Proper Placement of the Scar in Hair Transplant Surgery
This insightful information was posted on our hair restoration forum by Dr. Alan Feller of Great Neck, NY who is a member of the Coalition of Independent Hair Restoration Physicians.
Much of the hair transplant industry has been cleaned up since the advent of hair loss forums and websites like the Hair Transplant Network. However, there are still areas of hair restoration that remain largely unaddressed such as the proper “absolute” position of donor incisions.
This is why I scanned and posted the textbook definition as to how a proper donor incision should be planned and executed. I doubt any doctor will publicly contradict the text, and they shouldn’t since it is one of the few things in medicine that is objectively and demonstrably correct.
On the hair loss forum, a particular physician ignored the basics of “Hair Transplant 101” by harvesting a donor strip that was obviously too low and led to a needlessly greater chance of large scar formation. Was this just an isolated “once in a while” incident, or was this “less than optimal” approach to donor harvesting a more pervasive problem?
I think it is not only a prevalent problem, but epidemic.
By coincidence I had a patient in my office only a few days before Allan posted his results from a UK hair transplant doctor. What I found in the donor area was appalling. It demonstrated an utter and complete lack of understanding of basic scalp physiology and an almost purposeful desire to disfigure.
Most of the time, these awful results come from the “hit and run” hair restoration physicians who may perform one hair transplant per month. To them, the donor area is not a part of the body to be respected – and it shows in their results.
In the photos you can see an upper scar and a lower scar. The first doctor produced the lower scar. It is located below the occipital bump and predictably looks worse than it otherwise might have. The second doctor went way high in the donor area (in an effort to avoid the first scar no doubt), but because this scar is located well above the occipital bump the size of the scar is much smaller.
The problem with both scars is that both surgeons totally missed the very prime donor real estate. I was thankful for this because it made my job that much easier, but one must wonder why such amateur mistakes were made by hair loss doctors who have not only been in practice for years, but claim publicly to be “experts” and “leaders” in the field.
Here are a couple of other goofy scar results produced by self proclaimed “experts” in the field of hair replacement surgery.
In the photo on the left, the doctor had excised the donor strip well below the occipital bump, and that scar is smaller than one would normally expect for such an inappropriately low scar. We can only imagine how good his donor scar would have looked had it been excised on or above the occipital bump.
In any surgery the outcome is never 100% guaranteed, but the odds can be slanted in favor of the surgeon and patient by simply understanding some basics and applying them every single day. Why this has not been done is beyond me. Thankfully, such results can be reported on the internet for the world to see.
Dr. Alan Feller, D.O.
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Bill
Associate Publisher
Technorati Tags: hair transplant, hair loss, hair restoration, hair transplant doctor, hair restoration physicians, occipital bump, hair loss doctors, hair replacement
November 4, 2008 @ 12:33 pm
John,
Thanks for your comments. You can’t post a photo here on the blog however, I have forwarded your comment to Dr. Feller so he could respond personally. He may choose to respond on this hair loss blog, or he may choose to send you an email.
Best wishes,
Bill
Associate Publisher of the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.
November 3, 2008 @ 7:40 pm
I don’t know how to attach photo.If one would tell me,I am not ashamed to post it here.
November 2, 2008 @ 12:36 pm
Mr Feller
I red this post and I would like to say the following.
I agree with everything that you say.I have had a hair transplant surgery with a doctor from ohio.
My donor site incission was as low as it can be (impossible to repair by statement from other doctors who examined me).My scar is 1 cm wide.I am bolder than ever 1 year after the HT surgery.1840 grafts allegedly were put on my scalp.However statements by other 3 doctors are they can not see 1840 grafts on me.Infacts 200-300 grafts widely spreadout and growing in all possible directions is what I have on my head.The donor site was determined by doctors “surgical technicians”not the doctor.I did not have informed consent.I was abandoned by the doctor for hours in middle of surgery and left with the “surgical technicians”.The “surgical technicians adminirested the anesthesia on me,not the doctor.It goes on and on.I am disfigured and wear a hat 24/7.
Now,premises considered,will you put action where your words are and evaluate my case for afidavit of merit?
With the argument that our prima facie evidence of violation of the laws ,such as :
1. Defendant failed to personally evaluate the plaintiff sufficiently so the he could formulate an appropriate pre-operative diagnosis, and select the operation to be performed in violation of Ohio Administrative Code 4731-18-01
2. Defendant failed to perform or personally supervise all aspects of the surgery, or have aspects of the surgery outside of his supervision performed or supervised by another qualified surgeon with the consent of the plaintiff in violation of Ohio Administrative Code 4731-18-01.
3. Defendant failed to personally perform post-operative medical care, or delegate post-operative medical care to a qualified medical professional in violation of Ohio Administrative Code 4731-18-01.
4. Dr. Weiss negligently and recklessly delegated medical tasks in violation of the Ohio Administrative Codes 4731-23-02 and 4731-23-03.
5. Dr. Weiss negligently and recklessly delegated the tasks of selecting the donor site to harvest the hair follicles for transplant in the preceptor site in violation of Ohio Administrative Code 4731-18-01.
6. Dr. Weiss negligently and recklessly delegated the tasks of administering anesthesia to plaintiff to persons not qualified under Ohio law in violation of Ohio Administrative Code 4731-18-01.
7. Dr. Weiss negligently and recklessly delegated the tasks of preparing the donor grafts, and insertion of the donor grafts into the surgically prepared receptor sites in violation of Ohio Administrative Code 4731-18-01.
8. Lack of Informed Consent/Violation of R.C. 2317.54
9. Defendants engaged in the practice of medicine and surgery without the appropriate certificate from the State Medical Board in violation of R.C. 4731.41.
10. Violation of R.C. 3702.30
will you or any HT doctor out there,criticising the corrupt practices in your field help a victim of a doctor predator?So far I could not find any!Everyone states the apparent facts,named above untill they think I am potential patient for revision.When they hear from me that I filed law suit against a colleague of theirs they are reluctant to sign that the standard of care was breached.
I have a question for you all Doctors.Can there be ANY standard of care when doctor violated the provisions of the laws that I state above?Thoce conducts are forbiden by law.Question.How can they be standard?Question-Is there any of you who will say the obvious-they are not and can not be considered standard of care.
Thanks,
Jovan