Θα σχολιάσω το πρώτο περιστατικό.
Το dense packing αφορά όχι κλείσιμο κρατάφων και χτίσιμο χερλάιν μόνο,αλλά και δέσιμο β ζώνης με forlock που εδώ δεν έγινε, ήθελε σίγουρα και άλλα μοσχεύματα ή άλλη κατανομή που για μένα θα ήταν πιο ορθολογική.
Εκεί θέλουμε να δούμε συνολικό δέσιμο μέσα σε ζώνες με λέπτυνση τρίχας και όχι υγιή μαλλιά .
Τα υπόλοιπα έχουν επιτευχθεί όπως φύτρωση και πυκνότητα 45g.
Υγ:Cvial απαντώ γιατί έχω το δικαίωμα σύμφωνα με τους κανόνες(δέχτηκα πρόσκληση-απάντηση).
Ας δούμε τι λένε οι ιατροι για όλα αυτα και η βιβλιογραφια.
Dense packing: Ιατρικός όρος που επινοήθηκε το 1994 από τον Rassaman. (δειτε pdf)
Έτοτε χρησιμοποιείται καχραστικά για λόγους μαρκετινγκ, οσυσιατικά σημαινωντας αυτο που θέλει ο καθενας να καταλαβει.
Επιστημονική κριτική για το dense packing
Inadequate density will not provide cosmetic coverage, while excessive density (dense-packing) carries the risk of excessive vascular damage. This may lead to reduced graft survival11,12 and a thinner final appearance compared to transplanting at lower densities. Tykocinsky13 reported on his concept of “safe linear damage” (SLD), estimating it at 35mm/cm2. To calculate the Safe Incision Density (SID) for each instrument, the figure 35 (SLD/cm2) is divided by the blade width or the needle caliber. A 0.7mm blade has a SID of 50 sites/cm2 while an 18G needle (1,75mm diameter), has an SLD of just 17 sites/cm2
Mayer and Keene’s Study Comparing FU Growth with Different Planting Densities, presented at the 2003 annual meeting of the International Society of Hair Restoration Surgeons
Mayer, Keene, Perez 2004 Study Hair Transplant Orlando Workshop, presented at the 13th annual meeting of the International Society of Hair Restoration Surgery, Sydney Australia: August 2005
Tykocinski A. Safe linear damage. Lateral Slits Workshop. Annual Meeting of the International Society of Hair Restoration Surgery, Sydney, Australia: August 2005
Some experts consider megasessions and one-pass technique as too risky17 and endorse a more conservative approach. Unger considers that increasing the density in subsequent sessions is preferable to trying to achieve a high density in just one session (dense packing) that could result in delayed or severely reduced growth.18,19
Unger WP. Hair transplantation: current concepts and techniques. J Investig Dermatol Symp Proc. 2005 Dec;10(3):225-9
Unger WP. On: follicular transplantation by Bernstein &Rassman. Dermatol Surg. 1997 Sep;23(9):801-5
Unger W Dense FU packing. Hair Transplant Forum Int 2003;13:13–13
Nevertheless, dense packing has received plenty of criticism concerning decreased survival and depleting the donor area “bank”.44
Nakatsui TC. High-density follicular unit transplant. In: Unger W, Shapiro R, Unger M. Hair Transplantation. 5th ed. InformaHealth, London and New York, Jan 2011; p 358-361
Recipient area reasons
Creating >3000-4000 recipient incisions is likely to exceed the (unknown) safe “limit” of cumulative microvascular injury of the recipient area.26 Of course, this will rarely lead to actual scalp necrosis, due to the extraordinary anastomotic network of the scalp. Nevertheless, it can significantly reduce the survival rate of grafts and cause permanent loss of native hair. To minimize injury, most megasession advocates use only micro-blades for site creation and try to keep sites as small as possible. Small size micro-blades and dense-packing in megasessions require grafts to be significantly trimmed, which might decrease the survival rate even further, as Seager27 and Beehner28 have demonstrated since 1997. Moreover, longer sessions increase “out
-of-body” time, even with the most experienced surgical teams. Limmer (1996) demonstrated that even under optimal conditions, the graft survival rate is reduced by 1% every hour after the 6 hour-barrier.29 Grafts accumulate sub-lethal stresses from each stage of the procedure, that, in their totality, can lead to loss of survival. Thus, keeping every step to a reasonable duration is necessary.30 For this reason, some experts claim that the very long duration of megasessions is the principal disadvantage of this technique.31 Another factor is graft placement, particularly when unpredictable popping of grafts occurs. In these unfortunate cases, a session scheduled to last 9-10 hours according to the number of grafts and staff size/skill, can last significantly longer and jeopardize survival and result. Finally, due to the excessive number of grafts, forehead edema can be more pronounced and strategies to avoid that must be applied.32
Perez-Meza D. Wound healing and revascularization of the hair transplant graft: role of the growth factors. In: Unger W, Shapiro R. Hair Transplantation. 4th edn. New York: Marcel Dekker; 2004; p 287-94
Seager DJ. Micrograft size and subsequent survival. Dermatol Surg. 1997 Sep;23(9):757-61; disc. 762
Beehner ML. A comparison of hair growth between follicular-unit grafts trimmed “skinny” vs. chubby. Dermatol Surg. 1999 Apr;25(4):339-40
Limmer R. Micrograft survival. Stough D, Haber R, eds. Hair Replacement. St. Louis: Mosby; 1996. p 147–9
Parsley WM, Perez-Meza D. Review of factors affecting the growth and survival of follicular grafts. J Cutan Aesthet Surg. 2010 May;3(2):69-75
Hwang SJ. The effects of dehydration, preservation temperature and time on the hair grafts. Ann Dermatol. 2002 Aug;14(3):149-52
Steven C. Chang. Prevention of forehead edema and periorbital ecchymosis after hair transplantation. Hair Transplant Forum Int. 2005;15(3):88
Πολυ δυνατό hairline, κάτι που καποιοι ζητάνε επιμονα ενώ οι experts του εξωτερικού το θεωρούν λάθος και επιπλοκή
Too dense hairline border
There should be a “soft”, feathered appearance to at least the outer 3mm to 5mm of the hairline’s depth. This mistake very often coexists with the “overly straight” error. The hairline should not be a wall of hair, but an undetectably smooth construction that provides a smooth transition from the hairless forehead towards the hairy scalp.
Shapiro R. Principles of creating a natural hairline. In: Unger W, Shapiro R, Unger M. Hair Transplantation. 5th ed. Informa Health, London and New York, Jan 2011; p 374
Lam S. Hair Transplant Operative 360. In: Hair Transplant 360 for Physicians. Jaypee Brothers Medical Publishers (P) Ltd, 2011; pp. 47-126.
