Dr. Hasson/5059 Grafts/One Session/ 6 Months/Strip

[Jotronic]

This patient living in Japan is six months post-op from his procedure with Dr. Hasson. 5059 grafts were moved in one session with complete coverage accomplished for his NW5 pattern of loss. Being only six months out he has plenty of improvement to expect in the form of thickening and softening.

[Skeptic1st]

Looks totally Awesome to Me!

Wow, Thats what I call a terrific job!Its hard to beleive that this guy filled in so well after only 6 months post op. The only thing that dissapoints me is that I had only one third of those grafts moved onto my head in my first session.Does anyone know if there are only certain physicians that will perform the mega-sessions like on this gentleman with 5000+ in one shot?I can see what the benefits are but what are that down-sides or complications with getting everything done all at once?Why wouldint more patients opt for the meg-sessions instead of three or more individual meetings?
Dale

[Jotronic]

This is a very good question. Here is the breakdown. Firstly, there are very few clinics worldwide that can perform 5000 graft sessions and even fewer can do this on a relatively common basis. Our clinic for instance has endeavored to reach the goal of larger sessions over the past ten years.

It all started when we were doing 2500 and 3000 graft sessions on a regular basis. Other doctors were saying that it cannot be done on a regular basis. They said the scarring would be unacceptable. They said that the final growth would be less than optimal.

Then we were doing 3500 and 4000 graft sessions on a regular basis. Same arguments from other doctors but then something interesting happened. These same doctors that said 2500 and 3000 graft sessions were not possible on a regular basis started to do THE SAME THING. Now we do up to 4500 grafts on a regular basis and more often than before we can do 5000 graft sessions. To a much more rare extent we have done well over 6000 in one session and higher. The pattern has been that while we have consistently been able to safely extract more grafts on average than a typical hair transplant clinic the same doctors that in the beginning have said that it is not safe or even possible have slowly started getting the same numbers. This is a fact so the obvious question is why do these doctors now think that larger numbers are possible and even safe?

Here are the benefits of larger sessions:

1.) Less overall donor scarring as each consecutive procedure has the potential to create a wider scar.

2.) Less overall recipient scarring. Depending on how the recipient sites are made each pass will create varying degrees of scarring that any subsequent procedures will have to deal with.

3.) Less time to final results. Had the above patient broken this up into two procedures he would not be able to show photos like these till about Spring 2010 at the earliest. He's now back into his life and is able to enjoy his new appearance.

4.) Less overall downtime or time taken off from work. Why take up your two week holiday for recovery this year and AND take next year's two week holiday off for MORE recovery?

4.) Less overall cost. Most top clinics allow for a tiered fee structure meaning once you pass a certain threshold in the number of grafts you receive the additional grafts over this threshold are less expensive. Had this patient had perhaps 2500 grafts over two sessions the fee have been about 5000.00 more than the one session he had.

The cons to larger sessions:

In our opinion, none. In the opinions of our detractors, wider donor scars and less growth are the downsides however none have been able to move beyond simple opinions with factual data that is reliable.

One point to keep in mind. When we talk about doing larger sessions it does not always mean 5000 grafts or 4500 grafts, etc. It means we prefer to perform larger sessions for a given area than most other clinics. Specifically, some clinics will tell a NW3 that 1500 grafts will be sufficient for their loss and brush off the notion of needing a second surgery in the same area for density. Our position is that one should get the appropriate number of grafts for a desired area in one session (where possible) so that the patient shouldn't have to revisit this area surgically again. This is where the term "one pass result" or "one and done" comes into play. One area, one pass, done.

[TeeJay73]

Hi Joe,

TeeJay here. We spoke once on Spencer's show.

I read all of your posts - you're an incredible, realiable, honest source of valuable information. Like I had mentioned in another post, when we choose to combat our hair loss, we are in essence putting up our fists and fighting nature's intention for us, head on. And when we fight nature, we better be armed with good information and the right tools. That's why this forum, and guys like you, are so great. And I am unbelievably, endlessly impressed with the hair transplants of Hasson & Wong, including yours. If I lived in the area, there is NO DOUBT I'd see you guys!

I wanted to ask you a question about megasessions. When megasessions reach 4500 grafts, or more, do you know for certain and/or believe the yield rate is 90% or more? As a pure layman (I am certainly not a medical guy), my thoughts are these: more grafts mean more recipient incisions have to be made. When recipient incisions are made, we obviously bleed. And I believe we bleed because by "poking" our scalps to create recipient incisions, the surgeons are creating breakages in the local blood supply circuit, perhaps even breaking/rupturing tiny local blood vessels. So, when more recipient incisions, more "damage" is done to the local blood supply network that feeds our scalp. And with more "damage" done, is it possible/conceivable that certain grafts may not be "fed" because the local blood supply network in its area is too compromised? And if the graft is not "fed", does that mean it doesn't survive and grow?

I ask all of these questions because I am 1 year post-op (well, 1 year in about 2 weeks) from a 1600 graft session, and I believe I had an excellent yield rate. While I have no idea, I would suspect part of the reason for this, in addition to the incredible surgical skill of my IAHRS doctor, is that with only 1600 grafts, the grafts were more sparsely dispersed on my scalp with substantially less overall compromise to local blood supply than a megasession would create. And with a more intact blood supply network, the grafts were well "fed", and thus grew.

Thanks a ton for doing what you do Joe!

TeeJay

[Jotronic]

Teejay,

Of course I remember you. Thanks for chiming in with your excellent question.

I firmly believe that our yield with 4500 plus is just as good as anyone's with 1000 grafts. The key to this is in the incisions themselves.

We pioneered the lateral slit technique. This is the creation of recipients sites in a coronal plane to the direction of hair growth with custom cut blades matched to the width and depth of the FU being placed. Because these incisions are the same size as the graft the interruption to blood flow is less than with even comparably sized needles. Even compared to the relatively same sized needle a blade will create less damage to the recipient scalp than a needle in both the width of the incision as well as the depth (due to depth control allowed by the blade holder).

For more details on this you can see a video I made a couple of years ago about this very subject.

http://hairtransplanttv.com/mediagallery/display.php?videoURL=17.flv&videoTitle=Custom+Cut+Flat+Blades+vs+Needle+Incisions%3Cbr%3Efor+Recipient+Site+Creation

[TeeJay73]

Hey Joe!

Thanks for taking the time to respond. I learned something entirely new with your post an dyour video (well done video by the way, that poor melonhead :-). But the concept of recipient incision direction relative to the hair growth direction was foreign to me, until now. And it makes perfect sense. It appears that FUs occur naturally in a side-to-side fashion ("in a row") when looking at the scalp from the front (anterior). This actually helps hair loss dudes like us, because the resultant hair that grows from this row-like structure has a thicker, fuller cosmetic result. I checked out my doctor's website and he also uses coronal recipient incisions. I would imagine most, if not all, IAHRS doctors employ this method.

What also makes sense is why circular needles are probably not the best route for recipient incisions. They are round and therefore unassociated with any direction, and, as your video shows, can create more trauma to the local blood supply network, which is vital in post-transplant healing.

And finally, I sure hope there aren't any doctors that make sagittal incisions! :-) That'd be bad, eh?

Thanks for the education and answers my friend!

Hope all is well in your world,

TeeJay

[bullitnut]

great job, superb coverage and very natural looking. well done h and w