Hair Transplants - Megasession or Conservative Approach? - BaldTruthTalk.com
+ Reply to Thread
Results 1 to 6 of 6
  1. #1
    Senior Member
    Join Date
    Oct 2008
    Posts
    225

    Default Hair Transplants - Megasession or Conservative Approach?

    There seems to be two (opposing) schools of thought related to megasession hair transplants.

    As I understand it, megasession hair transplants are those in which 2,000 or more grafts are transplanted in a single session. I have heard that even 5,000 grafts have been transplanted in a single session. (Given that an average number of hairs in a graft is 2.3 hairs, one can quickly calculate the number of hairs transplanted in a megasession.)

    The conservative approach to hair transplants opposes the megasession approach in that 2,000 or fewer grafts are transplanted in a single session.

    I have heard numerous pros and cons associated with each type of session.

    With megasessions, pros that I have heard include: (1) fewer surgeries are required to reach the patient's goals, (2) the grafts tend to grow better, (3) increased hair density, and (4) results are very comsmetically significant. Cons I have heard include: (1) the donor area is decimated quickly, and, if results are not in line with the patient's expectations, the donor area is gone (or nearly gone), and there's nothing left to work with and (2) graft survival rate may be decreased.

    With the conservative approach, pros that I have heard include: (1) sometimes patient's are very content with a single, less-than-2,000 graft session, potentially saving him/her money and scarring/trauma from surgery, (2) graft survival rate is higher than in a megasession, and (3) the donor area -- the golden jewel for any man/woman seeking a hair transplant -- is treated conservatively (not decimated so quickly, so that if there is any future hair loss, there is still donor area to work with). Cons that I have heard include: (1) numerous surgeries can be required to reach a patient's goals, which may come with increased costs, inconveniences associated with surgery, etc. (2) results can appear "spotty" because grafts may not be densely packed, and (3) results may not be cosmetically significant.

    You can see that some of the pros/cons that I have heard in my own research of each method actually contradict one another.

    I personally tend to prefer the conservative approach, along with my IAHRS surgeon. But I was curious: what do others think? And, is there an clean and clear answer to the question of - what is better in hair transplantation, a megasession or conservative session?

    TeeJay

  2. #2
    Administrator SpencerKobren's Avatar
    Join Date
    Oct 2008
    Location
    Los Angeles, CA
    Posts
    404

    Default

    Hey TeeJay,
    This is a great topic. I think it's best to have a couple of our IAHRS accepted members provide their perspective...Stay tuned
    Spencer Kobren
    Founder, American Hair Loss Association
    Host, The Bald Truth Radio Show

    I am not a physician. My opinions and knowledge concerning hair loss and its treatment are based on extensive research and reporting on the subject as a consumer advocate and hair loss educator. My views and comments on the subject should not be taken as medical advice. Always seek the advice of a medical professional when considering medical and surgical treatment.

  3. #3
    Member JustJoe's Avatar
    Join Date
    Oct 2008
    Location
    Maryland
    Posts
    50

    Smile

    Quote Originally Posted by TeeJay73 View Post
    There seems to be two (opposing) schools of thought related to megasession hair transplants.

    As I understand it, megasession hair transplants are those in which 2,000 or more grafts are transplanted in a single session. I have heard that even 5,000 grafts have been transplanted in a single session. (Given that an average number of hairs in a graft is 2.3 hairs, one can quickly calculate the number of hairs transplanted in a megasession.)

    The conservative approach to hair transplants opposes the megasession approach in that 2,000 or fewer grafts are transplanted in a single session.

    I have heard numerous pros and cons associated with each type of session.

    With megasessions, pros that I have heard include: (1) fewer surgeries are required to reach the patient's goals, (2) the grafts tend to grow better, (3) increased hair density, and (4) results are very comsmetically significant. Cons I have heard include: (1) the donor area is decimated quickly, and, if results are not in line with the patient's expectations, the donor area is gone (or nearly gone), and there's nothing left to work with and (2) graft survival rate may be decreased.

    With the conservative approach, pros that I have heard include: (1) sometimes patient's are very content with a single, less-than-2,000 graft session, potentially saving him/her money and scarring/trauma from surgery, (2) graft survival rate is higher than in a megasession, and (3) the donor area -- the golden jewel for any man/woman seeking a hair transplant -- is treated conservatively (not decimated so quickly, so that if there is any future hair loss, there is still donor area to work with). Cons that I have heard include: (1) numerous surgeries can be required to reach a patient's goals, which may come with increased costs, inconveniences associated with surgery, etc. (2) results can appear "spotty" because grafts may not be densely packed, and (3) results may not be cosmetically significant.

    You can see that some of the pros/cons that I have heard in my own research of each method actually contradict one another.

    I personally tend to prefer the conservative approach, along with my IAHRS surgeon. But I was curious: what do others think? And, is there an clean and clear answer to the question of - what is better in hair transplantation, a megasession or conservative session?

    TeeJay

    It depends on the donor area, patient goals, cost, and the amount of times you want to return to have a session. For me, I wanted as few sessions as possible with as many grafts as possible. For me that was 2 sessions and ~5000 grafts.

  4. #4
    IAHRS Recommended Hair Transplant Surgeon Jeffrey Epstein, MD's Avatar
    Join Date
    Nov 2008
    Location
    Miami and New York
    Posts
    247

    Default

    Quote Originally Posted by TeeJay73 View Post
    You can see that some of the pros/cons that I have heard in my own research of each method actually contradict one another.

    I personally tend to prefer the conservative approach, along with my IAHRS surgeon. But I was curious: what do others think? And, is there an clean and clear answer to the question of - what is better in hair transplantation, a megasession or conservative session?

    TeeJay
    Dear TeeJay- It is always good to meet/communicate with an educated patient. This is a debate which in my mind has very clear truths- most of which support the larger procedure.

    After 14 plus years of specializing in surgical hair restoration, I have grown with the field as procedures have gotten larger and larger. I do in fact perform mostly “megasessions”, with the typical procedure of mine being 2400 or so grafts, ranging to as high as 3400 grafts (and occasionally more than that). Big is in fact usually better (as long as there is a need for these larger procedures), but not too big, which is the tendency of the occasional physician/clinic to use the same approach to every patient which are these 4000 plus graft procedures on almost everyone, regardless of the higher risk of donor site scarring (for a larger strip needs to be removed to get this very large number of grafts) and the temptation to put an overly large number of grafts where in the future with progressive hair loss the results are not going to be as natural appearing (i.e. too low of a hairline, filling in of the crown too much).

    The percentage of hair growth is primarily determined by how the grafts are handled, whether 1000 or 3000 grafts are transplanted, so is not determined typically by the size of the procedure, unless the team of assistants is insufficient to do these large procedures. In my office, I have a full-time team of 18 assistants with a huge amount of experience, so grafts are dissected then planted carefully and properly in a relatively short amount of time. In addition, with procedures larger than 2000 or so grafts, the donor site gets removed in two separate sections (one at the onset of the procedure, then once that first section is dissected down, the second strip gets removed several hours later) to preserve the blood supply for as long as possible, helping to assure the highest rate of growth. Many surgeons do not have such a large team, and therefore are simply unable to properly perform larger procedures- and therefore do not “recommend” them.

    The bottom line is, patients are looking for results, and if not enough hairs are transplanted, that patient is going to be disappointed. Many patients do not want to have multiple procedures when they can achieve the results they desire in just a single procedure - and this typically requires, with anyone with a Class 2 to 3 hair loss, a minimum of 2000, and often as many as 3000 plus grafts. Another typical advantage of larger procedures as opposed to having multiple procedures is that the cost per graft is less. And in terms of donor site issues, as long as proper technique is utilized, the supply should not be compromised whether a single or multiple procedure is performed.

    My final advice, however, is that every patient needs to do his/her homework, to make sure that the doctor performing the procedure specializes in hair restoration, and is able to achieve the results that the patient desires. All too often, patients come to me having had a prior procedure upset with the results with their density, because they were given unrealistic expectations- i.e. told that 2000 grafts is sufficient for filling in a Class 4 hair loss pattern.
    Jeffrey S. Epstein, MD
    Foundation For Hair Restoration

  5. #5
    Member JustJoe's Avatar
    Join Date
    Oct 2008
    Location
    Maryland
    Posts
    50

    Default

    Quote Originally Posted by Jeffrey Epstein, MD View Post
    Dear TeeJay- It is always good to meet/communicate with an educated patient. This is a debate which in my mind has very clear truths- most of which support the larger procedure.

    After 14 plus years of specializing in surgical hair restoration, I have grown with the field as procedures have gotten larger and larger. I do in fact perform mostly “megasessions”, with the typical procedure of mine being 2400 or so grafts, ranging to as high as 3400 grafts (and occasionally more than that). Big is in fact usually better (as long as there is a need for these larger procedures), but not too big, which is the tendency of the occasional physician/clinic to use the same approach to every patient which are these 4000 plus graft procedures on almost everyone, regardless of the higher risk of donor site scarring (for a larger strip needs to be removed to get this very large number of grafts) and the temptation to put an overly large number of grafts where in the future with progressive hair loss the results are not going to be as natural appearing (i.e. too low of a hairline, filling in of the crown too much).

    The percentage of hair growth is primarily determined by how the grafts are handled, whether 1000 or 3000 grafts are transplanted, so is not determined typically by the size of the procedure, unless the team of assistants is insufficient to do these large procedures. In my office, I have a full-time team of 18 assistants with a huge amount of experience, so grafts are dissected then planted carefully and properly in a relatively short amount of time. In addition, with procedures larger than 2000 or so grafts, the donor site gets removed in two separate sections (one at the onset of the procedure, then once that first section is dissected down, the second strip gets removed several hours later) to preserve the blood supply for as long as possible, helping to assure the highest rate of growth. Many surgeons do not have such a large team, and therefore are simply unable to properly perform larger procedures- and therefore do not “recommend” them.

    The bottom line is, patients are looking for results, and if not enough hairs are transplanted, that patient is going to be disappointed. Many patients do not want to have multiple procedures when they can achieve the results they desire in just a single procedure - and this typically requires, with anyone with a Class 2 to 3 hair loss, a minimum of 2000, and often as many as 3000 plus grafts. Another typical advantage of larger procedures as opposed to having multiple procedures is that the cost per graft is less. And in terms of donor site issues, as long as proper technique is utilized, the supply should not be compromised whether a single or multiple procedure is performed.

    My final advice, however, is that every patient needs to do his/her homework, to make sure that the doctor performing the procedure specializes in hair restoration, and is able to achieve the results that the patient desires. All too often, patients come to me having had a prior procedure upset with the results with their density, because they were given unrealistic expectations- i.e. told that 2000 grafts is sufficient for filling in a Class 4 hair loss pattern.
    Totally agree.

    "Big is in fact usually better (as long as there is a need for these larger procedures), but not too big"

  6. #6
    Senior Member
    Join Date
    Oct 2008
    Posts
    225

    Default Thanks for the insightful response Doctor Epstein!

    Doctor Epstein:

    Thanks for taking the time to respond, so insightfully. It speaks to the awesomeness (not even sure if that's a word!) of this forum.

    When I first began to notice my hair loss at about 25 years old (10 years ago), I ventured down the wrong path of lotions and potions and large, late-nite informercial hair transplant clinics. In a 1st hair transplant I had only 800grafts, under the guidance of the clinic, which produced nonsignificant results.

    But luckily, before too much damage was done, and before too many dollars were spent, I found the IAHRS, educated myself, and my results have improved dramatically with a recent procedure of 1,600+ grafts (currently 9 months post-op). My hairline has softened and I've had a big, big density pick-up in my frontal regions.

    The question of "how many grafts" per session came up while I was educating myself, and since I am such a curious person and an information gatherer by nature, I wanted to know the perspectives of other IAHRS surgeons.

    Thanks Doctor Epstein!

    TeeJay

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts

» IAHRS

hair transplant surgeons

» The Bald Truth

» Recent Threads

Careers
04-25-2010 03:56 PM
Last Post By Ahab
Yesterday 11:47 PM
link between dermatitis and propecia?
08-18-2015 08:29 AM
by Alex88
Last Post By BaldBearded
Yesterday 11:22 PM
am I losing it?
12-02-2017 01:28 PM
Last Post By BaldBearded
Yesterday 10:48 PM
Which is the best method for hair transplant?
Yesterday 09:14 PM
Last Post By Crashedbeats
Yesterday 09:14 PM
Experienced Finasteride help?
03-31-2018 11:24 AM
by Ben28
Last Post By oDD1ne
Yesterday 04:58 PM