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Mega-Sessions?


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  • Senior Member

lately, there has ben lot more discussion on these forums involving Hasson & Wong. I had never checked out their results, so i did. Very impressive. I also like their willingness to do mega-seesions, in some cases 5000+. i am sure they don't do it for everyone, but the right candidates. Reason i like it is because a session like that gives the patient the true shock-value after-effect that most of us hope and dream of getting from any hair transplant, but rarely do, and hence the disappointments.

i would love to find out which of the top american docs do such mega-sessions? Feller? True? shapiro? Anyone at all?

Help me out guys.

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  • Senior Member

Paris,

 

I am not aware of any american docs that can perform sessions as large as Hasson and Wong. Keep in mind that one must possess above-average donor density and/or above-average laxity to qualify for a 5000+ graft session. I too agree that their results are truly impressive.

 

GuitarPlayer

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yes, megasessions are the way to go. Atleast from the person's view. But are they safe? Or really possible? I mean the grafts being made by splitting FUs and all will not give overall more hair.

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  • Senior Member

Buttercup, (I love the Princess Bride, BTW) icon_biggrin.gif

Many are still waiting and watching in response to the amazing procedures being done at H&W. The willingness to push the envelope and (pardon the Star Trek reference) to boldly go where no man has gone before, is necessary to affect change. Both paris and GP bring up the point that these monster sessions are not for everyone, nor should they be. Each of these candidates seem to possess an abundance of donor hair, and tremendous scalp laxity (and a pretty deep pocketbook!!!).

What I think we will start seeing as a response within the HT industry is Dr.s moving average sessions of 1500 to 2500, to 3000 or 3500 for the right candidates. What this means is more labor intensive sessions, and additional staffing as well. I am not sure if this will raise pricing or not, we will have to wait on that. (hopefully not!) Now back to the issue---

Some of the questions raised by these sessions- Can dense packing past 50-60 g/cm2 achieve 99% growth and is it necessary? If 5000 grafts are transplanted and 500 don't grow, how will we know? Is intense donor depletion in late 20's early 30's safe 10-15 years down the road? Are these sessions really 1 pass, or do most still require a tune-up? What do the scars on these patients look like 6months, 1 year, 18 months post op? These are questions that run through my mind and I am sure many others as well. Personally (IMO)I would prefer 2 3000 to 3500 sessions in order to truly achieve a "perfect" HT. Again though, that is my opinion. Again, I certainly think the right clinic is performing these operations, and as we have had no negative feedback whatsoever from these patients, H&W is making a believer out of many. I have had this discussion many times, and it comes down to philosophy. Does a massive session produce the results of 2 large sessions that equal the amount of grafts placed at one time? Some say yes, some say no. Because we only get a few shots at getting this right, I have a feeling we are going to see something in middle, with the "best" Dr's simply moving up average sessions to 3000-3500. As in everything we have a spectrum, on one side we have 5-6000 sessions and the other 1500 sessions. I just think time will tell the tale here, with quite a few satisfied patients.

BTW, it is only a few years ago that sessions of 3000 were considered "unsafe" and now we see them becoming an industry norm, for doctors that truly want to service and satisfy clients. This is a great thread, and one that bears watching. I would hope that we see some responses from doctors as well, just to get their perspective.

Go Cubs!

 

6721 transplanted grafts

13,906 hairs

Performed by Dr. Ron Shapiro

 

Dr. Ron Shapiro and Dr. Paul Shapiro are members of the Coalition of Independent Hair Restoration Physicians.

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I agree with The post By B-spot it is very well thought out and written, i spoke with Matt Zupan today from Shapiro Medical and this is almost exactly what he told me, i think you will see Shapiros group raise their sessions a bit although it sounded like theyre not going to commit to 5000+ anytime soon but its nice to know that you do have options if you understand and accept the possible risks wich are very rare with top surgeons like Hasson & Wong, having done 2523 & 3297 graph sessions my feelings are 2 mega sessions of 3000 or 3500 each if you have it and then possible touch ups with a good FUE Doctor down the road, in fact my current plan is 2000 more strip if i can and 2000-3000 fue possibly BHT for my crown in years to come.

 

To answer your question about wich american Docs do Megasessions heres my thoughts: Shapiro would be the Only American Doctor i would use for strip and probably 3500 is the tops you could get him to do in one sitting, good luck, Mudpuppy

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  • Senior Member

Mud, I looked at your pictures on hairlosshelp, and you are going to look phenomenal, my friend!!!!!! I had 3100 done the first time, and I am hoping for at least 3200 to 3500 the next time, which should put me near you in the front and some decent coverage in the back. I am following you in that I hope I have enough to do 1500 to 2000 after two 3000+ sessions. I have about 200 cm of baldness to cover, so after 8000 grafts I should see 50 in the front and 30 from the midscalp back, and be looking mighty fine!!!!!!! icon_biggrin.gif (this is all figuratively speaking of course!)

Go Cubs!

 

6721 transplanted grafts

13,906 hairs

Performed by Dr. Ron Shapiro

 

Dr. Ron Shapiro and Dr. Paul Shapiro are members of the Coalition of Independent Hair Restoration Physicians.

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  • Senior Member

I have a 2nd HT scheduled with H&W in less than a week. Why did I pick them...........because of their ability to consistently perform mega sessions of sometimes more than 5000 grafts....with excellent results! Is it safe? It sure seems to be based on the provided results. Do I wish I would have used them 1st time around? Absolutely!

 

As for other American Doc's mirroring this, I would guess it's heading that direction. H&W seems to have paved the way posting fantastic results. The reference to Shapiro heading this direction adds credibility since he is top notch.....I would guess others will start doing the same in the near future. Overall, the move for more in a session makes sense. Why have 4-5 HT sessions when you can get what you want in 1-2? There are so many benefits. It is taxing on the surgeon's time but maybe that can be improved also?

 

Look at it in the business sense. HT's are a service performed by clinics and provided for those consumers who have need of the HT. In order for the clinic/surgeon to be successful, they will try to meet customer needs as best they can. What are customer's now desiring..........mega sessions of an increasing number of grafts for a more efficient restoration process.

 

My first HT a year ago, I received 1200 grafts and was told to have "reasonable expectations" and that most people don't come back for a 2nd HT. I'm disappointed now 1 year later when I realize what I could have now if I knew more then. If they can't harvest enough during my 2nd HT, I may have to go back for a 3rd to get the results I'm looking for. If I'd had a true mega session 1st HT the 2nd could have been the last.

Hairbank

 

1st HT 1-18-05 - 1200 FUT's

2nd HT 2-15-06 - 3886 FUT's Dr. Wong

3rd HT 4-24-08 - 2415 FUT's Dr. Wong

 

GRAND TOTAL: 7501 GRAFTS

 

current regimen: 1.25mg finasteride every other day

 

My Hair Loss Weblog

 

Disclaimer: I'm not a Doctor (and have never played one on TV ;) ) and have no medical training. Any information I share here is in an effort to help those who don't like hair loss.

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  • Senior Member

Bank, I agree that awareness and demand has been raised with regards to these mega-mega sessions. What I disagree with is the idea that consumers are driving/controlling the market. What I think is happening is these sessions are opening up a completely new section of the market. Most of us still require several sessions to reach our goals. I think we are seeing younger patients seeking more of an "instant gratification" session, which I can really relate to. I chose not to pursue a HT in the mid 90's in my early 20's, simply because the thought of multiple surgeries and a lifelong commitment to more surgeries later on in life turned me off. Entering my 30's and with larger sessions available, it is a no-brainer at this point in my life. I do have to say that before doing 3 years of research, that I would have RAN to a HT doctor for a 4 to 6000 graft session. I'm a little older now, and I am resigned to the fact that my hairloss has progressed into a type 6 almost 7 on the norwood scale, so I am glad I did not try to restore my original hairline as I would be shit out of luck right now. I am certainly very impressed by the results of these massive sessions and I hope that fellow sufferers continue to have great success.

Go Cubs!

 

6721 transplanted grafts

13,906 hairs

Performed by Dr. Ron Shapiro

 

Dr. Ron Shapiro and Dr. Paul Shapiro are members of the Coalition of Independent Hair Restoration Physicians.

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  • Senior Member

Hi

 

I think it is natural for everyone to want more and mega.. However, I can tell you there is no way you could take 4000-5000 grafts from my head.. I've had 2 procedures of 1400+ each and have been very happy. Keep in mind I was concerned with shockloss as nobody knows of my procedures.. It depends on the person, their scalp laxity and density... Sometimes more is not always better based on the client

JOBI

 

1417 FUT - Dr. True

1476 FUT - Dr. True

2124 FUT - Dr. True

604 FUE - Dr. True

 

 

 

 

 

 

 

My views are based on my personal experiences, research and objective observations. I am not a doctor.

 

Total - 5621 FU's uncut!

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The B Spot,

 

You are "Spot" on with your assessment of megasessions. The questions that you raise are excellent and are the exact same questions that have been put to us by fellow physicians and prospective patients alike. I believe that for the most part we have answered the questions and proven ourselves to those who have been dubious.

 

The thing that you are missing is the time line in the development of these megasessions. The reason for this is the absence of H&W from this site for the past year. Prior to this, H&W were front and center on this website regarding our megasessions, dense packing techniques, Lateral Slit, custom size incision blades and other innovations which led to the development of what Pat Hennessey has appropriately termed the "Ultra Refined Dense Packing" technique.

 

H&W showed more results and had more patients chronicle their own experiences than all the other clinics combined. So, B Spot, when you say that time will tell the tale here I think that ( due to no fault of your own) you have already missed the boat. In fact in 2003 when Pat Hennessey awarded the 1st and only International Patients' Choice Award H&W won ??“ apparently by a landslide.

 

Still there were those ??“ primarily physicians- who were still skeptical and felt that only seeing would be believing. We stepped up to the plate and produced 25 patients in the flesh for viewing at the ISHRS meeting in Vancouver in 2004. These patients either had received sessions of >5000 fu's in a single session or were dense packed in one pass at >70 fu per cm2.

 

I believe that we made most physicians believers that day. This is what Dr. Richard Shiel wrote afterwards in the Hair Transplant Forum Magazine.

 

"Meeting Highlights

The indeligible image I will take away from this meeting is that of the patients of Drs. Victor Hasson and Jerry Wong. These were demonstrated at the Live Patient Viewing on Friday afternoon.

To say that these results were "mind-blowing" would be an understatement. Please picture a young man with over 5000 FUs harvested and planted in A SINGLE SESSION and growing with close to 100% perfection. Not only growing, but planted at up to 80 grafts per square centimeter and giving the appearance of completely normal hair direction and density with no "crinkle" whatsoever and a donor scar of 1-2mm.

The rest of us will be a long time catching up with the skills of Jerry and Victor and their wonderful staff of assistants."

 

Since that time we have had numerous doctors come and observe our technologies including Drs. Ron Shapiro, Paul Rose, Glen Charles, Alan Feller, Ed Epstein, David Seager and others.

 

In addition Pat Hennessey has asked us to host a workshop for the Coalition Drs. Which will be held here this summer.

I believe that this website has been instrumental in raising the bar for HT surgeons worldwide. It has raised the level of knowledge in the patient population to the extent that they demand the most up to date surgery available.

Today that means dense packed, one pass, megasessions of which we have already performed over 2000 times in the past four years.

 

Victor Hasson MD

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  • Senior Member

Dr. Hasson,

Thank You for taking the time to answer the questions raised by myself and others, and for expressing your views here. Myself and many others have been astounded by the results yourself and Dr. Wong have produced in the past years. I can appreciate not settling for the "standard" and truly pushing the limits of science and technology. In regards to the timeline, what I meant was the ability to view patients that have undergone 2 larger sessions versus the "one pass" techniques employed by you and Dr. Wong, coupled with other clinics raising the bar to include larger sessions. Of course, I am referring to patients like myself; those who plan to do 3000+ sessions consecutively, and who benefit from the Frechet/Tricho closure methods that your practice and other "top" clinics now use. (my strip at 1.25cm x 27cm long yielded 3100, so a 2cm strip of the same size would have yielded 4300+ with ease)

I am aware of your tremendous success as I have combed (no pun intended icon_biggrin.gif), through the photos of your patients with great relish. I think we might be arguing too fine a point, and it may be moot, but philosophically a difference exists. That might be that many doctors cannot physically or mentally perform such sessions, they are unwilling to provide the equipment or staff necessary as well, or simply do not agree with sessions of that size. If that is the case, they will either step up to providing larger sessions, (3000 to 4000), or fall by the wayside. Regardless, your results are amazing, period. I think I would enjoy a conversation or two over a pint, should the occasion present itself. Thank You again, and continued success.

Go Cubs!

 

6721 transplanted grafts

13,906 hairs

Performed by Dr. Ron Shapiro

 

Dr. Ron Shapiro and Dr. Paul Shapiro are members of the Coalition of Independent Hair Restoration Physicians.

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  • Senior Member
Originally posted by the B spot:

Bank, I agree that awareness and demand has been raised with regards to these mega-mega sessions. What I disagree with is the idea that consumers are driving/controlling the market. What I think is happening is these sessions are opening up a completely new section of the market.

 

Spot-

 

I think we're just "splitting hairs" (pun intended!) icon_cool.gif Even with this new market segment wouldn't this still be considered "market driven"?? Otherwise, why raise the bar at all from previous sessions of around 2000 or so?

 

I realize there are still going to be those individuals at the NW2 or NW3 (I remember those days, I think?) that will be content with 1500-2000 at a time (Rottun from this site comes to mind recently).........maybe in a more progressive fashion having a session every 3-4 years or so as their loss continues over time.

 

Unfortunately, Joe's like us at the NW5 stage or so can use a little more in one pass. I guess either way hairloss needs are being met and that's what it's about. I suppose there will be a place for surgeons who still want to "maintain" at the 1500-2500 level...........but I feel with MPB progressing to NW5 and NW6 in many cases the larger sessions are going to be more desireable! Who knows for sure.

 

For me, I never really considered an HT before a couple of years ago. My wife didn't really care that I was losing my hair. I guess it was one of those things where hairloss is now a bonafide choice.......if you want to spend the bucks!

 

Always appreciate reading your posts, Spot!

Hairbank

 

1st HT 1-18-05 - 1200 FUT's

2nd HT 2-15-06 - 3886 FUT's Dr. Wong

3rd HT 4-24-08 - 2415 FUT's Dr. Wong

 

GRAND TOTAL: 7501 GRAFTS

 

current regimen: 1.25mg finasteride every other day

 

My Hair Loss Weblog

 

Disclaimer: I'm not a Doctor (and have never played one on TV ;) ) and have no medical training. Any information I share here is in an effort to help those who don't like hair loss.

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Originally posted by the B spot:

Dr. Hasson,

I think we might be arguing too fine a point, and it may be moot, but philosophically a difference exists. That might be that many doctors cannot physically or mentally perform such sessions, they are unwilling to provide the equipment or staff necessary as well, or simply do not agree with sessions of that size. If that is the case, they will either step up to providing larger sessions, (3000 to 4000), or fall by the wayside. Regardless, your results are amazing, period. I think I would enjoy a conversation or two over a pint, should the occasion present itself. Thank You again, and continued success.[/quote)

 

HOT DAMN, B-spot this is what i have been wanting to get across but maybe im not the greatest poster, i took this out of context because the last paragraph was the best part especially this sentence-- "that might be that many doctors cannot physically or mentally perform such sessions, they are unwilling to provide the equipment or staff necessary as well, or simply do not agree with sessions of that size. If that is the case, they will either step up to providing larger sessions, (3000 to 4000), or fall by the wayside."

 

That is EXACTLY where its headed........ In my opinion, sincerely, Mudpuppy

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Absolutely Bank icon_biggrin.gif, I am merely looking at it this way only because every patient is not a candidate for these sessions. What we do agree on is the effect this new market share is having on other clinics by raising the bar. I think what we will see is clinics that "only" do 1500 to 2000 graft sessions start to rethink their strategy.

BTW, you starting to get excited yet?

 

 

Thanks Mud!!!!

Go Cubs!

 

6721 transplanted grafts

13,906 hairs

Performed by Dr. Ron Shapiro

 

Dr. Ron Shapiro and Dr. Paul Shapiro are members of the Coalition of Independent Hair Restoration Physicians.

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  • Administrators

Thanks to everyone for their excellent and thoughtful input regarding this truly cutting edge topic. I'd like to add a little historical perspective to this discussion.

 

The story of hair transplantation over the past ten years has been the evolution toward much larger numbers of smaller grafts. The benefits for patients have been excellent ??“ faster healing, greater coverage and density and undetectable naturalness even after only one session.

 

But while the newest follicular unit techniques were almost universally embraced by educated patients - not all physicians embraced these changes. Performing large sessions of microscopically prepared grafts, while easier on the patient, was harder on the clinic.

 

Some physicians resisted and made arguments against the follicular unit grafting that was emerging as the new "Gold Standard" in hair transplantation. Their two chief arguments were ??“

 

1) That mega sessions of 1,200 to 1,500 follicular unit grafts were too large and would over tax the scalp's vascular system and thus not all grafts would grow.

 

2) That the smaller and more refined 1, 2, 3 and 4 hair follicular unit grafts would not be able to create the appearance of density.

 

Today, with the evidence of thousands of cases of follicular unit mega sessions, such arguments appear almost reactionary.

 

Perhaps early on such skepticism was merited. But once the overwhelming evidence in favor of follicular unit mega sessions was evident those who clung to such arguments lacked credibility.

 

To debunk these two chief arguments against follicular unit grafting Dr. Rassman in the mid 1990's brought over twenty of his mega session patients to one of the annual International Society of Hair Restoration Surgery (ISHRS) meetings. Many found the impressive results to be clear evidence that large sessions could yield both impressive growth and density.

 

To the skeptics Dr. Rassman said that "Those who don't believe it can be done should not stand in the way of those doing it everyday".

 

Now ten years later the follicular unit procedure has evolved to an ultra refined level and yesterday's 1,200 to 1,500 graft mega session is today's minimum size session.

 

Once again the evidence is in and during the 2004 ISHRS meeting in Vancouver the overwhelming evidence filled a huge room ??“ compliments of Hasson and Wong and their patients. Dr. Hasson and Dr. Wong could have borrowed Dr. Rassman's words in saying - "Those who don't believe it can be done should not stand in the way of those doing it everyday".

 

But skepticism remains. Today some skeptics argue in favor of not moving beyond the standard follicular unit procedure that they argued against embracing years ago.

 

Today some skeptics are concerned that the large size of the sessions (many now in excess of 4,000 follicular unit grafts) are too large and will over tax the scalp's vascular system and thus a smaller percentage of grafts will grow.

 

However, given the much smaller blades and minimal depth incisions now used in these giant sessions proponents can argue that the overall trauma to the scalp's vascular structure is no greater than the smaller sessions using larger blades and more invasive incisions. While some argue that giant sessions may mask potentially lower rates of growth, the impressive end results produced by Hasson and Wong and others physicians performing dense packing over the years lead me to believe that their ultra refined techniques enable patients to achieve excellent growth rates ??“ even with huge sessions.

 

A second concern is that the amount of donor tissue removed in one session to yield such high graft counts may increase the risk of donor scarring to an unacceptable level. I think this issue will be actively debated by patients and physicians over this coming year and beyond. Ultimately the results will provide the evidence needed to resolve this issue.

 

In my opinion, the debate about what is optimal is not between standard follicular unit grafting and ultra refined follicular unit grafting in excess of 4,000 grafts. The real debate is how large should an ultra refined follicular unit session be ??“ 3,000 grafts? 4,000 grafts?, 5,000 grafts? or even 6,000 grafts?

 

Much like they embraced standard follicular unit grafting in the nineties, patients have now enthusiastically embraced Ultra Refined Follicular Unit Hair Transplantation and the clinics that are performing. For the patient the choice between standard follicular unit grafting and ultra refined follicular unit grafting is the proverbial "no brainer".

 

I find it very encouraging that many leading physicians have also embraced recent evolutions in follicular unit grafting and now are using ultra refined techniques that enable them to provide patients with high density "one pass" sessions when appropriate. Many of these surgeons have also expanded their capability so that they can do much larger sessions when it is appropriate for the patient.

 

Thus a patient who is an excellent candidate for 3,500 grafts can do this in one session rather than two sessions of 1,750.

 

In my opinion the ability to perform Ultra Refined Follicular Unit Hair Transplantation with sessions of over 3,000 grafts is the new "Gold Standard" in hair transplantation. Standard follicular unit grafting just isn't the optimal procedure from the patient's point of view. The bar for true excellence has moved higher and dedicated physicians need to stretch to remain at the cutting edge.

 

That is why having the capability to perform large sessions of Ultra Refined Follicular Unit Hair Transplantation has been required of all members of the Coalition of Independent Hair Restoration Physicians since March of last year.

 

Many members of the Coalition currently believe that most patients with average density and scalp elasticity typically should not exceed 3,500 to 4,000 grafts in one session. However, for ideal candidates many Coalition members have done sessions in excess of 4,000 grafts, with Hasson and Wong doing cases as large as 6,000 grafts.

 

Those physicians who master large sessions of Ultra Refined Follicular Unit Hair Transplantation will be rewarded as knowledgeable patients seek them out. Those who are unwilling or unable to step up and provide such a cutting edge procedure will be left wondering why patients are traveling out of their area to get hair transplantation.

 

In my opinion, hair restoration web communities and the patients who make them live and breath, will act as a positive catalyst in this evolutionary process.

 

It's also great to see cutting edge clinics like the Shapiro Medical Group, the Charles Medical Group and Hasson and Wong opening their clinic doors to other physicians by hosting the Coalition Surgical Workshops. Clearly they value improving the work of their entire profession over trying to maintain "competitive advantage".

 

The next Coalition Surgical Workshop will be hosted this coming August in Vancouver by Hasson and Wong. I know that interest in their work is very high and this event will be very well attended.

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

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  • Senior Member

Pat,

 

Thanks for summing things up.......very eloquently put and informative, as usual. Makes me think back to those who had HT's 10 years ago versus what is available today. What a difference!! A huge positive for the follically challenged. icon_wink.gif

 

Quote from B Spot: "BTW, you starting to get excited yet?"

 

Spot - That's the understatement of the century! I wish next week would hurry up and get here. Can't wait for Dr. Wong to work his magic on the 15th!

Hairbank

 

1st HT 1-18-05 - 1200 FUT's

2nd HT 2-15-06 - 3886 FUT's Dr. Wong

3rd HT 4-24-08 - 2415 FUT's Dr. Wong

 

GRAND TOTAL: 7501 GRAFTS

 

current regimen: 1.25mg finasteride every other day

 

My Hair Loss Weblog

 

Disclaimer: I'm not a Doctor (and have never played one on TV ;) ) and have no medical training. Any information I share here is in an effort to help those who don't like hair loss.

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