Hair Restoration with Strip Harvest in a Male Patient with Severe Hair Loss

Case Description

History: This is a 60-year-old healthy Caucasian male with a long history of hair loss. He stated he has a strong family history of hair loss on both sides of the family and has lost his hair over the past twenty years. He believes that his hair loss has since slowed down and has not changed in a few years. The patient has never taken any medication for the prevention of hair loss. The patient deals with clients on a routine basis for his profession and desires a “more youthful appearance.”

Physical Examination: This patient exhibits a Norwood 6 pattern. There is only very scant miniaturized hair in the midscalp area. He has a healthy scalp and has excellent elasticity in the donor area. Also, his density is very high, measuring 120 follicular units (FU)/cm2 in the posterior donor and 94 FU/cm2 in the lateral donor areas.

The donor hair contains a high percentage of 2- and 3-haired grafts, straight, of average caliber, and dark brown in color.

Plan: The plan for this patient is to harvest as many grafts as possible. The goal is to cover the frontal and midscalp zones with high density and to cover the anterior part of the vertex zone with as many as grafts allow. Because of the patient’s severe hair loss and limited donor, we need to be conservative in the use of grafts. We will restore a natural framing of the face with a conservative hairline that is not too low or aggressive. Also we do not want to dedicate too many valuable grafts to the back of the scalp.dedicate too many valuable grafts to the back of the scalp.

Surgeon:

David Josephitis, DO, FISHRS

Location:

Minneapolis, Minnesota, USA

Website:

www.shapiromedical.com

Procedure: A linear strip harvest (FUT) was performed. There was excellent elasticity, and a strip of 25.5cm x 1.5cm was removed. Grafts contain 1,2,3, or 4 hairs. We obtained 752 singles, 2515 doubles, 856 triples, and 83 quadruples for a total of 4196 grafts. The grafts were stored in a chilled HypoThermosol solution with liposomal ATP prior to transplantation.

Around 500 single grafts were placed in the hairline zone in a natural and irregular pattern. In the center of the bald scalp we allocated all of the triple and quadruple grafts. For the rest of the scalp we used 2-hair grafts.

The patient was sent home with postoperative instructions and was advised on the use of liposomal ATP every half hour for the first 48 hours along with daily hair washings.

Results: The photos show the patient before and after 12 months. The patient has excellent coverage thanks to the large session that was able to be performed.

Discussion: This case shows one of the common types of patients that are routinely seen by the hair transplant surgeon. This one specifically shows the results that can be obtained in a patient with severe hair loss. All patients, especially those with a Norwood class 5 or higher, need to have appropriate…

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ABHRS/IBHRS Code of Ethics Policy Statement

WHEREAS, the American Board of Hair Restoration Surgery (ABHRS) is a surgical certifying board organized to examine physicians in the area of hair restoration surgery; and

WHEREAS, the ABHRS is a surgical certifying board organized to promote the safe practice of hair restoration surgery;

NOW, THEREFORE, the ABHRS has established the following policy: As a Diplomate of the American Board of Hair Restoration Surgery, I pledge myself to…

Use every opportunity to improve public understanding of the role of the Hair Restoration Surgeon.

Cooperate in every reasonable and proper way with other physicians and work with them in activities contributing to the advancement of quality patient care.

Maintain the confidentiality of privileged information entrusted or known to me by virtue of my role as a hair restoration surgeon within the constraints of the law.

Accept no personal compensation from any party that would influence or require special consideration in the provision of care to any patient.

Provide patient care impartially, provide no special privilege to any individual patient based on the patient’s race, color, creed, sex, national origin or handicap.

Use only legal and ethical means in the provision of care to my patients and strive to expose those physicians deficient in character or competence, or who engage in fraud or deception.

Maintain the highest standard of personal conduct.

Abide by the highest ethical standards in activities designed to attract patients to my practice including recognition and enforcement of the American Board of Hair Restoration Surgery advertising policy which requires Diplomate status should not be embellished, to utilize truthful advertising, and to designate my ABHRS membership as ABHRS Diplomate as opposed to “Board Certified” by the ABHRS.

Maintain loyalty to the goals and objectives of the American Board of Hair Restoration Surgery as stated in the American Board of Hair Restoration Surgery By-Laws.

Promote and encourage the highest level of medical ethics in providing competent medical service with compassion and respect for human dignity.

Recognize and discharge my responsibility and that of the Medical and/or Osteopathic profession to uphold the laws and regulations relating to the practice of hair restoration surgery.

Strive for excellence in all aspects of medical practice.

Continue to study, apply and advance scientific knowledge, make relevant information available to patients, colleagues and the public, obtain consultation, and use the talents of other health professionals when the best interests of a patient so indicates.

The ABHRS Guidelines For Truth in Representation And Advertising have been established to help members avoid what can be universally considered as misleading or unacceptable messages.

We have encouraged ABHRS/IBHRS members to review their individual as well as group practice websites and marketing materials to assure that misleading or ambiguous language as defined in the following infractions are not included. Members of the public who are seeking professional services from a hair restoration surgeon should consider these terms as “red flags”. If they are used in a doctor’s marketing material or website, the consumer should beware.

The following issues/concepts are considered misleading or inappropriate:

False Statements and Copyright / Trademark Infringement

Including inaccurate credentials. E.g., claiming ABHRS (American Board of Hair Restoration Surgery) Diplomate status or IBHRS (International Board of Hair Restoration Surgery) status when the individual has not earned this designation, or claiming inaccurate expertise in hair restoration surgery in general.

The use of other physicians’ before & after photos as their own.

Violating the copyright of others with the illegal use of photos or text.

Ambiguous use of the ABHRS Logo which implies non-ABHRS/IBHRS diplomates are also diplomates.

Inappropriate Use of Staff

Specifically, the surgical act of creating extraction incisions for removal of live tissue, whether during follicular unit transplantation (FUT), or follicular unit extraction (FUE) procedures, is a non-delegable act, and must be performed by the physician of record. In addition, the creation of incisions for placement of grafts is also non-delegable, and must be performed by the physician of record. Evidence of unlicensed, non-physicians performing surgical procedures clearly outside of legally enforceable standards of care is in clear violation of ABHRS ethical guidelines.

Inappropriate, Misleading, Inaccurate Terminology

The use of the following, or similar terminology that misrepresents the physical realities of high quality hair transplant surgery:

“Scarless surgery”

“No incision”

“No touch”

“No cutting”

“Cloning”

“Hair multiplication”

“Non-invasive”

“Guaranteed results”

“Unlimited grafts”

“No risk”

“Pain free”

“Eliminates the need for additional procedures”

Case Description

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ABHRS/IBHRS Code of Ethics Policy Statement

False Statements and Copyright / Trademark Infringement

Inappropriate Use of Staff

Inappropriate, Misleading, Inaccurate Terminology

ABHRS Guidelines for Display of ABHRS Logo