Strip Surgery an expose' at a private clinic... Hairtech

[hairtech]

When small private clinics perform 3500-4000 graft FUT, it is an all day event. To undertake this type of procedure there has to be a team effort and a concerted approach. The experienced technicians that are vital to the private doctor. It is now 8:15AM and this is what is going on.

50 year old white male in for 3500 hair transplant by FUT with additional eyebrow
work. Pt is in perfect health and is currently NOT on oral meds for hairloss. Dr. Harris's classification of him is a Norwood 5/6 with residual vellus hairs as well as some intermediate hairs. His classification doesn't quite fit the Norwood but I believe you can get the picture.


First off... I want to try to walk you through our office and give some light to the players here.

When you walk into the office you meet friendly Veronica. She plays several roles here and has been apart of the office for 3 years.

Then the waiting room.

Now this is what I see when I walk into the employee break room. My point is that we are all organized around efficiency. The boards are specific in our duties.

The patients pre-photos. He is in the chair already. I am somewhat worried that his existing hairs will be cause for concern for slowing placing/planting. We will see.

 

[hairtech]

This is Caroline. She is our star "cutter". She can produce 1000 for this case. She has been with Dr. Harris for 10 years.

Patient is receiving Intraveneous Valium. Sedation is important and comfortable for the patient. Janiece is helping Dr. Harris. She has been with Dr. Harris for 8 years. She also acts as the office manager.

There will be some lag before I get the next series out today... however I am taking pictures of everything.

Now the surgery is in full swing. The next few pictures are somewhat graphic so please be aware. This is typical of all strip excisions.

The techs in the back are beginning to cut the strip. Dr. Harris cuts his strip out in 4ths.

We use plasmalyte as a holding solution. It is similar to BSS. BSS was what I brought to an office down south.

Whew... Jim is done with the surgery. It is now 9:10AM

The strip dimensions are 1.1cm in width X 35cm in length.

It is now time to sliver. We have two sliverers. One of them is considered to be the best in the industry... Byamba can cut 300-350 perfect slivers in under 3 hours. Byamba is wearing the pink scrubs today. Our second sliverer is extremely important also.

Yes there is a couple of transections at the end of this sliver... This is a common occurance and especially near the end of a strip piece.

 

[hairtech]

We are a third of the way placing the case. We are moving quite rapidly. Here are more pictures concerning the grafts.

Now sites have been created. This is a magnified view. It is what I see through my glasses.

Sites are now done...

Dr Harris started out with 3200 sites.

First we are going to work on the eyebrows.

Both eyebrows are complete... Tina placed each graft and Dr. Harris created each site... a sort of "stick and place" if you will. Tina reports that about 75 grafts per eye was used.

left eye (OS)

Right eye (OD)

We started to place heavily after the eyebrow was in completed. It is about 12:30PM. I am kind of worried at this point because it is getting late and we have to move rapidly but safely and with great quality that is expected.

Around 2:00PM we have reached about 25% of the way.

Take note in the length of the hairs. Some clinics leave long hairs on the grafts and some clinics do not. Dr. Rose comes to mind when doing this. One reason physicians prefer this technique is so that a technician can tell the angle of the hair when transplanting. I did not learn this way, but it is an effective trick. It is also good for telling us through these pictures the progession of the transplant.

A different angle...

We are now running low on sites. The patient was scheduled and paid for 3500 grafts. Our numbers at the end of cutting were 4014. What does this mean? That means we place 514 grafts at no extra charge.

I am happy for the patient and the patient is happy too. What is strange is that at one particular clinic I worked at, they would charge extra for these grafts. A large amount extra. I think that is scandalous. Watch out for clinics that have these tendencies. I think they word it in such a way that the physician "may" need to get more and if they do, then would you "like" to receive more... at a premium. Not here. And not at most un shady clinics.

More cool pix...

More cool pix...

Well we are finished... whew. I am satified with this result thus far, the time that we accomplished it in, the extra grafts that were provided, and the manner in which we all worked as a team. I am gathering more statistics around 11:00AM concerning this case... going to cross-reference some averages and provide them after Tina and I check over the grafts and give this fellow his first wash. Goodnight.

Ok the patient came back for his first wash and post operative graft care. During this time we "reset grafts" and check everything. You will see the difference it makes when we do this. I will let the pictures tell the story. Have a happy 4th of July.

http://www.hairlossadvances.com/forums/ ... g_0201.jpg

 

[s.a.f]

Very informative but slightly different to what I've experienced.
Some comments/questions :
Firstly would'nt you have prefered to shave down the patients head for surgery that makes it much easier to implant the grafts.
What length were the hairs in the grafts you implanted? Usually most clinics have them at just a few mm's long. Again to make it easier for them to place.
Most surgeons also opt for staples to close the strip.
What did you mean by 'reset' the grafts the next day.
And do you know what density cm2 the grafts were implanted at?

I also think that some of the pics of the strip removed make it look more gruesome than it really is, it looks like big chunks of flesh but what is the real depth of the strip tissue? roughly 4/5mm?

Thanks again for showing people whats involved.

 

[Aplunk1]

EXACTLY what s.a.f. said.

BTW, thank you for the walk-through. Very informative.

 

[hairtech]

Very informative but slightly different to what I've experienced.
Some comments/questions :
Firstly would'nt you have prefered to shave down the patients head for surgery that makes it much easier to implant the grafts.

Yes it would make it easier but the patients sometimes don't prefer for a shave down.

What length were the hairs in the grafts you implanted? Usually most clinics have them at just a few mm's long. Again to make it easier for them to place.

We leave them a little longer to get the correct angle of the curve when implanting as well as to give a patient a short preview as shedding will occur of course.

Most surgeons also opt for staples to close the strip.

Most surgeons DO NOT use staples. In fact I worked for 5 private doctors and every major hair mill and never saw staples. Most prefer sutures, deep layer, running, interupted, etc.

What did you mean by 'reset' the grafts the next day.

If any grafts have sort of moved out of place, while this is rare, we set them back down if need be.

And do you know what density cm2 the grafts were implanted at?

Probably 50-60cm2

I also think that some of the pics of the strip removed make it look more gruesome than it really is, it looks like big chunks of flesh but what is the real depth of the strip tissue? roughly 4/5mm?

This is as real as it gets buddy. 1.1cm by 25-33cm average.

Thanks again for showing people whats involved.

 

[s.a.f]

I also think that some of the pics of the strip removed make it look more gruesome than it really is, it looks like big chunks of flesh but what is the real depth of the strip tissue? roughly 4/5mm?

This is as real as it gets buddy. 1.1cm by 25-33cm average.

No I did'nt mean the width of the strip (1.1cm) I meant what is the depth of the inscision. I could see that there was some fatty tissue (yellow) beneath the follicles how deep does the scalpel actualy penetrate?

 

[hairtech]

Now that is completely dependent upon how much fat the patient has is his head. I have seen some doctors use a blade and try to cut as close as possible to the follicles but that adds a risk to the transections. Most doctors sort of pull or put tension and the strip comes out like butter. I know that looks sounds graphic and all but that is the reality.

 

[Optimist]

Have the patients in those pictures given permission to diplay them?

 

[hairtech]

Yes we ask for internet display of pictures consent in writing. I have been doing this since 2003.

 

[fnlostish]

great pics !!!!!!!!!!!!!!!!!!!!!

 

[hairtech]

thanks bud...