A patient seen approximately 15 years ago for correction of pluggy-looking hair transplanting carried out in another office. The hair in the grafts has been cut short just prior to the surgery.
An intra-operative photo showing that portions of each of the larger grafts had been excised. At the same time as that was done, a combination of micrografting and micro-slit grafting was carried out in the same area.
Nine months after the photo shown in Fig. 28b showing a far more natural distribution of hair because of the combination approach of excising portions of old grafts and adding new smaller ones.
This 56-year-old gentleman had undergone hair transplanting 15 years prior to seeing me in 2002. He had fine-textured, reddish-to-blonde colored hair. The transplanted area was moderately pluggy-looking and would have appeared much worse had his hair not been so fine and relatively light-colored. The density in the transplanted area was also relatively low. In addition to the preceding, his MPB was obviously extending further laterally and he had lost all of the hair behind the transplanted zone. He was basically left with a pluggy-looking, unsatisfactory isolated frontal forelock, as is shown in the photo. I designed lateral "humps" for completion of the frontal-third of the area of MPB and a new hairline zone in front of the old one. The black crayon line delineates these objectives.
A patient who had been in a car accident and had severe scarring alopecia in the temple area.
A patient before repair of transplanting done in another office. The areas to be treated are outlined in black grease pencil.
The same patient shown in Fig. 30a, 10 months after his first frontal repair session (1973 FU).
The same patient shown in Figs. 30a and b, 11 months after his second repair session (1361 FU), the latter behind the first one.
A photo of a back view, taken at the same time as the photo in 30c.
Many patients who come for repair of older-type transplanting have alternating rows of scars and hair in their donor area as shown in this schematic drawing with H denoting the hair-bearing sections and S the scar-bearing sections. A strip is excised that contains two rows of scar and one row of hair as shown in the drawing and the wound is sutured closed. One ends up with one scar instead of two. The single scar is in addition, far narrower than both of the two that have been excised. One also ends up with two rows of hair-bearing skin adjacent to each other. The result of this sort of repair harvesting is that a) one obtains additional hair from the hair-bearing section that was excised as part of the strip, and b) the donor area looks thicker rather than sparser despite the removal of additional hair because one is left with one finer scar instead of two, and just as importantly, there are two rows of hair adjacent to each other now.
A clinical photo of a patient who demonstrates old methods of harvesting prior to repair.
After a strip that has been excised that contains two rows of scar and one row of hair as demonstrated in the schematic drawing in Fig. 31a. Obviously, the donor area looks better after this harvest despite the removal of additional hair.
A scar from an infection in the donor area during a preceding hair transplant done elsewhere. Many people believe that such scars cannot be improved upon by additional strip harvesting. This is not necessarily true.
The same patient immediately after excision of the strip from the area shown in Fig. 32a. In such cases, it is particularly important a) to not close the wound with any tension whatsoever and b) that one border of the new incision should run through intact hair-bearing skin, thus supplying a better blood supply to the new wound.
Six months after the photo in Fig. 32b showing that the scar has not become wider with the passage of time. The hair adjacent to the remainder of the scar has been clipped short just prior to another strip being removed in order to further improve the scarring.