H&W - Another First in The Industry - 9168 Grafts In One Session

[Jotronic]

Dr. Hasson and Dr. Wong are known world wide for being true innovators in the field of hair restoration. Dense packing, the Lateral Slit Technique, donor closures, etc. They are also known for being able to safely harvest more hair in one procedure than any other clinic.

We were the first clinic to document and share on the forums 4000 grafts in one procedure, 5000 then 6000 grafts. We then shared 7000 grafts and 8000 grafts in a single procedure. No other clinic has ever achieved this. I'm excited to share that Dr. Hasson has now broken the seemingly impossible barrier of 9000 grafts in a single procedure. The exact number is actually 9168 grafts, again, in a single procedure.

The patient is from Italy and as any patient that gets this many grafts in a single session his donor density and donor laxity were above average. Hopefully he'll give us permission to share his photos. Regardless, I wanted to share this achievement with the group.

[nh 610 a]

Holy crap that's amazing can I ask for some details of the op Joe, eg donor density nw scale hair type . With that sort of a yield the guys going to get amazing coverage , leave it to h & w to lead the way . Congrats to all concerned

[Jotronic]

Ok, here is the update. The patient finally left the office at about 12:30 this morning. Here are some of the photos I am allowed to share at this time. The patient is about a NW5 although the frontal scalp has a bit more hair than a typical NW5.









This photo shows the density in the slivers that were prepared before final dissection. His hair is coarse as well so the final numbers combined with his native hair should provide for a pretty spectacular result.

[Spex]

A superb achievement to all involved!

Well done
Spex

[Follicle Death Row]

Mind boggling! Just incredible. So was the strip about 33cm x 2.5cm? I'm going to be a norwood 6 someday. This definitely gives me hope. Can we see more pics of the Italian patient who got over 8000 too? His result looked amazing. The grey hair works so well. Off to do my laxity exercises now.

[John P. Cole, MD]

Interesting achievement. I think that other clinics posted many of the firsts, however. As I recall, Dr. Rassman was the first to exceed 5000 grafts around 2000 or 2001. I'm not positive about the date. I was the first to exceed 7000 in 2004, 9000 in 2005, and 13,000 in 2005. The problem with super megasessions in my experience is that the growth is sometimes very poor. For that reason, I stopped doing them.

My personal opinion and personal experience is that the growth becomes variable above 7000 grafts in a single session. One theory I have is that the recipient area can become overwhelmed with free radicals and poison the grafts. Not only can the growth of such very large sessions be very poor, future growth can be very limited following subsequent transplant procedures. It is almost as if the body mounts an immune response to the transplanted grafts in future surgeries. I found that even small follow up surgeries produced low yields.

It is not to suggest that these large sessions cannot be done or that they cannot produce optimal results. I've seen good 7500 to over 9000 graft results. The problem is that the growth seems to be variable above 7000 grafts. For this reason, I do not recommend that patients consider procedures above 7000 grafts. I've said it before more than once. Just because I can do something does not mean that I should do something. That is just my cautionary opinion, which is not meant to take away from this remarkable feat.

[Jotronic]

Dr. Cole,

If you take a moment to reread my post you will see that I was very specific with my statement. I said we were the first to "...document and share on the forums...". There is nothing ambiguous or left to one's imagination with that statement. I'm well aware of Dr. Rassman's valued contributions to the field over the past 20 years. Since his breakthrough so long ago our clinic has lead the field in getting more grafts in a single session than any other clinic. We routinely get over 4000 grafts for patients, quite literally, on a daily basis. 5000 grafts occurs quite often as well and we have far more 6000 graft cases than anyone. I am not aware of anyone else breaking 7000 grafts and I'm positive that no one else has broken 8000 or 9000 grafts.

I believe you have misunderstood the significance of this accomplishment by kindly sharing your own milestones in this thread. Your 7000 and 9000 graft sessions are invalid with regards to the context of this thread as this 9168 graft procedure was pure head hair and not BHT or a BHT/head hair hybrid. There is a big difference with this as with body hair the total number of grafts that can be moved is only limited by the amount of hair that one has on their body. It is a far more vast and rich potential donor supply than scalp hair and is not encumbered by the pesky detail known as "donor laxity" The only thing that really limits the use of body hair is money and of course reduced yield. In addition, to qualify your procedures as being in a "single session" they would have had to have been performed in a single day. Any FUE type procedure netting more than a couple thousand grafts would take more than a day thereby further disqualifying said procedures being in the same context as this procedure.

If we were talking about large sessions in general, that were not limited to scalp hair alone, then we'd have to include the cases that come quite close to 30,000 grafts that have been (unfortunately) performed in the past.

I guess to be fair I could have been more clear in my initial post and said that this was a scalp hair procedure but most people know that this is what we do.

Anyway, Happy Easter!

[Jotronic]

Here is the 11 month update on this case. Again, to avoid any confusion, this is all head hair taken with strip in one day.

[Dan26]

This guys skin went from yellow to white!

[John P. Cole, MD]

My question is why did the scalp color turn brownish from yellowish. When i look at the immediate post surgery photos, the density of grafts is not all that amazing in the crown. I know from evaluating the cross sectional trichometry (CST) of patients that thinning becomes apparent when the CST in the crown drops to below 50% of what is in the donor area. I also know that in the frontal area patients with coarse hair can appear full with when the CST drops to over 80% of the CST in the donor area when the hair is coarse. When the hair is fine, more modest disparities in the CST will produce the illusion of thinning or hair loss. When I look at the post surgery density, i don't see something that suggests the density of grafts is greater than 50% of the original density. Then when I magnify, i see the individual grafts, but they are less visible because the difference in skin tone and hair color are not as remarkable. Then i look at the background. I see yellow in the post surgery shot and blue in the pre-surgery shot. Then I look at the photos and I see a full head of hair. At that point I'm thinking, why is this guy back in after his 9000 graft procedure. I still stick by the warning that 9000 grafts is a dangerous number to shoot for in a single procedure because based on my experience this level is hit or miss in terms of growth. These are just questions I have, but the result looks good. Just for kicks, I used two different filters to look at the pre-op photos. One is the actual before and the other is with a darker filter. Iti's amazing what a filter can do to a result.

This is the darker color I see in the after skin in the recipient area now. Just questioning. However, I know that it is literally impossible to get a full appearance in any crown in a single session unless the preexisting hair was fairly full and there was no hair loss such as shock loss between the first procedure and a year later. One cannot get this sort of illusion of fullness in a single session in the crown on one pass in my experience regardless of how densely you pack the grafts. Then again, when high densities grow, you can get better results. Still, with high, high densities and larger quantities of grafts, the potential for full regrowth is less than optimal.