Dr. Sharon Keene offers 5,000 FU Megasessions

[Robert_]

Dr. Sharon Keene has started scheduling patients for procedures of up to 5,000 grafts in a two consecutive-day surgery session. Dividing this super megasession into two days allows her to continue her hands-on approach. Dr. Keene participates in every aspect of the surgery; from making the incisions to placing the majority of the grafts herself. This method is extra-laborious for Dr. Keene, but gives patients faster and more refined results than ever.

 

 

One of Dr. Keene's recent patients is showcased in a photo album here.

 

This patient recieved 4,317 follicular-units transplanted over the course of two days. The breakdown consists of 2,195 FU's to the frontal region and 2,122 to the mid-frontal region and crown, totalling 4,317 grafts.

 

Limited scalp laxity and donor-area density prevented Dr. Keene from harvesting as many grafts as she would have preferred. Under more ideal donor hair characteristic conditions, she would have provided a more dense coverage for the entire recipient area. Do to this limitation and the patients' wishes, she concentrated the density more in the hair line and forelock areas. Donor hair availability varies greatly in patients. The two most important factors are scalp laxity and donor hair supply.

 

The bottom patient photos are at only 8 months post-op. This procedure can be considered "mature" at 12 months post-op. Stay tuned for the 12 month post-op photos when the become available.

 

 

-Robert

[Robert_]

Dr. Sharon Keene has started scheduling patients for procedures of up to 5,000 grafts in a two consecutive-day surgery session. Dividing this super megasession into two days allows her to continue her hands-on approach. Dr. Keene participates in every aspect of the surgery; from making the incisions to placing the majority of the grafts herself. This method is extra-laborious for Dr. Keene, but gives patients faster and more refined results than ever.

 

 

One of Dr. Keene's recent patients is showcased in a photo album here.

 

This patient recieved 4,317 follicular-units transplanted over the course of two days. The breakdown consists of 2,195 FU's to the frontal region and 2,122 to the mid-frontal region and crown, totalling 4,317 grafts.

 

Limited scalp laxity and donor-area density prevented Dr. Keene from harvesting as many grafts as she would have preferred. Under more ideal donor hair characteristic conditions, she would have provided a more dense coverage for the entire recipient area. Do to this limitation and the patients' wishes, she concentrated the density more in the hair line and forelock areas. Donor hair availability varies greatly in patients. The two most important factors are scalp laxity and donor hair supply.

 

The bottom patient photos are at only 8 months post-op. This procedure can be considered "mature" at 12 months post-op. Stay tuned for the 12 month post-op photos when the become available.

 

 

-Robert

[Gorpy]

I also think the results are impressive based on the severity of this guy's hair loss and the limited donar supply.

[Bonzo]

You can't go wrong with Dr. Keene's tallent-Bonzo

[ElectraGlide71]

Very impressive surgery approach with the pictures to prove the results. I'm envious, if not downright jealous. Electraglide

[damo]

Rob the pics are impressive considering he was that bald!

 

Damo

[Smoothy]

with due respect to Dr. Keene who has been trained under some of the best in Shapiro and worked with Rose and others-- I do not agree to these large megasessions.

This is just my opinion based on years involved as well as knowing 5-6K megasession patients compared to other patients with 5K over several HT over severl years and their respective apperance outcome 5 years later.

 

The first problem with large sessions like 5K, is blood supply to the grafts for survival (although with micro FU, it is not as a problem as past, still grafts still are lost due to large number vying for survival). They are too close together so over a large area, more risk.

The donor area must be stretched beyond what is normal, thus resulting in more shock loss and wider donor scaring (usually).

Finally, some doctors do these large megasessions and disect the FU's into 1-2 hair and do not get many 2-3-4 hair grafts-- Thus making more $$$$ at the patient expense.

 

This is just my experience--and The patients I know w/large megasessions after 5-6 yrs have a "thinner" apperance than people I know with the same # of FUs over several surgeries.

 

3500 is probably toward the high end of HT staying in the "safe zone" limited survival risk and donor scarring-- Just my opinion

[Pat - Community Publisher]

Smoothy,

 

I do share many of your concerns about these mega mega sessions. Many surgeons who have more than enough surgical assistants to do 5,000 plus graft cases do not do so because they are reluctant to remove more donor than they feel can be safely removed.

 

I tend to agree with surgeons like Dr. Ron Shapiro, Dr. Jeff Epstein and many other top notch surgeons who believe that it is generally not wise to remove donor strips that are wider than 1.5 cm.

 

Thus while these surgeons will take long narrow strips they are generally still limited to about 3,500 grafts per session as they do not want to take wider strips and risk unacceptable donor scarring.

 

Their graft counts also tend to understate the total number of hairs actually transplanted because they will often use "follicular families" (a graft made of a couple of follicular units that are very close together)to create better density in the mid scalp regions.

 

On the other hand some clinic regularly cut three and four hair grafts into 1 and 2 hair sub follicular unit grafts that make the graft count sound more impressive when reported online.

 

I really think it would be much more accurate for patients to discuss these issues in terms of the total number of hairs transplanted rather than grafts, which often are apples and oranges depending on the clinic cutting the grafts.

 

The top clinics all use the same single bladed scalpel for donor removal and none use a magic wand that enables them to safely remove more donor tissue than another clinic. They all face the same donor area limitation. Those that push the outer limits push the outer limits of safety.

 

As a patient whose biggest session was 1,450 grafts I think cases of 2,500 to 3,000 are very impressive, especially given that these graft counts often include "follicular families" that provide more hair and density. These cases may not grab headlines online. But I think they are the way to go for most patients unless they happen to have exceptional scalp elasticity and density in the donor area.

 

Pat

[Pat - Community Publisher]

Dr. Keene's office asked that the below response to my above comments be added to this thread -

 

Pat,

 

I read your post indicating your concerns regarding megasessions over 3500 grafts. Please also have this posted to address those concerns.

 

I want to assure you that Physician's Hair Institute does not split follicular units. The grafts are cut according to their natural groupings into 1, 2, 3 and 4 haired follicular units. Hair density is a factor in the way the hairs bundle, i.e, numbers of hairs per graft. If it is low, possibly yielding too many ones, than Dr. Keene does request follicular families. It is important to note that it is actually harder to cut follicular families of a sufficently small size to be considered a micrograft when the patient has had multiple surgeries. There are cases where Dr. Keene has cut the 1 haired graft numbers that the patient was charged for in half, because that was what the donor yielded, but she did not feel that the patient should be charged for every one.

 

You are right that some clinics split follicular units to meet the numbers of grafts that a patient requests, but Physician's Hair Institute is not one of them. I have worked at a clinic where doctors did indeed request that we cut down the larger follicular units routinely to meet the numbers of grafts expected, and that was for one day cases, but Dr. Keene is not one of those doctors. Dr. Keene informs patients if the number of grafts we aimed for is not met, and refunds the difference. Patients are told in advance, especially for the two day megasession, that this may occur.

 

In regard to the blood supply issue, this is not applicable. As noted, this patient recieved 4317 grafts to cover 252 sq cm, so that averages to about 18 grafts per sq cm. More coverage was created in the frontal area to create the illusion of density, so that the grafts per sq cm was higher there and lower in the crown. But obviously the grafts were not so tightly packed as to risk compromising the blood supply. In addition, the smaller blades used today also decrease this risk, even in cases where the grafts are tightly packed.

 

In regard to the potential for a more visible scar in the suture area, when a consecutive day megasession is scheduled, Dr. Keene takes the amount of donor she considers safe based on scalp elasticity to avoid making the closure too tight. She also uses a double suture closure (an external nylon layer and an internal dissolvable suture) when closing the donor area, which allows greater tension without spreading than a single layer of suture. However, as you pointed out, a tight closure can result in a widened scar in the suture line. Thus, only certain patients are candidates for the consecutive day megasession, and this is assessed in the patient consultation. Dr. Keene does not recommend it for every patient, and every patient at Dr. Keene's office is assessed by the doctor on an individual basis.

 

Although we don't routinely take pictures of the suture line, we will obtain some when next our CDS megasession patients have follow up appointments so you can see the results for yourself.

 

Thanks, Pat, for presenting both sides of the issue, to keep patients and doctors informed. But if you think a technique we send to you is not advisable, based on medical opinions from other MDs who have not done the procedure, than please alert us to that fact so we can address your concerns immediately.

 

Finally, results speak for themselves. We will keep you posted as we obtain more photos for our consecutive day megassesion surgeries.

 

Sincerely,

 

Lisa,

Medical Assistant to Dr. Keene in AZ

[Gorpy]

Yes, this is exactly why I think I have made the right decision to go with Dr. Keeene. :-).

[GuitarPlayer]

Does Dr. Keene take two seperate strips in two days? In other words, one strip on the first day and then another strip on the second day. I have always read that one should wait at least six months or so before doing another strip procedure. Or does she take one very large strip on the first day?

[Hairtechnician]

Hi GuitarPlayer,

 

Dr. Keene takes one continuous strip from the donor area, but half of the strip is taken from one side of the donor area on the first day, and the other half from the other side on the second day"??? the donor strip is joined in the middle leaving a single line of scar, the same as a single day surgery would provide.

 

The reason for the usual recommended six month wait between surgeries has to do with a number of factors. A very important one involves the recipient area where the grafts were placed, and not where the hair was removed. Typically, the newly transplanted hair will go into shock, causing the hair shaft to fall out from between 2 to about 6 weeks after surgery, although the root remains behind. Then, depending on each individual's growth rate, the new hair will start to emerge about 3 months after surgery. Hair goes through different growth stages, and not all of it is in the same cycle simultaneously, so hair continues to emerge for about 8 months. Further density occurs due to the hair shaft getting thicker for up to a year. At any rate, at about six months, the doctor can once again see where the newly growing hair is located in the recipient area, allowing him or her to transplant additional hairs in between, while avoiding transecting existing hair follicles.

 

Another reason for the six month wait is because the strip on a subsequent surgery is typically taken from the same area as the previous donor strip to minimize scarring. Consequently, it must be very well healed before additional donor is taken. While suture can be removed after only a week with a double closure, the skin does continue to heal for months. Depending on the width of the original donor strip, it will take many months for the scalp to stretch out and allow for another strip to be excised from the same area.

 

In the case of consecutive day surgery, the second part of the strip is removed on day 2 from an adjacent area, not the same area, therefore issues of donor elasticity and scar tissue do not exist...it is as if it has been removed in one strip, except the hairs have been allowed to remain safely in their own ??habitat' overnight. The supermegasessions that are the catalyst for the consecutive day surgery necessitate a wider strip, usually from 1.5 ??“ 2.0 cm in width across the back of the head, in order to yield the thousands of donor follicles for transplantation. This is the same total width that would be necessary if it were removed 6 months apart in 2 different surgeries.

 

Dr. Keene would agree that if you are having a second surgery with months in between, then you should wait for 6 to 12 months before getting an additional surgery.

 

This was probably more detail then you wanted but hope it answered the gist of your question.

 

Just a little about my background. I have been a medical assistant to Dr. Keene exclusively for the past 4 years, and before that assisted in surgery for a number of different doctors and clinics around the country.

 

Lisa (assistant to Dr. Keene in AZ)

[Robert_]

Thank you, Lisa, for taking the time to reply to this thread and to clear up any confusion regarding Dr. Keene's procedures.

 

-Robert

[GuitarPlayer]

Thanks for the reply Lisa. Is the reason for doing a 5000 graft session in two days as oppossed to one have to do with the amount of technicians on hand or is there another reason? I noticed you wrote that the strip is typically 1.5-2cm wide. I believe I read one of the moderators on here post that docs like Ron Shapiro and Jeffrey Epstein do not take strips more than 1.5cm because they believe it produces a wide scar. What has Dr. Keene's experience with this been? Thanks.

[Smoothy]

I appreciate the insight to opposite views as express by Dr. Keene's assistant. I still feel that 4-5K grafts in the hairline and frontal core/midscalp in a single session is too much and graft survival risk increases, now if the crown is also included then the area of coverage increases thus limiting survival risk. I guess the key is "packing" as long as graft packing isn't used (which the grafts have to fight for adequate blood supply due to close placements)- then it might not be an issue.

[Hairtechnician]

GuitarPlayer,

 

I addressed the scar concern in the post above--only certain people are candidates based on scalp laxity. The scars have been minimal, but as I stated we don't have photos. We will obtain them in the months ahead.

 

Regarding why we schedule the super megasession surgery for 2 days: Dr. Keene has 10 assistants, but she does not choose to turn all the placing over to them. She only does one case per day and does not intend to change that in the near future. She prefers to do much of the placement herself, taking part in the surgery from start to finish. If you want more detail on why, or have further questions, you can look at her website, or schedule a consult with her.

 

Additionally, most doctors and clinics would agree that 3000 grafts in a day, regardless of the number of assistants, and even if the doctor turned all of it over to his or her assistants, is a full day of surgery. To avoid prolonging it to 12 hours, she prefers to split up super megasessions.

 

Most of her surgeries are single day surgeries doing up to 2500 grafts. We just wanted people to know they had another option.

 

I don't plan to become a regular poster, so please do contact our office if you have further questions.

 

Best,

Lisa

[SorleyBoy]

Smoothy

I'd have to concur with your 'graft packing' statement. I had 2,500 grafts placed throughout front AND crown (By Dr Keene by strange co-incidence) this should give a relatively low/moderate density at maturity, BUT . . . in terms of graft survival I would have to say that, almost a month after the procedure - I 'guestimate' that only 8 - 10% of the hair implanted has so far been shed. The remainder has continued to grow and is now some 3/8" long in most areas. . . . Possibly an argument for less dense coverage? Nonetheless this phenomenon might re-inforce your 'blood supply' theory (not to say of course that it's just a physiological function peculiar to me).

 

Sorleyboy