Total Crown Renewal, Follow-Up

Dr. Mark DiStefano commented on my Total Crown Renewal post, and I’m highlighting it here:

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 FOXâ„¢ 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.

[See Dr. DiStefano’s full comments here]

I thank Dr. DiStefano for his comments. The number of surgeons capable of performing the correction surgery for the deformity created by scalp reductions are very limited I have seen many doctors attempts at this corrective procedure and it was botched. For our readership, most surgeons are cocky about their abilities to see a single surgery and then with a book in hand, do it themselves. This corrective procedure is a rare example of the failed logic of this premise.

But basic to my problems with this surgery is the logic of the scalp reduction surgery itself. When the scalp is stretched (even with the well designed Frechet Extender discussed above), the hair that comes from the sides of the head is diluted so much that the density of the donor area is significantly depleted. This means that the available hair to treat the front and top of the head is reduced substantially (robbing Peter to pay Paul). Unless a person has an unusually high donor density and a reasonably loose scalp, there may not be enough hair to properly treat frontal balding. My second problem with Dr. DiStefano’s approach is that the procedure always produces a deformity when it is successful (the famous “slot deformity”) and the only way to manage this problem is with the Triple Flap Procedure that Dr. Frechet has personally defined. That would leave me asking, “Why would anyone want to have a Total Crown Renewal and get a deformity that still needs another surgery to correct?”. Certainly not me!