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N° 0.
User deleted
Dear Forum members,
Since we started the net based teaching of the FUSE technique , we have received heartening response – from ht surgeons as well as the general public.
However, we feel some ht doctors are still hesistant about taking the plunge.
They have some valid questions/doubts.
1. FUSE/fue graft survival rates- some fear that the fue grafts may have a lesser survival rate
2. Graft density- some feel that the FUSE grafts cannot be placed as closely as traditional strip FUs.
3. Donor area scarring- some feel extraction of the FUSE grafts may lead to pinpoint numerous scars in the donor area giving a moth eaten appearance to the donor area, if it is shaved.
Today, we shall address one of the concerns-
Donor area scarring
Different terms have been used, mainly suggesting that there may be numerous minute scars all over the donor area instead of one linear scar that occurs in strip surgery. That is not so.
There are 3 views we wish to submit on this-
1. In FUSE, the follicular units are extracted in an alternate fashion. That is, no 2 adjacent FUs are taken out. As a result, there is no large scalp area with FUs missing and empty skin visible. Moreover, if care is taken to use micropunches of less than 0.9mm diameter, the skin totally heals itself without any hypopigmentation or pock mark scars.
(If one uses punches >/= 1mm diameter, it is more likely to give some visible scarring).
How would the donor area compare visually after having taken out thousands of FUs by FUSE vis a vis by strip?
In one sentence,
If one takes out, say, 3000 FUSE grafts from the scalp and shaves off at a later date, a human eye won’t be able to make out that feared moth eaten appearance at even 2 feet distance from the person.
The reason is that human eye’s visual acuity is comparatively less.
Peering very closely, with maybe some sort of magnification, one will see small empty areas where the FUs were. But nothing comparable to a long (albeit thin) scar of strip surgery.
A helpful analogy would be to take the example of looking at a row of trees vis a vis a hedge.
The tree trunks can be compared to old fashioned 4mm punch scars (or the linear strip scar of FUSE).
No matter how thin the linear scar is, it will be visible if the person keeps his hair short- 2to3mm, because it clearly demarcates itself as a line.
Just like one can always make out the tree trunk against the skyline.
FUSE grafts sites are, on the other hand, comparable, to a hedge.
Since the micro holes are diffusely spread out and minute, with hair growing in between, it is difficult for the human eye to make them out except under very close inspection. (Just as in a hedge, it is impossible, on a casual glance, to see the wooden branches.)
2. The patient’s perspective : Most of the patients today agree that they would like to retain the choice of being able to keep the hair on the back side of the head to a length of 2-3 mm.
If hair are kept to that length, the strip scar being in a straight line draws attention, even if it is very fine (Anything in a straight line looks unnatural).
Whereas, FUSE/fue microscars, even if visible on close inspection , will not be visible with hair at 2-3 mm length.
100:60:10. (results of survey at our clinic)
For every 100 people opting for hair restoration surgery, 60 would like the FREEDOM to be able to keep short hair on the back side of their head.
10 persons out of 100 felt that they will even like the freedom to be able to shave off their scalp occasionally without attracting attention to any linear scar.
We cannot dismiss this large percentage’s preference just by saying, ” Why would anyone like to keep short hair after having a hair surgery to get hair back?”
3. The visibility of the donor scars
a. Increases with time in a strip FUHT owing to the stretch on the scar.
b. Decreases in a FUSE/fue graft owing to melonocyte migration (leading to reduction or absence of any hypopigmentation.)
FUSE graft donor site typically follows the following pattern:
2-3 weeks: Mild hypo/hyper pigmentation in donor area micro-holes.
3 months: The pigment level matches the surrounding skin. But minute scarring may be visible on close inspection.
6 months: No visible scarring even on close inspection.
It may still be pointed out that since the FU’s have been taken out empty spaces would be left where they were.
Won’t it be visible to the naked eye?
No.
Again the visual acuity of the human eye contributes to this happy situation.
How?
a.) It has been previously documented by ht surgeons, that even with 50% of the hair removed/ trimmed from an area of scalp, the untrained casual observer cannot notice any visible thinning.
b.) FU’s are placed in the recipient area at a density comparatively less than what nature gave initially. On shaving off the recipient area (or keeping very short hair), the scalp hair growth in the recipient area does NOT look unnatural.
Similarly, in the donor area too, if even 50% FUs are taken out and the hair trimmed short, it does not look unnatural.
One must, therefore, realize that it is not whether any microscars will be visible on shaving off ones scalp after FUSE/fue.
The patient’s important consideration is that if he opts for a strip FUHT, the linear scar will always be visible if he shaves off or cuts the hair to 2-3 mm in the area from where the strip has been taken.
Focussing on that patient requirement, I feel, ht doctors should see the option to use the FUSE/fue in a different light and pursue it with more vigour and enthusiasm.
Next I would like to address the other two fears namely graft survival and density (with appropriate pics).
That I plan to defer for the time being as I think this post is long enough already.
Dr.(Capt) Arvind Poswal
Dr. A's Clinic,
A-9,First Floor,
Chittaranjan Park, (Near Nehru Place), New Delhi-110019, India. www.besthairtransplant.com
www.fusehair.com
[email protected]
Ph- 91-011-26274368,91-098-101-78062
Timings-10a.m.. -
-arlecchino-.
User deleted
Ottimo NumeroZero!
Quindi il Dott. A., riassumendo dice che:
se si usa un punch inferiore a 0.9mm di diametro la cute guarisce da sola senza lasciare esiti cicatriziali visibili e senza indurre fenomeni di ipopigmentazione.
cicatrici posso essere visibili con l'uso di punch con diametro superiore al mm.
Anche con 3000 uf prelevate via FUE non si nota nulla del famoso effetto "mangiato dalle tarme", se non a testa rasata da molto molto vicino o con qualche ingrandimento (si noterebbero piccole aree vuote).
A quando le prossime puntate?
P.s. Tu NumeroZero che opinione hai del Dott. A.? Se è veritiero quello che afferma, come mai chirurghi esperti come il Dott. Cole usano ancora punch da 1 mm?
Ed ancora, come mai Cole non ha mai messo nella sezione foto del suo sito, foto di persone con la donor rasata ad un anno? Le ha sicuramente, e sono quelle di pazienti che fanno una seconda procedura e che devono per forza rasare la donor... -
N° 0.
User deleted
Ho ancora pochi dati sul dottore indiano.
Cole utilizza il punch da 1 mm solo nei casi in cui le u.f. siano da tre o più capelli.
Nei casi di u.f. con 1 e nella maggior parte di quelle u.f. con due capelli utilizza un bisturi da 0,75.
Feller ne utilizza uno da 0,8. Eccolo qui:
La ragione dell'utilizzo di uno stumento di tali dimensioni è che l'uso di un bisturi più sottile come ad esempio quello utilizzato dalla DHI (0,5 mm) porterebbe ad una ovvia transection di tutte quelle u.f. che eccedono un capello e di parte di quelle da uno.
Considera anche che una eccessiva scheletrizzazione durante il prelievo con il relativo traumatismo della manipolazione, può portare ad una percentuale di ricrescita inferiore.
Cole è molto rispettoso di quanto indicato dai pazienti e ti garantisco che sono molto pochi i pazienti che amano vedere pubblicate le proprie foto.
Se avessi l'occasione di avere un consulto nel suo ufficio di Atlanta, potrai vedere un gran numero di foto che per ovvi motivi non ha il permesso di pubblicare su Internet.
Ultimamente sta tentando di offrire delle graft gratis per avere il consenso, ma mi pare che non abbia avuto grandi risultati.
Ciao
Edited by N° 0 - 1/12/2005, 03:15. -
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A proposito dell'argomento "esiti cicatriziali", vi riporto il risultato di una mia piccola ricerchina.
Comincio riportandovi l'intervento di patrick in riferimento alla mia domanda sul forum di forhair, nella quale chiedeve di descrivere le tecniche per minimizzare il rischio di formazione dei wihte dots, i puntini ipopigmentati che possono formarsi a seguito di un intervento FUE. Questa la risposta:
It is impossible to predict that (ndr - chiedevo se era possibile predire la formazione dei dots).We just noticed that patient with dark skin tend to have that side effect more often than fair skin.We tried to take precautions in every patients assuming they are at risk.
Here is some of the solutions and the radical behind it:
1 . COMPRESSION
When you have a 1mm punch ,it will produce a scarring of 1mm of diameter that could appear as white dot because scar tissue lack color.
In repair cases for plugs ,we use bigger punches and we sow with regular sutures the wound for 4 days;and we had no visible scarring because we reduced the size of the wound .We applied the same idea for the the donor area.If we reduced the size of the wound created by the punches ,we should end with no scarring at all.The question is how to do that because the area could be big.We used sutures ,staples,traction of the donor area ,compressive bandage,...Some of this technique could increase the discomfort and we tried to work with the patient to see what could be better for him.
2. TOPICAL STEROID
Scarring is a natural process of wound healing.It is the result of the inflammatory event that occur when there is a open cut of the skin.The steroid is an anti inflammatory and will decrease the scarring formation ;and also steroid is the treatment to flatten the hypertrophic scar .These medication act by "eating" the fibrose or scar tissue.
Same idea is applied for hair cycle products.
3 FARMING
It is the insertion of body hairs in the donor open sites.One of the treatment of scar or old plug scars is to graft them with hairs.It alleviate the contrast of the scar and the surrounding area and some times gives back some color to the scar.This procedure is also used to treat vitiligo which is a type of skin discoloration .Body hairs is proven grows also in scar tissue.In order to wait and see if there is white dots so we can treat them by grafting them,we just anticipate and graft the open sites.It is a preventive treatment.
Those are different avenue we have to minimize side effects of FIT in the donor area.And we are still looking for best way to address that matter.
Qui il post intero: http://www.forhair.com/hairtransplant/view...topic.php?t=648
Quindi, di fatto si puo agire in tre modi: comprimere la zona per ridurre lo "spazio vuoto", utilizzo di steroidi topici (che dovrebbero disinfiammare la zona e prevenire processi infiammatori) e inserimento dei BH nei fori di estrazione.
A proposito della procedura del FARMING, che prevede, appunto, l'iserimento di BH, c'è una procedura simile del dottore indiano, Arwind Poswal, che prevede di rimettere solo una pezzetto del capello estratto nel foro di estrazione. La procedura si chiama Donor sealing. Qui trovate informazioni su come funziona
http://www.fusehair.com//Donor%20seling.htm
Vi riporto un pezzetto:
Donor sealing
Wound healing in the donor area following extraction of the hair follicular
units is a complex event, where the doctor can intervene in various
ways
The issues at hand are---
1. Whether to leave the wound to heal by secondary intention?
2. If one tries to bring about a semblance of healing by primary in-
tention, then how to go about it?
The 2 relevant major events in healing of this type of wound are----
a) Collagen synthesis / fibrosis
b) Epidermization.
If the wound is left to heal by itself , (i.e. by secondary intention),
the process to collagen synthesis / fibrosis tips the balance against epide-
rmization.
As a result, one gets a cylindrical defect filled predominantly with collagen.
This results in appearance of white dot like scars (0.75mm to 1.25mm dep-
ending on the size of the punch used)
Attempt should, therefore, be made to have as close a resemblance to hea-
ling with primary intention as possible .
One option would be to close the individual punch holes (by sutures/adhesive)
Not only is this approach impractical, it also will lead to a lot of stretch on the surrounding skin.
The option we chose was to use the epidermis of the follicular unit to close the micro-punch hole.
In this method, the deeper layers of the wound heal by secondary intention/ collagen tissue, but the superficial layers, viz., epidermis heals by primary intention.
This method, therefore, tips the balance in favor of epidermization without excessive graft handling.
Epidermis is the color bearing layer of skin .When the wound heals with epider-mis on top, there are almost no pigment variations (excepting those that may
occur in nature).
Since the method involves sealing the donor wound with the epidermis, we have named it in a descriptive and self explanatory manner as “Donor Sealing”.
This approach solves some other problems too.
One of them being, that if one transplants the graft without removing/ trimming
the epidermis , there are chances of unevenness/cobblestoning in the recipient area.
This would happen more so if the grafts were to be placed in slits/ needle points.
The contributing factor being the extra epidermis in the same area.
By removing the epidermis from the graft, we get the tissue to be used to effect-
tively seal the donor wound.
At the same time, we get rid of the extra epidermis (which would otherwise be a liability in the recipient area).
In riferimento a questa procedura, l'opinione di Cole è la seguente:
http://www.forhair.com/hairtransplant/view...topic.php?t=630
" I am not a huge fan of donor sealing. donor sealing is simply taking the top section off a graft and putting it back in the donor extraction site. This is just bald skin. It will not typically grow hair unless there is a resting telogen hair high in the dermis that is relocated back to the donor area. Mostly it is simply the top of a graft with hair fragments an no viable hairs. We tried the same thing 3 years ago, well before Dr. A even began doing FUE. we were not impressed with the results.
Placing bald skin plugs back into the donor holes will not prevent any of the potential complications of FUE and it might actually be deleterious. By placing the plug of bald skin back into the extraction site, you limit the ability of the donor extraction site to contract. The space occupying bald skin exerts an outside pressure on the contracting skin that could make the extraction site more visible.
we are well versed in using plugs of skin from our long history in the hair surgery field. Plugs of many sizes have been used for years. Skin grafts of many sizes have been used too. Typcially, we saw that the plug of skin placed into a extracted hole lost its pigment or it became hyperpigmented 15 years ago. Skin grafts do the same thing and this is essentially what the donor sealing is- a skin graft. The primary method of grafting 15 years ago was to cut holes in the top of the scalp and place plugs ranging from 1mm to 5 mm in size. The resulting skin graft was typically lighter or darker than the surrounding area. therefore, donor sealing is nothing new and it offers no advantages. We prefer to allow the extraxction sites to contract and to treat them with anti-inflamatory agents to reduce the risk of hypopigmented spotting or to place body hair grafts into the extraction sites. This offers far better advantages than donor sealing in our opinion. We've tried both and we find our techiniques superior. of course we are open to Dr. A performing a study to test all methods if he likes and then to present his data in a scientific forum. We've evaluated all methods on our own and we have presented our efforts at medical meetings to a large group of physicians. This is what Dr. A should do in my opinion, as oppossed to simply marketing a technique that he claims to have invented even though its a technique that's been around in one form or another for over 40 years. he should also consider showing the results of this effort one year later rather than before the fragments of dead hair fall out. these dead hairs are not going to grow. if they stay in too long they might even create a foriegn body infamatory auto-immune reaction that can lead to a pseudocyst formation. "
Quindi secondo lui non è una soluzione valida e preferisce (come ha scritto patrick) utilizzare antifiammatrori o bodyhairs nel foro di estrazione.
In riferimento a Woods, non ho trovato interventi relativi ai white dots, ma gli ho scritto (oltre che per altro) chiedendo anche in riferimento a questo. Appena ho qualche nuova info la piazzo qua sotto. in ogni caso, in una sua intervista postata qui da Lorenzo sul vecchio form), gli viene chiesto cosa ne pensa degli interventi e delle sostanze da utilizzare in donor per favorire la guarigione. Lui molto sagacemente dice che la sostanza migliore resta il sangue del paziente..
E sull'utilizzo dei BH nei fori dei trapianti dice che se non si rovina la donor, questo procedimento non è necessario.
ciao
Edited by -cripto- - 1/12/2005, 13:46. -
titty.
User deleted
Molto interessante, sopratutto questo:
"The steroid is an anti inflammatory and will decrease the scarring formation ;and also steroid is the treatment to flatten the hypertrophic scar .These medication act by "eating" the fibrose or scar tissue.
Same idea is applied for hair cycle products"
In poche parole idrocortisone..
Se non sbaglio numero zero l'aveva utilizzato nella donor.... -
avevo un cespuglio.
User deleted
CITAZIONE (titty @ 28/4/2008, 23:28)Molto interessante, sopratutto questo:
"The steroid is an anti inflammatory and will decrease the scarring formation ;and also steroid is the treatment to flatten the hypertrophic scar .These medication act by "eating" the fibrose or scar tissue.
Same idea is applied for hair cycle products"
In poche parole idrocortisone..
Se non sbaglio numero zero l'aveva utilizzato nella donor...
Interessante.
Qualcuno sa con che risultati?. -
MARK1981.
User deleted
tutti i dottori che praticano la fue x la 1 settimana fanno usare creme che contengono idrocortisone.e' ovvio . -
alanbenjo1.
User deleted
Ciao a tutti. Volevo sapere come risulta da vicino l'area ricevente di un intervento: formandosi anche lì tessuto cicatriziale immagino che il cuoio capelluto assumera un aspetto rffrtto lucido, essendo lucido il tessuto cicatriziale... o sbaglio? Spero di esseremi spiegato . -
alanbenjo1.
User deleted
Volevo anche sapere se con il tempo le mini cicatrici restano percettibili con piccoli pruriti, o dolori del cuoio capelluto. Ad esempio io sono uno che lo stress lo avverte molto sul cuoio capelluto, ed infatti provo enorme piacere coi massaggi del cuoio capelluto: non vorrei trovarmi dopo una FUE ad avere x sempre dolori in testa! . -
smeraldo.
User deleted
macchè....secondo me lavarti la testa ogni giorno tia iuterebbe gia adesso a non avvertire prurito 
. -
gnappome.
User deleted
CITAZIONE (MARK1981 @ 25/11/2008, 01:53)tutti i dottori che praticano la fue x la 1 settimana fanno usare creme che contengono idrocortisone.e' ovvio
Scusa mark, crema da usare in tutta la testa o solo nella parte donatrice? Avresti qualche nome di crema? Grazie.. -
5alfa-reduttasi-tipo2.
User deleted
cmq nn dovrebbe far male la crema in questione ... potrebbe svolgere anche una azione anti effluvio . -
gnappome.
User deleted
si ma...un nome ce l'avete o no? . -
MaicoL..
User deleted
Ce ne sono molte,
comunque crema a base di idrocortisone 1%,
come il DERMIRIT,
ma ci sono anche altre che contengono con l'idrocortisone anche l'aloe vera e sono migliori..
FUE E ESITI CICATRIZIALIby Aragorn |
