March 23 2009, 3:31 pm PT | Posted in: Other Surgical Procedures
Hi Dr. Rassman, thanks for your great contribution to hair loss sufferers, and the art of hair transplantation.
I have a question concerning a practice said to completely eliminate balding in the crown area called “total crown renewal” done by a doctor in the U.S., or it’s original counterpart, the triple flap with tissue gain/scalp extension done by it’s inventor in Europe. This practice is not promoted as a “repair” procedure, but is promoted to completely eliminate crown area baldness for “normal HT candidates”. I saw pictures on their site and the result “seems” great, but I am wondering if it causes a new “head shape” by stretching and pulling the sides of the scalp to such extent.
- Would the face and profile look different by such a procedure?
- Would the crown hair, while completely full, look peculiar to some extent? (Most pictures I saw were from the back, not face or side…)
- My last question: I already had 2 strip procedures for a total of 5000 grafts (one scar). Would this procedure be a risk to my existent scar? (stretching)
I am puzzled because I was about to go for a last strip for the crown, while maybe I could save all these grafts for other areas “if” needed in the future (I’m a 38 y.o. and good responder to propecia and minoxidil), and solve the crown problem with this total crown renewal procedure. What would you recommend?
Thanks very much in advance for your help!
The procedure you referenced is an old procedure called scalp reduction using a Frechet Extender (named for the doctor that created it). For a reasonable Norwood Class 6 patient it would take between 3-5 scalp reduction procedures, ending up with what is called a Triple Flap procedure. The scalp reduction procedure has been discredited as a deforming procedure thanks in part to me being so outspoken about it. I am a personal victim having had three of them in 1992. I was furious at the deformities that it created on my scalp and let the world know about it though publications in the Hair Transplant Forum (industry newsletter) and debates before medical physician audiences. Now, people doing this procedure could be open to malpractice actions if things went wrong and I have personally testified as an expert on such cases in the past.
Call it anything you want but as Shakespeare wrote, “A rose by any other name would smell as sweet” — in other words, however you change the name, it is what it is and in my opinion the scalp reductions should not be back on the market because they are deforming procedures.
Paid advertisements (not an endorsement):
It is truly regretful that Dr. Rassman was so scarred, both physically and emotionally by scalp reductions performed on him nearly two decades ago. I have known Dr. Rassman since I entered this field from Emergency Surgery almost 15 years ago. He has been a leader, entrepreneur, academician and teacher in the field of hair restoration.
When I entered the specialty of hair transplant surgery, Dr. Rassman had already established his practice and was experimenting with new hair transplant techniques.
With his help, the (then) modern use of the FUE (follicular unit extraction) procedure changed how we view the use of “plugs” or punches. Most hair transplant surgeons stopped using the punch 10 or more years ago . But with his invention of the FOX™ Megasession technique, he helped to lead the rest of us to today’s FUE method. When he started with this technique, many physicians were skeptical and discredited the “punch technique. But now, after continued development and refinement of technique, this has opened up an incredible area for donor hair and seemingly scarless (lack of linear scar in the donor area) surgery.
This, too, can be said for the Total Crown Renewal®. Although it may appear this procedure is based on the “old” scalp reduction, the Total Crown Renewal® utilizes different techniques to make dramatic final results.
With the old scalp reduction, the area of balding was pulled closed with from 1 or more scalp reductions. The problem with the “old” scalp reduction, was that it used mechanical stretch, (brute force), to stretch the hair bearing scalp together. This usually resulted in “stretch back, phenomena that resulted in production of excessive scar tissue in the area. Also when the number of scalp reductions was done to complete the process, there was a slot formed in the midline of the scalp and the hair was now going in the wrong direction.
Dr. Patrick Frechet recognized the problems associated with scalp reductions and (like Dr Rassman) developed new techniques to obviate these problems.
Dr. Patrick Frechet devised a procedure to do the following:
1. Stretch the scalp using biological stretch hence, the use of the extender, as opposed to mechanical stretch, which would thin the scalp, create a large scar and not allow for a complete removal of the bald tissue.
2. Invented the “extender”
3. Invented the Triple Flap Slot Correction Procedure
This procedure is not the same one that Dr. Rassman had almost 20years ago.
I would like to address the other questions that were asked:
There is absolutely no change in the face, its contour or looks, either head on or in profile.
The crown looks full and there is no “peculiar look to it, as long as you do not shave your head. (Please refer to patient selection below.)
As for doing the Total Crown Renewal® (aka extender placement followed by the triple flap) after having a routine HT– there is an increased risk of complications in performing the Total Crown Renewal®. . (Please refer to patient selection below.)
Patient selection for the Total Crown Renewal® (TCR):
Not everyone is a candidate for the TCR. Consideration needs to be scalp tightness, age, past medical history, smoking history as well as previous surgical hair/scalp procedures.
This procedure is not for everyone. It is for a select group of individuals that would otherwise not be able to get the look of complete coverage for their entire bald scalp.
This procedure is more complicated and requires an experienced surgeon with meticulous skills. The patient must understand that there is more risk involved for loss of the flaps, that would require additional surgery should it occur. However, the rewards are far greater than those of the conventional hair transplant. As for increased scarring, there are definitely more scars involved than in the normal HT, but these would easily be covered as long as one did not shave their head. Frankly, I have had NO patients interested in shaving their head following the Total Crown Renewal® procedure!
My patients who have had this procedure are very happy with the results to date. No doctor can give the same look of density throughout the entire scalp using standard HT if someone is going to end up a class V or VI. It is not possible today, using only scalp hair.
Dr. Rassman states that this procedure has been discredited by him as well as others. I would agree that the old scalp reduction is not a viable procedure today, but the scalp reduction using the Frechet Extender and the Frechet triple flap slot correction is considered not only acceptable, but cutting edge surgery. It is well established internationally and has been presented at ALL of the world renowned hair restoration meetings. These include the largest organization of hair restoration surgeons, the International Society of Hair Restoration Surgery, The European Hair restoration Surgery, The Orlando Live Surgery Workshop as well as numerous other national hair restoration meetings.
This procedure has been extensively written and taught in ALL of the academic text books on hair restoration, Hair Transplantation by Unger and Shapiro as well as Hair Transplant Surgery by Stough and Haber. Articles on this procedure have also been in the Hair Transplant Forum, the ESHRS periodical, Dermatological Surgery to mention a few. The hair transplant surgical community and professional associations agree that Dr. Frechet’s work is outstanding.
Dr. Frechet has performed this surgery in front of live audiences which included Dr. Rassman and the results were always the same …Impressive.
Again, this is not for every patient, it is for a select group who want the best result in terms of density, they do not want to shave their head, they want to show off the look of a full head of hair and realize that there will be more scarring than with a regular HT. They understand that and still they choose to go through it.
Just ask my patient who was a victim of the Rhode Island night club fire who was told there was nothing that could be done for him. Everyday he woke up to a huge scar on the top of his head. Only with the TCR was he able to get his hair back and finally was able to put the physical and emotional pain of the fire behind him. In addition, his full head of hair was restored in 12 weeks rather than 9-15 months needed for traditional hair transplant procedures.
Through ISHRS’s OPERATION RESTORE, the Total Crown Renewal® procedure has improved the lives of other patients whose hair and lives have been damaged due to tragic situations.
The Frechet and Total Crown Renewal® procedures are performed throughout the world and are clearly recognized and endorsed within all organizations of the hair transplantation community…………………..just as Dr. Rassman’s Fox Megasession™ was several years ago