On Your Head Be It!

Balding man

I asked an old friend, a world renown Hair Transplant surgeon his opinion on mega session procedures being offered on the net?

One clinic in particular were offering upwards of 10,000 grafts or more in a split 2 day session?

10,000 holes punched into anyone's scalp in an extended session seemed extreme to me, so I emailed him for his views.

He response alarmed me. It brought 'flashbacks' of the bad old days. When Elton John and Russ Abbot were the 'unacceptable faces' of hair transplant surgery.   

My friend cited a report in the 'Journal of Plastic & Aesthetic Surgery'. The article sent to him for his comments concerned a case of Necrosis from hair transplants.

He told me that this very topic was high on the agenda to be discussed by the members of 'Forum'. The monthly journal issued to their thousands of members by I.S.H.R.S  (The International Society of Hair Restoration Surgery).

He was concerned that the problems induced by high volume transplants and poorly trained assistants could cause the industry damage and stated the reasons why.

I asked him if I could publish his words and he agreed, albeit anonymously. 

His opening comments refer to a case history of Necrosis he was viewing after being asked to comment on it.

The case history first published in  2009 and republished by the Journal of Plastic & Aesthetic Cosmetic Surgery in 2010. 

As the procedure was performed by a Plastic Surgery Clinic and reported in that industries journal, the problem has taken some considerable time to surface.  Only recently becoming apparent to the hierarchy of hair transplant surgeons.

I cannot show the photos my colleague reviewed nor identify the clinic concerned for legal reasons. Let alone risk them  being linked to my site. However you can Google 'Necrosis after hair transplant surgery' to see other examples,





''The doctors concerned seem a bit mystified about why they got the necrosis?

Our I.S.H.R.S. experts say that although the donor density was acceptable, 970 FUs from a donor area of 120 sq. cm, the donor holes were probably cut too deep and damaged the underlying arteries. The operating doctors do not really understand what has happened. 

It is only the collection of guys in our Internet group - all with over 20 years experience and some like me with 35-40 years who can make an educated guess at what really happened. 

It is clearly a case of poor harvesting technique and it is now happening more often as less experienced surgeons try to copy the "masters" like Cole and Harris and do 4000 grafts in a sitting. They have a gentle "touch" that allows them to get away with such a risky procedure.

Many others will not be so lucky and we will have a repeat of the "Cowboy Clinics" fiasco of the 1980's . It did not affect Australia or the USA but hit Hair Transplants in the UK for a decade or more. 

It is coming fast, courtesy of the new Robotic devices which promise to allow Plastic Surgeons to do Hair Transplants with the aid of an expensive computer controlled machine and lowly paid assistants but with minimal personal training or experience required by the surgeon.

It is a recipe for disaster and we all know it but don't know what we can do about it. The Plastic Surgeons have the legal qualifications and can do whatever they like.

Several of our guys report seeing similar cases already in the USA and many more will come over the next 12 months. None of this has been published and I am surprised that the clinic reported their own case. Such a degree of honesty would be unknown in the litigation-prone West these days.

Anything more than 3000 grafts involves a helluva lot of holes in the scalp and sooner or later you are going to have problems. New and inexperienced scalp surgeons seem to think that they can go on pushing up the numbers forever. The fact is that you cannot.!!

Every scalp has its own limit where the damage to the blood supply by all the holes in the side, back top and front will result in a failure of blood supply and death of patches of scalp tissue at the side , top ( or both). I have already heard and seen reports of such cases and there must be many others not reported because there would be serious litigation involved.

Now it is not just a matter of numbers of holes but the depth of holes or size of recipient slips and holes that are important as well. Really deep donor holes can damage the arteries supplying blood to the scalp. The age and thickness of the scalp and amount of sun damage are important as well as is previous scalp surgery or burns.

Once you get to numbers greater than 2000 you have to consider a lot of safety factors.. We saw it all in past decades with big plugs with laser holes and scalp flaps, even mini grafts in large numbers. Nothing has changed except the type of procedure. Once you pushed any of these procedure past a certain point you are likely to have catastrophic problems and litigation.

If people want to push their luck and undergo these outrageous numbers of grafts in one session then warn them and let them go. "On your head be it' sounds an appropriate comment.

I would split 5000 grafts into two sessions several months apart. I am sure that there will be some discussion about this in FORUM soon as reports of problems are coming in to our "Masters" discussion group but no-one has enough experience or the full facts to write about it yet. The other thing is that once it is published in I.S.H.R.S. ''FORUM' and the newspapers get onto it, it will cause bad publicity for all''. 

March 2104


What concerns me is by the time the hair transplant 'establishment' has acknowledged and published their findings and people become aware of the practice,such  cases will continue to appear?

Whether it be at the hands of a 'part-time' cosmetic surgeons performing the occasional hair transplants. Or be it a plastic surgery clinics performing hair transplants as an ad on to range of procedures. Hair Transplant is a highly specialised procedure.

You never hear of anyone asking a hair surgeon for a nose job? Why would they use a plastic surgery clinic for a hair transplant procedure?

Either way, the heartache and trauma it can cause people needs to be acted on.  My colleague suggested I warn people. Hopefully I'm doing just that.

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