: Was the doctor you "hired" the one that removed the strip? Or did the assisting doctor (not a technician) remove the strip? You may have clarified this before, but please confirm.
Please understand I'm trying to be very objective with my comments and looking at the situation logically based on the information you've shared. It does not, nor is it intended, to diminish the fact that you have a wide scar that you're trying to fix, and things were not done correctly. I get it.
I measured my donor density of the area above the strip before the surgery and it was around 42FU (I had FUE previously over the area) and the strip length of 25cm listed in the medical certificate is absolutely spot on, so going by all available evidence the width was likely just above 3cm. I agree there might have been a mistake when they wrote 4cm, but say if some of the grafts in the strip were transected or unusable due to the FUE scarring it might be possible. I don't know.
I similarly figured out the donor density of the strip had to be around 29FU from the medical certificate, and then later spent 5-10 minutes discussing it with the surgeon - they never corrected me. Indeed they mentioned they could transplant 28FU into scar tissue in a single pass which i thought was ideal because they could match the density of the surrounding native hair in a single pass.
So let's say the strip wasn't 4cm but closer to really 3cm (most likely), this confirms the medical certificate was filled out incorrectly (despite the fact it was hand written), the doctor and no one else noticed despite the rarity of a 4cm strip, and the surgeon again failed to correct it when discussing it with me later. It also doesn't explain why there was any tension placed on the strip, why a longer but less wide strip wasn't taken, nor why so many grafts were needed. I find the clinic not knowing the size of the strip and most of the surgical choices more troubling than the surgeon just taking a huge 4cm strip and hoping for the best.
The surgeon was the one who removed the strip. They also did the initial incisions with pre-made slits which all grew, but then handed the rest over to the tech who did stick and place. They then left the room for the rest of the surgery and only checked in at the end.
Have you ever seen a scar revision make things worse? Do you have any thoughts on attempting a partial revision?
This is exceedingly helpful - thanks so much for your time.
I similarly figured out the donor density of the strip had to be around 29FU from the medical certificate, and then later spent 5-10 minutes discussing it with the surgeon - they never corrected me. Indeed they mentioned they could transplant 28FU into scar tissue in a single pass which i thought was ideal because they could match the density of the surrounding native hair in a single pass.
So let's say the strip wasn't 4cm but closer to really 3cm (most likely), this confirms the medical certificate was filled out incorrectly (despite the fact it was hand written), the doctor and no one else noticed despite the rarity of a 4cm strip, and the surgeon again failed to correct it when discussing it with me later. It also doesn't explain why there was any tension placed on the strip, why a longer but less wide strip wasn't taken, nor why so many grafts were needed. I find the clinic not knowing the size of the strip and most of the surgical choices more troubling than the surgeon just taking a huge 4cm strip and hoping for the best.
The surgeon was the one who removed the strip. They also did the initial incisions with pre-made slits which all grew, but then handed the rest over to the tech who did stick and place. They then left the room for the rest of the surgery and only checked in at the end.
Have you ever seen a scar revision make things worse? Do you have any thoughts on attempting a partial revision?
This is exceedingly helpful - thanks so much for your time.
JoeTillman
Valued member
It wasn't they "might have made a mistake". They did make a mistake, guaranteed. A 4cm wide strip was not taken and it is nothing more than a clerical error. Shit happens. You keep repeating this issue as if it is an offence punishable by some regulatory body. It isn't.
Reviewing the information presented, at least here on this forum, your donor density was not 42 per cm2. Assuming a 2cm wide strip was taken which in and of itself would be wide, that would mean your donor density would be 58 per cm2. That isn't great but it's good enough to consider a strip if the circumstances all lined up.
Regarding the placement, nothing untoward happened here. The incisions were not made by a tech. They were made by a doctor, that was assisting the main doctor. I do believe this could have been communicated to you better, but you should stop referring to an MD as a tech, as it is simply not who did the work. That was my main concern, that a tech was making the incisions, but it was a doctor. It doesn't make the outcome any better, but it is misleading to continue calling the doctor a tech.
You already know my thoughts on scar revision since we've been through this entire discussion on another platform, which I only just realized today. Asking my thoughts here, after already having spent plenty of time with you on this exact subject under your other username, is an inconsiderate waste of my time. I take these interactions seriously because I'm genuinely trying to help so I question why you'd run though this entire discussion with me again, a second time. Were you expecting or hoping for a different answer?
Reviewing the information presented, at least here on this forum, your donor density was not 42 per cm2. Assuming a 2cm wide strip was taken which in and of itself would be wide, that would mean your donor density would be 58 per cm2. That isn't great but it's good enough to consider a strip if the circumstances all lined up.
Regarding the placement, nothing untoward happened here. The incisions were not made by a tech. They were made by a doctor, that was assisting the main doctor. I do believe this could have been communicated to you better, but you should stop referring to an MD as a tech, as it is simply not who did the work. That was my main concern, that a tech was making the incisions, but it was a doctor. It doesn't make the outcome any better, but it is misleading to continue calling the doctor a tech.
You already know my thoughts on scar revision since we've been through this entire discussion on another platform, which I only just realized today. Asking my thoughts here, after already having spent plenty of time with you on this exact subject under your other username, is an inconsiderate waste of my time. I take these interactions seriously because I'm genuinely trying to help so I question why you'd run though this entire discussion with me again, a second time. Were you expecting or hoping for a different answer?
I have microscope pics of my donor density - it's around 42FU, not 58FU. If I had that much donor density I'd avoided FUT altogether and only pursued FUE. I consulted with a few clinics and was told my donor was more depleted via FUE and that I could maybe get 1k grafts from another FUE session but then that would be the end of things. However given my scalp laxity FUT surgeons were saying I could get 1600 grafts easy and potentially even improve the look of my donor.
Based on the FUE scarring it's a good 3cm that was excised. Not 2cm. The donor density, length, the photos from the clinic, my scalp laxity all suggest the strip was over 3cm.
Im not trying to be misleading when I refer to the person that did my incisions as a tech because when i initially posted this thread that's only what i knew her as. It's only afterwards did the front desk tell me she was a MD (which was a relief to hear) but then wouldnt tell me anymore information. I still don't have access to her experience nor medical qualifications. What should I believe based on this?
Im definitely not trying to waste your time - nor did we go into any of this detail on another forum. I only mentioned I had a 1cm FUT scar there. And since going into this much detail you're now arguing a different approach. I dont know how to research this because different clinics just give different answers on what to do; FUT clinics tell me to try a revision, whereas FUE clinics tell me to put grafts in it. If i understood why the scar stretched I'd know what was the best approach, but the clinic doesn't even seem interested in helping me with that.
If i knew how and why scar revisions worked then id know what to do. If i had some guarantee that a revision wouldnt make things worse then its worth trying. If i understood the surgical choices made for my case i;d know what my options were looking forward. But the clinic isnt really helping; the doctor seems disinterested, the front desk ignores me and I fear the rep is only interested in damage control. Nobody is putting me first. My case is complicated and I dont enjoy discussing this stuff. I genuinely hate it but am constantly forced to in order to climb my way out of this. So no Im not trying to waste your time. im genuinely lost.
Based on the FUE scarring it's a good 3cm that was excised. Not 2cm. The donor density, length, the photos from the clinic, my scalp laxity all suggest the strip was over 3cm.
Im not trying to be misleading when I refer to the person that did my incisions as a tech because when i initially posted this thread that's only what i knew her as. It's only afterwards did the front desk tell me she was a MD (which was a relief to hear) but then wouldnt tell me anymore information. I still don't have access to her experience nor medical qualifications. What should I believe based on this?
Im definitely not trying to waste your time - nor did we go into any of this detail on another forum. I only mentioned I had a 1cm FUT scar there. And since going into this much detail you're now arguing a different approach. I dont know how to research this because different clinics just give different answers on what to do; FUT clinics tell me to try a revision, whereas FUE clinics tell me to put grafts in it. If i understood why the scar stretched I'd know what was the best approach, but the clinic doesn't even seem interested in helping me with that.
If i knew how and why scar revisions worked then id know what to do. If i had some guarantee that a revision wouldnt make things worse then its worth trying. If i understood the surgical choices made for my case i;d know what my options were looking forward. But the clinic isnt really helping; the doctor seems disinterested, the front desk ignores me and I fear the rep is only interested in damage control. Nobody is putting me first. My case is complicated and I dont enjoy discussing this stuff. I genuinely hate it but am constantly forced to in order to climb my way out of this. So no Im not trying to waste your time. im genuinely lost.
JoeTillman
Valued member
Since I first asked you about the tech that operated on you, almost exactly 24 hours ago, you referred to the doctor as a tech five times. I assume you learned she was a doctor before yesterday, therefore, referring to the doctor as a tech is indeed misleading when you've been told otherwise.
Untrue. I told you on the other platform that FUE into scar would be the safer approach because you've already had one stretch back. I went further in saying that two passes with FUE would be ideal to make sure the first pass would take since scar tissue is more unpredictable. I also said that I don't recall seeing a scar revision turn out worse than the scar being revised, at worst it usually stretches back to the same width, more or less. And no, you didn't go into any of this detail, I agree, but it seems unusual for you to share so much of the other details but never once mentioned the problems in addition to the wide scar. I also find it unusual that you have two usernames with separate threads going on at the other platform.
I do not for one second believe you are not sincere regarding seeking help and answers. I meant it when I said I "get it" with regards to your situation. However, I would expect that if I've already engaged with you on one platform, while you're using a different alias there (one of two) that you'd give me a heads up that I'm dealing with you here under your "Wicker" alias as well. The multiple aliases, the rehashing of the scar revision issue after I already gave you my opinion on that, and the omission of the doctor/tech doing surgery issue, makes the entire affair, peculiar.
No hard feelings, I wish you the best, and good luck.
