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Necrosis Scar Repair From FUT

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Philb

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#1
Here is a repair case that Dr. Bisanga is working with, the result in full is ongoing and will keep it posted.

This case our patient had a surgery 3600 grafts FUT with another clinic, the scalp was tight, during the healing the scar line on one side turned necrosis leaving a large scar tissue in the strip area.

A traditional scar revision was not possible due to the size of the scarring and tightness of the scalp, so the idea was to test BH and see what his yield was like. The reason for BH and not scalp hair was due to the fact his scalp donor had become very thin and in areas less than 40 FU per cm2, and considering he was a potential NW5 it was felt that any scalp hair should be used in the recipient.

The patient also wanted to repair areas in his hair line that were thin after his procedure. First Dr. Bisanga performed 100 BH test on the patient to assess the growth, later we performed another 235 BH for the scar and 600 scalp FUE to improve the frontal area.

The BH FUE was performed with low density to maximise the yield from the procedures with the patient knowing that to be able to camouflage the area will take multiple ops, but also with the best yield.

PRE ANY SURGERY AND AFTER 3600 FUT (NON BHR)






SCAR HEALING 3 WEEKS POST 3600 FUT



12 MONTHS POST OP HEALING AFTER OP (NON BHR)



BHR BODY HAIR TEST



4 MONTHS BH TEST GROWTH




600 SCALP FUE & 235 BODY HAIR PLACEMENT




6 MONTHS POST OP GROWTH


 
Nervousnelly

Nervousnelly

The Coolest Member
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#2
This is certainly one of those cases that you hate to see because it is a reminder that what we are doing/considering is indeed a surgery and there are always possible complications that can take place. It is a demonstration of the risks of larger sessions and what can transpire when the envelope is being pushed. I really feel for this guy.

So far the results look very good and hopefully things will fill in a little bit better in the scar tissue. Thanks for the post Phil. I really appreciate the thought process of Dr. Bisanga and his efforts to not over harvest the donor area.

NN
 
Bigmac

Bigmac

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#3
Hi Phil.

I never knew that Dr Bisanga was/is in the process of repairing this patient.

Am I correct in saying its the guy from the Spanish forum that was posted on HLH.

What does Dr Bisanga say may have contributed to necrosis of the scar,is this an infection?

The body hair looks to be achieving good growth for him which is a relief, will the patient be getting more body hair transplanted into the whole scar or just on that huge part.

His donor scar looks to be quite high up imo, is this common in patients you see as i always thought they should be slightly lower down.

Thanks bm
 
Nervousnelly

Nervousnelly

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#4
Ya the scar itself is offset and rather wide for a first time patient. Not really what you call pencil thin. I hope this poor fellow gets things totally resolved. Great that Dr. Bisanga was willing to take on this case. Keep us posted.

NN
 
north country boy

north country boy

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#5
the scar looks very high! more so at the sides ,and the front third is thin after the first ht, what was H and W comments on this? did the guy get some refund, because H and W dont do fue last i heard so there couldnt do much for him in repair work

looks like the body hair is growing in nice
 
Shang

Shang

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#6
I agree this scar looks way to high, I hope he never loses enough hair to reveal it. What I have noticed from H&W's scars is that they tend to take the strip on the sides of the head alot higher than other clinics, or do I just imagine this. Very unlucky with the scar this guy, hope the BH fills it in somewhat.
 
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Aspinal

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#7
These pictures of this scar scare the hell out of me...how often do these situations occur? Do drs give a refund when something like this occur`s? Compensation if any won`t help much as he`s scarred for life.



 
 
the B spot

the B spot

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#8
Aspinal wrote:
These pictures of this scar scare the hell out of me...how often do these situations occur? Do drs give a refund when something like this occur`s? Compensation if any won`t help much as he`s scarred for life.


 
I think these situations occur more often than people think. This IS one of the drawbacks to pushing the envelope on a patients donor---If this occurs in 2 out of every 100 patients or every 200 patients, it is too high of a risk, imho.

Backing off a little is always ok---a practice that does not receive enough credit.

Thanks for sharing Phil,
Jason
 
G

Guest

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#9
I'm not sure why this clinic has decided to openly post our patient without revealing any of the details of the surgery. Many patients from other clinics come to us quite frequently and we do not resort to disclosing the offending clinic. Maybe we should change our approach to this.

Fact is, we were in discussions with this patient from the very beginning. During his surgery we discovered that his donor scalp was more tight than we had anticipated which resulted unfortunately in a much higher tension closure. This was discussed with the patient on the day of his surgery and we reiterated more than once that we would do whatever it took to address the issue properly when the time was right. He was very understanding and agreed to keep in touch regarding progress and his plans to return so we could do right by him. That is what we do. Next thing we know he's gone for BHT and the operating clinic is now trying to use this to their advantage.


Jason,

The donor strip that was taken was not "pushing the envelope" as you stated and does not happen 1 out of 100 times much less 2 out of 100 times. This is 1 in 7000 times. The donor strip was a mere 1.1cm wide on the side in question which is in the prime territory of what your clinic removes on a daily basis. This could have happened at any clinic. "Backing off a bit" as you put it is not always the best route either. There is a well known patient of yours where you backed off not once but five times resulting in a necessary scar revision due to the additional scarring that backing off multiple times will create.


The issue regarding this patient is very unfortunate and is the only time that we have experienced this outcome. What is also unfortunate is that an esteemed clinic and industry colleague has to resort to parading this case on the forums for their own benefit.
 
Nervousnelly

Nervousnelly

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#10
Well maybe it was unfortunate that the previous clinic was mentioned as I am certain that all clinics don't bat 1000, but nonetheless the patient obviously wanted to seek out alternatives after a bad experience. I think that all top clinics will make every effort to satisfy patients and correct any possible complications but patients will certainly lose faith in a physician when things go wrong.

Although 1.1 cm might be a typical routine size of a donor extraction it evidently was indeed "pushing the envelope" in this particular case as all patients are not created equal. Each case must be evaluated on an individual basis and not based on averages. Yes, I know that a premier clinic like H&W would have done all to ensure this does not happen but nonetheless it is clear that possibly an error in judgement was made. Now clearly I am not a surgeon so I guess I should ask the question:

What is the likelihood that this would have happened with a donor strip 1/2 this width? Or more importantly, why does this happen?

Personally I think that all clinics have issues on rare occasion. We are dealing with the human body and many uncertainties. I don't look at something like this as a knock against the clinic (unless these things start happening routinely) but just a reminder to all of us that this is indeed surgery and there are risks.

NN
 
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lorenzo

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#11
Hello I am Lorenzo I assist H&W with translation with Italian patients when I am available and needed. I work as a part time real estate agent and in no other capacity am I involved with H&W therefore my opinions are my own.

Joe has already stating about this case so I am not going to comment. I just want to say in life you live by the sword to die by the sword. Top clinics do post before pictures but do not mentions names because it in my opinion it is considered low class. Since I have assist the Italians I have met 5 patients that have gone to BHR before they came to Vancouver. If fact there is on that had surgery on Wednesday but I will keep my opinion to myself.
One of the patients was this gentlemen. http://bellicapelli.forumfree.net/?t=37219069. Take a look and tell me what you think.

Once again this is my opinion. And thank you for having this forum..
 
Nervousnelly

Nervousnelly

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#12
Funny how no one else is touching this thread. Apparently, I am the only big mouthed idiot willing to voice my opinion. Anyways....

H&W are a world class clinic. Definitely on my short list of those I would let touch my head. What I find interesting is that this thread was in the process of being burried and likely few people saw it until Jotronic dredged it up and pointed it out to everyone. Even those that saw the thread likely didn't see the very obscure marking that it was indeed a prior H&W patient. Then when it is getting burried once again, Lorenzo decides to point it out to all again. Kind of silly if you didn't want to draw attention to it.

More interesting is that they both (on their 1 and only post on this forum) made reference to being above mentioning other clinics and how it is low class, etc. and then sling mud at Bspot, SMG and BHR, all of whom are esteemed members of this forum. Huh?))N_):)

Be fortunate that Bigmac didn't delete your only contribution here. Sorry Bigmac. I know that you would rather not have any wars and just let things slide but you know me now and I had to voice my opinion. I just think that they should contribute something to the forum if we are to let their voice be heard.

NN


 
timuk

timuk

My member is cooler than NN's
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#13
NN..

You make some very valid points (as always)...

I am guilty of what you mentioned.. I had read this thread and decided to stay away..... but that is not what the honest forums should be about..

Any surgery carries a risk of things going wrong, I guess even the top surgeons have results that are below their usual standards.. after all we are all human..

As for just jumping in and making a "hit and run" , I also agree with you... though I can see how threads like this can cause controversy...

Tim
 
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Bigmac

Bigmac

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#14
Hi NN

Like Tim i agree you raise valid points.

When i first saw this post i did not think BHR were having a dig at H&W,just posting a repair case of theirs and showing what can happen if something goes wrong with your HT.

No one would give a second thought if it were a Norton patient they posted but reality is this is surgery,complications can happen and the patients researching need to be aware of all the risks as well as the benefits.

Every clinic will have patients with less than satisfactory results for whatever reasons.Its only when they are a regular occurance that one should be concerned but as we know these cases are few and far between from top clinics.

bm
 
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Philb

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#15
It is always hard and easy to speculate after the fact, so we do not want to create a tempest with accusations but rather just stick to what we can say. Certainly something went wrong somewhere; I know the patient is quite philosophical about it and just wants to move forward.

The BH is growing well for him, the problem with BH is it is no quick fix but more important to take time and get a decent yield from each procedure rather than waste more hair. When we meet him soon we can update his progress thus far, but the objective is to cover the area concerned, maybe not a very high density but enough to give coverage so for example if the wind blows it at least gives some illusion of thickness and not a bare patch of skin.

For the record this is hardly a new case plucked from nowhere, the patient has posted his own case in detail already and it has been posted on at least two or three US forums some months ago, I hasten to add, not by us, or a patient of ours or anyone in any way connected to us.

We have had case posted about our patients, naming us expressly and portraying a lesser standard of result; that was and is not the point, as I say below sometimes it may be possible aspects are not controlled by us. When this occurs I guess you have to decide on your reaction, either to explain the case, which I have done on a few occasions, or to feel that it is unjustified. If you add your professional knowledge and experience it should help to educate the readers to understanding HT better. No one bats 100 every time as it has been rightly said, and sometimes even with all due care aspects are out of your knowledge or control, doesn’t make for a bad procedure with any less care or attention given.

In this case now his scalp is tight making it hard to remove a decent number of grafts, coupled with his lower than average density to the point now we have suggested no more scalp hair be removed, stay on meds and let time show. From what he said the BH has improved further and he is happy to continue down this road, how much long term density we can give him time will tell.