Hair restoration in a female patient post craniotomy and radiation treatment for Astrocytoma. (malignant brain tumor)

Case Description

Patient History: This 40-year-old white female underwent a surgical procedure for the removal of a malignant brain tumor from the right frontal lobe of her brain and also underwent radiation therapy to the area, which led to the complete loss of her hair in that region. She was left with a cosmetically poor appearance to the entire frontal region of her scalp. She did, however, have excellent donor hair and was a good candidate for hair transplant surgery to the affected region. This case shows the capacity under the right circumstances to have a successful transplant performed on a post-radiation region of the scalp, which is sometimes considered to be situation that many surgeons would not undertake.

The patient after removal of a malignant brain tumor from the right frontal lobe of her brain and radiation therapy to the area.

Physical Exam: The patient is a healthy white female who aside from her history of a malignant brain tumor is otherwise healthy in all respects. She was given clearance by her oncologist as being cancer free and thereby safe to proceed with a procedure.

Her hair loss extended throughout the entire right frontal/parietal region and to some extent along the left frontal region as well. Her hair texture and quality in the donor region was dark brown, very thick, and above average density at > 200 hairs/cm².

Surgeon:

Daniel McGrath, DO

Location:

Austin, Texas, USA

Website:

mcgrathmedical.com

The Plan: The patient was counseled ahead of time that she would need 2 surgeries to achieve optimal results. She understood the potential that some of the hair might not take due to her scalp having undergone radiation therapy. She did, however, have very good blood supply to the area in question, and the entire area that was to receive hair had excellent capillary refill (a simple way to test for adequate blood flow to skin tissue) The proposed procedure was to move the maximum number of grafts in the first procedure and then follow up with a second procedure at about ten months after the first procedure. The goal was to produce a natural hairline with enough density behind the hairline to allow the patient to have better hairstyling options and not to have to rely on wigs or hats to cover her scarred scalp. The challenge in this case was to transplant the maximum number of grafts possible without compromising the existing scalp and avoiding any possibility of scalp damage or necrosis.

A natural uniform hairline was imperative and achieving maximum density to the entire region was also a primary goal.

Photo immediately post-op with grafts in place.

The Procedure: The patient underwent two separate transplant procedures and had a total of 4,752 grafts transplanted equaling approximately 9,000 to 10,000 hairs. We used 800 single-haired grafts to create a soft hairline and the remaining grafts varied in size from 2 to 4 hairs, distributed behind the hairline to create density. Both procedures were performed using the strip harvest method to maximize the number of hairs obtainable.

The patient had little to no scarring in the donor region and at no time throughout the process did she experience any pain or complications.

Before and After 2 FUT Hair Transplant Sessions

Before and After @ FUT Hair Transplant Sessions

Discussion: This case demonstrated the ability to transplant into an area of the scalp previously treated with radiation but, more importantly, the ability to create adequate density combined with a cosmetically appealing hairline. The process has left our patient with the ability to style her hair and to go out in public with the confidence she desires. This case in my opinion was a complete success and despite the challenges of a large surface area and a scalp that was compromised from radiation therapy the outcome exceeded our expectations.

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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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Location:

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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