Janna, the long time lead medical technician for the Shapiro Medical Group, posted an extensive reply at the bottom of my Hasson and Wong blog post. I think her in-depth comments raise the big issue of the day ??“ just how large can a single surgical session safely be?

Those who have done their research know that in recent years leading hair transplant clinics have moved toward smaller and less invasive incisions and larger numbers of follicular unit grafts. But just how many grafts can be safely harvested and transplanted in one session?

In my opinion, there are two surgical philosophies that have real legitimacy in this debate, with Hasson and Wong best representing one school of thought and the Shapiro Medical Group best representing the other.

Both clinics have the capability to do very large sessions using tiny incisions and highly refined grafts. Yet the Shapiro Medical Group only exceeds 4,000 to 5,000 grafts in very rare cases. Hasson and Wong have many well publicized cases exceeding 5,000 and even 6,000 grafts in one session.

The Shapiro Medical Group also believes in keeping all 3 and 4 hair follicular units intact and thus tend to have follicular unit grafts that contain on average slightly more hairs than Hasson and Wong.

However, as Janna points out in her reply, despite these philosophical differences, these two clinics' techniques share much in common.

I believe that these two variations in technique and philosophy are the true contenders for the optimal "Ultra Refined Follicular Unit Hair Transplantation" procedure.

Clinics that have not developed the skill or capability to do minimally invasive sessions larger than 2,500 grafts may argue that larger sessions cannot or should not be done. But their credibility sufferers when they are not capable of performing such larger procedures.

I welcome a friendly and fact filled debate regarding what is ultimately the optimal procedure for the patient - when all is considered. I expect that some patients will be drawn towards one philosophy or the other based on their own temperament, philosophy or even budget.

But I don't expect any truly educated patient to argue in favor of large invasive incisions that are not carefully oriented and or session sizes that provide far too few grafts and hairs to make a real difference for patients with significant hair loss.

Ultra Refined Follicular Unit Grafting is the new gold standard. But which variation of this cutting edge procedure is deemed optimal remains to be determined. I look forward to the members of this community getting actively involved in this friendly debate. I encourage those who are interested to read Janna's comments, which are at the bottom of the page, and reply either on the blog or here.

Onwards and Upwards, Pat

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Never Forget - It's what radiates from within, not from your skin, that really matters!

My Hair Loss Blog

View some of the Leading Hair Transplant Clinics that I have visited.

Sharing is what keeps this community vital. Please join in. To learn how I restored my hair and started this community, click here.

Follow our Community on Twitter.

"No matter how good the physician and his ability too create small scars, the wider the strip the more POTENTIAL for a wider scar."

I seem to recall that I got blasted for making this same statement.

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2700 Total Grafts w/ Keene 9/28/05
663 one's = 663
1116 two's = 2232
721 three's = 2163
200 four's = 800
Hair Count = 5858

1000 Total Grafts w/Keene 2/08/07
Mostly combined FU's for 2600+ hairs

My Photo Album

See me at Dr. Keene's Gallery

" There is still a question about decreasing yield when transplanting densities over 30 to 40 fu/cm2."

This is very interesting stuff. Thanks Janna for your very detailed input.

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____________
2700 Total Grafts w/ Keene 9/28/05
663 one's = 663
1116 two's = 2232
721 three's = 2163
200 four's = 800
Hair Count = 5858

1000 Total Grafts w/Keene 2/08/07
Mostly combined FU's for 2600+ hairs

My Photo Album

See me at Dr. Keene's Gallery

Fractionating grafts rip the customer off. Grafts need to be transplanted as they occur in nature. Shapiro is looking out for the best interest of the patient/customer not their bank account. Fractionating grafts equal artificially high graft counts and the customer pays more and gets less. This sounds like the more is less effect.

What an excellent post by Janna. Some of us fall into the "less than desirable donor area" category and it's easy to get wowed by the pictures of our uber mega session brethren. Just because it can be done on some people doesn't mean it's the safe thing to be done on you.

That's quite an articulate and well written piece of prose worthy of an MD himself.

To suggest that it in some way does not relate to H&W and is speaking of the broader HT community (a community that Pat himself acknowledges rarely delves into the sort of graft counts of H&W) is ridiculous.

I scoff at the idea of two sessions somehow being ok and even - *gasp* - better for the patient? Two years out of ones life spent hiding under a hat, looking, quite literally, like an ass.

Then you have the ridiculous clowns come on here proclaiming Shapiro as the saver of people's money. No, he's not ripping people off. I wonder though how much more two sessions as opposed to one would cost (when you factor in the discount pricing scheme of most clinics for larger sessions).

Bottom line is results speak louder than words. You guys can justify your positions all you like but at the end of the day, its H&W pulling people out of NW6-ville, and there isn't a single clinic in the world who's managed to do that as consistently or even on par even with their best cases.

NW6-ville sprinkled with 1's and 2's is what I gather from what I have read here. There is no need to resort to name calling (clowns huh). Pat is trying to have an educated consumer-based discussion. Leave the trailer park antics for the Jerry Springer show.

Pat, there is likely not a one size fits all category. If H&W can do one mega session what takes two sessions from other doctors, and get the same quality results without vascular damage or higher than average graft failures then that is the way to go. But realistically, only a controlled study will tell us whether large sessions result in more failures or not, or any kind of vascular damage. Otherwise we are all just guessing based on anecdotal evidence.

As the host of this forum, I'm really just a facilitator. Ultimately it's up to the members of this forum to choose what procedure and physician (if any) is best for them.

But ideally all considerations should be considered, discussed and debated for the best decisions to emerge.

The members of this community are actually influential in influencing the direction in which the hair restoration profession moves. I would like to see patients making wise and well informed long term decisions for themselves and ultimately the hair restoration profession.

I think we all want the same thing - optimal results that are safely and cost effectively achieved in a minimal time frame.

Personally I would do surgery with any member of the Coalition. They all do ultra refined work with careful microscopic dissection of grafts and minimally invasive incisions, which enable them to dense pack grafts and do larger sessions.

Yet these leading physicians do have a range of opinions on how much donor area can be safely removed in a single session. They may also define and trim follicular units into grafts that may on average have more or less hair (thus my request that physicians and patients post both graft and hair counts in their post to enable an Apples to Apples comparison).

Open and civil debates in which rational thought and evidence prevail over emotions is healthy in my opinion.

Let's stick to valid information during this discussion and avoid name calling or personal attacks.

All the best for all of us, Pat

__________________
Never Forget - It's what radiates from within, not from your skin, that really matters!

My Hair Loss Blog

View some of the Leading Hair Transplant Clinics that I have visited.

Sharing is what keeps this community vital. Please join in. To learn how I restored my hair and started this community, click here.

Follow our Community on Twitter.

I think that it is fantastic that this site under the direction of Pat recognizes that there is more than one ball game in town. You can't allow a small group of posters run a forum and silence the rest. Just because a dog barks loud and frequently doesn't mean that it is the top dog or might I say top clinic.

There is a downside to these big sessions. You better believe it. Sometimes a conservative approach is in the best interest of the patient. Grafts need left intact, instead of broken down to market a clinic because they do the highest graft counts in one session.

Lets talk results. Just because every damn patient that goes to your clinic wants to have their 15 minutes of fame in the internet hair loss forum spotlight doesn't mean you have the best and most results. There are alot of excellent doctors turning out great results everyday that stay low profile and off the boards. It's all about marketing. Dominate the boards and keep the clinic busy and profit. Domination is the marketing tool. Naysayers are silenced, humiliated, and criticized. It's getting old.