December 2005 - Posts
In the past, there has been a general philosophy to do smaller number of grafts per session. I have found, as in one of my repair cases today from London, UK, that after 800 or so grafts, the patient has almost no outcome that he is happy with. The donor scar is usually not just superficial, but goes down much deeper. The fibrosis extends both vertically and horizontally. The need to repair him is obvious in the front. However, the tissue now is tougher to work with both in the recipient area and the donor area.
Therefore, its better to do larger sessions for many reasons.
The three obvious reasons are:
- Better cosmetic results; more pleasing to the patient.
- Lesser scarring, and therefore, less damage to his donor area. In this way, he or she has greater donor reserve.
- Lesser number of procedures needed.
In today's case, the patient from London, UK who had 800 grafts before, we are doing over 4000 grafts.
My other case today from Croatia is a large first time sessions similar in number of grafts.
This new philosopnhy will eventually overtake the smaller session surgeries. It is in the interest of the patient to obtain the best results with the least damage.
--Dr. Antonio Alvi Armani
There is often an argument presented that high density may not be possible with blood flow to the grafts.
We find after routinely doing surgeries at 70-100 grafts /cm², there is no issue with blood flow. The scalp is a very vascular (high bloodflow) area. Normal hair is supported at a very high density with the same blood flow. So why should grafts have an issue with blood flow?
However, the procedure normally done at many clinics of doing lower density in an area (30-40 grafts/cm²) is a problem when the patient is not happy with the growth, comes back and redoes the area a year later.
When an area gets operated on once, the tissue forms a tough texture with toughness of the skin and this does cause a blood flow problem on the second surgery.
Therefore, it is better to do a high density transplant the first time in a 'virginal' scalp area, than come back repeatedly to the same area. Blood flow is the best the first time around, not when the tissue is manipulated on two or three times. This is why we feel it is best to offer our patients the maximum or high densities the first time around.
Our average surgeries are in the 70-100 grafts/cm², with a few exceptional surgeries, in special cases of Hollywood stars or others where we do go higher up to 150 grafts/cm².
--Dr. Antonio Alvi Armani
We have recently performed two surgeries each with 5000 grafts in one day.
- 5187
- 5150
These larger sessions are possible with our new Alvi Armani closure technique, LVS, Least Visible Scar through undermining the sides of the closure sites. The lines are nearly invisible and a much larger number of grafts can be harvested this way.
--Dr. Antonio Alvi Armani