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Recent 4644 FU Case - Dr. Paul Shapiro

Paul Shapiro MD

Paul Shapiro MD

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#1
4,644 FU case, Norwood Type 6, Dr. Paul Shapiro



This patient was a perfect candidate for a large megasession.

He is a 52 year old Norwood Type 6 with a very good donor. He is healthy without any history of high blood pressure, diabetes, smoking, etc.. In these large megassessions the patient is sitting still for a long period of time and we give large doses of lidocaine and epinephrine. So I want the patient to be healthy to avoid any possible medical side effects.

Our goal was to get as much coverage as possible. As you can see I packed more densely in the front ½ and still did not completely cover the crown. I would say I covered about 150 sq cm of scalp but I did not measure it.

When I do a large case like this I take ½ of the donor out in the morning and the other half of the donor out just before lunch. I have the technicians keep grafts from the first ½ of strip separate from the second half. I want the grafts from the earlier strip to get placed first. My goal is to have the FU €™s placed within 4 to 5 hours of being out of the body. Studies show that grafts survival decreases the longer the FU €™s are out of the body. Studies shows that at 4 hours out of the body the graft survival rate is 95% and at 6 hours the graft survival rate is 90%.

In this patient I finished harvesting the first half of the donor at 9:30 am. By noon our technicians had almost finished cutting this first half section. I then removed the second half of the donor and we broke for lunch. The technicians started to place the one hair FU €™s at 12:40 in the hairline and were done placing the hairline 1:40pm. I usually use 400 to 500 one hair FU €™s in the hairline. The whole session was finished at 7:30. I would have preferred to be done a bit earlier for the safety of the follicles, but I can say that the majority of the hair follicles were placed within 4 to 5 hours of being out of the body.

By the end of the session the patient was grumpy and complaining of back pain but happy that he had such a large session. He is a type A guy and even with valium on board, it was difficult for him to sit still for that long. The last two hours were especially difficult and we would have been finished earlier if he had not been so fidgety at the end of the day. I find a patients personality, and a history of back pain and/or neck pain are important to know when planning a long day of surgery.

Here is the breakdown of grafts and hair count.



1 Hair FU - 983 Hairs €“ 983

2 Hair FU €“ 2703 Hairs €“ 5406

3 Hair FU - 856 Hairs €“ 2568

4 Hair FU €“ 102 Hairs - 408

Total FU - 4644 Total Hairs €“ 9365



The total length of the strip was 26.5 cm long.

At its widest the strip was 2cm wide in the middle and at the temples the strip was 1.5cm wide. The strip dimensions was as follows



10.5 cm long of 2.0 cm wide strip

9.5 cm long of 1.8 cm wide strip

7.5 cm long of 1.5 cm wide strip



Taking a total FU count of 4,644 FU and a total area removed of 49.35cm his donor calculates to 94 FU/cm.sq which is higher then average. On average most donor strips have 80 FU/cm.sq.


 
Last edited:
Nervousnelly

Nervousnelly

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#3
Very detailed write up. Great sized session. Should likely be a 1 and done scenario. This guy will have an age appropriate hairline with some fairly decent density.

NN
 
Bigmac

Bigmac

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#4
Dr Paul

Thanks for all the info and surgery details,very interesting read and its good to hear how you take the patients health into consideration.

He had a great hair count,more than the average.The placement looks good with the staggered hairline.

I hope he keeps you updated with his progress as it will be good to see his final result.

Thanks bm.
 
Peachy

Peachy

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#5
Obviously a very long day for the patient, but how about the strain on the good Dr and the technicians? Interesting to note the FU survival time and rate out of the body.
 
Nervousnelly

Nervousnelly

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#6
What I found interesting about this case also is that when I read about the donor being above average I thought that it didn't look that way to me, but when I went and relooked at the photos I could understand. The pics of the donor dry versus wet and immediately post surgery tell 2 different stories.

NN
 
janna

janna

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#7
The patient has salt and pepper hairs so it's more difficult to assess the density until donor is examined in person. Of course it's also much easier to assess under the microscope. :)
 
Shang

Shang

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#8
Salt and Pepper hairs, thats a new one for mec;;9. A nice detailed account of the procedure, I like the detail about the graft survival time also, interesting.
 
janna

janna

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#9
The term salt and pepper to me sounds nicer than saying someone has lot of gray/white hairs.
 
janna

janna

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#10
10 DAYS POST OP UPDATE: 4644 Grafts - 9365 Hairs - Dr. Paul Shapiro

Pics taken at 10 days post op when he came in to get his staples removed. He did a great job of cleaning the recipient and donor area. He is thrilled so far and despite living 1/2 time in another warmer state and living about an hour and half from our clinic, he says he'll keep us updated with his progress by coming back anytime we ask. I apologize the first pic is a bit blurry.


















The patient's wife was amazed at the donor scar - or lack of any signs of scarring so far. I applied some antibiotic cream as we normally apply it for the first few days after surgery on the scar. Since the staples leave a little bit of red spots, I took the precaution to apply it right after the staples were removed.







 
Bigmac

Bigmac

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#11
He is looking good at day ten,his donor closer looks very good.

Cant wait to see this one grown out as he got a lot of hair.