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Old 11-15-2009, 11:59 AM
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Hey all,

I didn't want to hijack Campbell's post, so I'll start a new thread to ask my question.

In a recent thread made by Campbell, Spex stated "This is not necessarily true due to the fact that very FEW patients actually have 5000 grafts available in one session due to their own individual donor density / laxity", however, it is said Dr. Hasson "routinely harvests over 5000 follicular unit grafts in one session." and for Dr. Wong - "5000 plus graft cases are relatively common." as well as "3500 to 4500 grafts in one session are an everyday occurrence"

I'm using Hasson and Wong as an example, who are of course famous for their mega-sessions and see a lot of patients which will most-likely mean that they see a larger number of patients requesting such a large amount of grafts in one session, compared to other clinics. This may have an impact on the amount of people they see that are suitable for 5000+ grafts.

I'm in no way suggesting Spex is wrong, but there is a marginal difference between "very FEW patients actually have 5000 grafts available in one session" and it being common/routine at Hasson and Wong.

Does anyone have any numbers on this? How common is it that patients will be able to have 5000 or close to 5000 grafts harvested in 1 session? 1 in 1000, 1 in 100, 1 in ...?
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Old 11-15-2009, 12:31 PM
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Maxxy,

Possibly putting my quote into context may help a little. I posted that in response to your quote below to try help the patient - Topic where i posted.

Quote:
P.S. also, a clinic over the water will be to do the 5000 grafts in 1 session, which I'm sure will save you a lot.
This is not necessarily true and i stand by that. You informed the poster he could get 5000 grafts in one session overseas and based on my experience 5000(+) patients in one session are not that common. Yes there are patients that can achieve that and require it but on AVERAGE that is not possible SAFELY.

3500 - 4000+ session are routinely performed by many clinics mentioned here BUT for a patient to achieve 5000+ grafts in one session safely; they need to have well above average donor density and laxity without hindering further sessions or causing excessive scaring. Sometimes it's just NOT physically possible to hit 5000(+) in one session based on the individuals own variables even though they may want and warrant that size sesison. This is the point i was trying to help get across to the new poster who required some help.

Spex
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Old 11-15-2009, 01:01 PM
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Hey Spex,

I would have included my comments from the post if I thought it was relevant, I don't see what that has to do with my question or the fact you find very few patients are able to obtain 5000 grafts in 1 session (which I'm not disagreeing with) - but thank you for posting the link.

You will also see, in Campbell's thread that I apologised and agreed with you that it may not be possible, stating the reasons why I made the comment in the quote you provided. I would have also posted the question in Campbell's thread but didn't want to take his post off-topic.

I simply wanted to know other peoples views on how common it is and stated the reason I was asking the question - I hope you didn't take offence to it.
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Old 11-15-2009, 04:59 PM
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I think it'd be tough to make a blanket statement and give a rough figure/% that would apply to hair transplantation as a whole, Maxxy.

I think Spex laid it out for the host of limitations that can occur just on account of our own bodies.

Even then, there are very few clinics capable of doing 5k+ -- safely -- without sacrificing the quality of their closure, and having a staff large enough to handle the sheer workload of such a session size.

To top it all off, we only get to see a % of cases that are allowed to be posted publically.

5k+ is certainly rarefied air, but 4k....even 3k...is pretty rare in the context of hair transplantation as a whole, even to this day.
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Old 11-15-2009, 05:36 PM
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Hey Thana,

Yeah, I thought it may have been a tough question to put in to actual numbers.

Maybe some doctors or representatives could chime in with their observations; It would be good to hear from Jotronic as he must encounter such patients on a regular basis.

Jotronic, if you read this - are there many patients that come in looking for a session of around the 5000-graft mark that could literally have the session that day in terms of suitability or is this extermely rare? Also, from the people that are turned down for such a large session how many can achieve this goal in 1 session after performing scalp exercises?

I know this is also going to be difficult to put in to numbers.
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Old 11-15-2009, 11:15 PM
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Maxxy,

What can be harvested in a single session depends on donor hair density, scalp elasticity, the size and experience of the surgeon's staff, and what a surgeon is comfortable harvesting in a single session.

Donor density and scalp elasticity vary in each patient, but are generally static when comparing averages. Thus, the variables we are concerned about are the size and experience of a surgeon's staff and what a physician is comfortable harvesting.

In other words, why would Dr. X harvest 3000 follicular units when Dr. Y would harvest 5500 follicular units on the same patient A?

Assuming physicians are cutting true follicular units, Dr. Y would have to be taking a longer and/or wider strip than Dr. X.

The technique of each physician varies and while some are comfortable pushing the envelope, others are more reserved.

Personally, I'd like to hear from JoTronic as to an approximate percentage of patients Dr. Hasson and/or Dr. Wong harvests over 5000 follicular units. I know your quotes above indicate that it's common. However, I'm under the impression that patients with this type of density and elasticity are rarer.

Best wishes,

Bill
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Old 11-16-2009, 01:40 AM
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Maxxy, you have not offended me at all - its a good topic

On the average patient, 5000 + grafts in one session is indeed not commonly available i think we can all agree to that and as confirmed above. However it's a numbers game and HW (who are a fantastic clinic who i have the up most respect for) on average will certainly get more 5000+ candidates(above average density/laxity) through their door due to the fact they are are well known for their very large mega sessions and staff size.

HW appeals to high NW levels - Its rare to find a high NW patient who doesn't want to obtain as many grafts safely as possible in one session so therefore statistically HW will see more 5000+ patients than the average clinic. On the same note that a Mercedes dealership will see on average more people walk through their door looking for a Mercedes.

It's all well and good wanting 5000+ grafts in one session BUT on average it's not necessarily available to harvest safely. This is only my opinion and i would also be interested to hear from Joe.

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Old 11-16-2009, 02:52 AM
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Yeah, Spex - I totally agree! That's what I was getting at when I said:

Quote:
I'm using Hasson and Wong as an example, who are of course famous for their mega-sessions and see a lot of patients which will most-likely mean that they see a larger number of patients requesting such a large amount of grafts in one session, compared to other clinics. This may have an impact on the amount of people they see that are suitable for 5000+ grafts.
Spex, in the time you have been working for Dr. Feller or even before this, have you ever personally encountered a patient that would be suitable for 5000 grafts in 1 session (not taking the clinic/doctor into consideration)?
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Old 11-16-2009, 06:34 AM
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I have met a handful of guys in my time who i would consider having all the different variables to potentially suit such a session if it was physically practical. However i am not a doctor so to determined whether or not they were eligible or not can ONLY be determined by a Doctor and one that has a great experience with very large sessions.
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Old 11-16-2009, 07:08 AM
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If the length of your strip is 20 cm and the width is 1 cm and you have average density 100 follicular units per sq. cm, then that strip would give you 2000 grafts. If you were to double that width to 2 cm (increase risks on donor scar) then that would give you 4000 grafts. If you were to lengthen the strip to 25 cm with a 2 cm width, then that would be 5000 grafts. But around the turn of the head, I think 2 cm would be quite wide so strip may narrow there. Of course laxity exercises could reduce chances of a widened donor scar but I think more of a risk nonetheless.
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