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pitfalls with tricho closure technique

D

drmwamba

Valued member
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#1
Hair transplant is based on finding balance between the recipient area and the donor .Recipient being the miror and donor area the bank .with the event of follicular unit transplant ,it seems like we resolve most of the concerns about the recipient area.Physicians were more concerned about the donor and lately we assisted at the birth of two techniques (FIT/FUE and TRICHO CLOSURE) as a solution for the donor.They render the scar in the donor "quasi" invisible to the naked eye.

We know all about the presence of white dots with the FUE technique.What about the tricho closure?

I would like to illustrate some findings we can have with two scar repair cases That showed up to our clinic:



This 26 yo patient ,moving to a NW6-7 finds himself with this railway image of scar ,not specific of trcho closure,but common in any strip if the suture were made to tight.On the top right picture ,in the blue circle ,you will see hairs emerging from the scar ,the key advantage of tricho closure ,when this phenomenon is homogen through all the suture line.Which is not the case in our patient.

You can notice in the bottom picture scar without hairs ,wide ,and also hairs emerging in ackward direction .This fact may look very bad and those patients can not have a short cut anymore.

See microscopic details of the scar texture,and the hair direction modified .



Another case in a mature patient who had two prior strip surgeries:



Tricho closure is great but you have to respect all the precautions(size of your harvested tissue,number of previous procedures,stretch back,...) related to a normal strip procedure.The change in hair direction may create a super density that could attract our sight and make the scar noticeable , especially with wet hairs or short hair cut.

As a treatment for those patients , we grafted BHT in the first one .For the second one ,we removed the hairs in the scar donor by FIT and re direct them in the right angle in the same holes ;and we complete it with some BHT.
 
the B spot

the B spot

Pick your Poison!
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#2
Excellent write up. Trico closures work best on closures that have very minimal tension---when you increase tension it can "pull" the hairs growing through the scar so they go through the skin at an odd angle.

Again, trico is a great advancement--but like all things in this industry---you have to temper your "hype"

Take Care,
Jason
 
Bigmac

Bigmac

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#3
Thanks Dr Mwamba for a great informative post.

Would you say when a tricho closure is succsessful and the scar is pencil thin the hairs for the most part grow through at the correct angle?

I can see how the tension can cause the follicle to be pulled and thus grow out the scar at the wrong angle.

bm.
 
janna

janna

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#4
Great informative post. When surgery is performed, there are risks and tricho is certainly not a cure all to strip harvesting. You still need skilled surgeons who know what they are doing.
 
D

drmwamba

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#5
When the scar is thin,it seems like hairs coming through the scar have a good angulation or the difference in angulation is not that noticeable.

Dr Frechet in one conference said you must keep the size of your strip around 1cm wide,you need to avoid to use it in a 2nd or 3rd surgery.

But others physicians proved you can not follow Frechet's recommendation and obtain great results.

I do not have much experience with the tricho and right now I still perform the double closure which produced thin scars .I want just to attract the attention to practitionners to follow the basic rules in strip closure and apply them to tricho in order to avoid catastrophy .
 
Bigmac

Bigmac

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#6
Hi Dr Mwamba

Do you have any pictures of double closure scars and what is the protocol with these as opposed to tricho.

Thanks bm.
 
D

drmwamba

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#7
Double closure is the classic suture technique.You close the deep tissue with an absorbable suture (that could last 1 to 3 months).This suture will help to bring the two edeges of the wound side by side.And on the skin ,you just apply another suture (absorbable or not) that need to be tighed with no tension.Which will avoid the railway image .

The difference with the tricho is the overlapping in the tricho and side by side edge in the double closure.

For deep tissue,you close it the same way.

I will keep looking for a picture that could show it.Usually patients keep long hairs in the donor and it is very difficult to get a perfect picture.Hairs are usually on our way.
 
Bigmac

Bigmac

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#8
Hi Dr Mwamba,were you able to find any pictures.

Also a question i have,when a tricho closure is being utilised the doctor cuts/trims the edges of the skin along the closure area,are the grafts contained in this tissue planted or are they disected when the tissue is trimmed?

Thanks bm.