Question About a Megasession Procedure

[TomA]

I've heard that megasessions (4000-4500 grafts) can take 8-10 hours.

 

My question is about physician fatigue vs multiple physicians.

 

Are there normally other physicians that assist in the procedure? I was told by one doctor that there are actually assistant doctors as well as nurses and surgical assistants that "take turns". I'm not sure who takes turns with whom, but I assume that the other docs may assist with the actual surgery while the nurses and surgical assistants take turns with one another.

 

Can one of you experts that has actually had a megasession please tell us how this went for you?

[TomA]

I've heard that megasessions (4000-4500 grafts) can take 8-10 hours.

 

My question is about physician fatigue vs multiple physicians.

 

Are there normally other physicians that assist in the procedure? I was told by one doctor that there are actually assistant doctors as well as nurses and surgical assistants that "take turns". I'm not sure who takes turns with whom, but I assume that the other docs may assist with the actual surgery while the nurses and surgical assistants take turns with one another.

 

Can one of you experts that has actually had a megasession please tell us how this went for you?

[Bill - Seemiller]

TomA,

 

Great question...

 

Yes, they can certainly take between 8-10 hours depending on the session size and size of the staff.

 

Typically only one physician does the work from my experience, however...

 

The longest part of the procedure is placing the grafts into the recipient sites. Since the technicians typically place the grafts (not the physician), many times they rotate technicians while others take a break.

 

Fatigue therefore doesn't become as much of an issue for the clinic, at least, no more than smaller sessions...but fatigue can become an issue for the patient since you will be sitting for a long time .

 

Hope that helps.

 

Bill

[TomA]

That's much different that what I expected--wow I'm really glad I asked! Assuming I do this, I might have freaked out if the physician walked away in the middle of things!

 

Does that mean that the lead Doc cuts out the donor area and sews you back up?

Then someone else takes that "strip of flesh" (ick) and cuts out the follicles.

Does the lead doc then make the incisions for the grafts? And then the tech puts the hairs into the "slits"? How does the tech find all of those tiny slits? Or does the tech make the holes, too?

 

I wouldn't normally ask something like this, but I've noticed that you do already do tutorials--can I make a suggestion for one? Could you walk us through what we might expect on a treatment day from beginning to end? It looks like you've had three different docs, including one megasession, so your perspective on this would be very valuable to me, and I suspect others as well!

 

But fatigue can become an issue for the patient since you will be sitting for a long time

Well hopefully my "experience" with 15 hour flights to Hong Kong will allow me to breeze right through it... though I suppose they won't serve cocktails!

[Bill - Seemiller]

TomA,

 

I'm glad I could help.

 

I will certainly do my best to answer your question. I can write, at some point, a general tutorial for this based on my experience (actually I am pretty detailed on my surgery experiences if you click on the links below), however, all clinics operate slightly differently. But your suggestion is a good one, so I'll add that one to my list when I have time . So here are the answers to your quesitons more specifically:

 

What the doctor typically does in a Strip surgery:

 

1. The initial consultation

2. Drawing of the hairline and planning where to place the grafts

3. Apply the local anesthetic (sometimes a lead tech or nurse will do this)

4. Remove the donor strip

5. Make all the recipient sites using magnification (recipient sites made determine the direction of hair growth, not the placement of the grafts themselves)

6. Come in to check up on you

 

What the techs (typically there are at LEAST 5 of them) typically do in a Strip surgery

 

1. Cut the hair follicles/grafts from the strip using magnification

2. Assist in counting of the recipient sites being made by the doctor (sometimes the doctor counts, sometimes you the patient helps)

3. Placed the cut grafts into the recipient sites made the the doctor using magnification - that's how they can find the recipient sites. (Sometimes there are up to 4 techs doing this at one time - sometimes only 1 - the more working at one time, the faster things will go).

 

There are SOME doctors that allow a lead tech to assist with making the recipient sites...but this is not common place at this time.

 

Regarding cocktails...I suppose if you took first class you'd be served...but since you can't drink before your surgery, I guess you'll have to settle for juice

 

Bill

[Janna]

Bill, I hope you don't mind if I disagree with couple points you have made in your responses.

 

As much as I enjoy most aspects of my job, and I truly enjoy planting the grafts, but I have to admit that "fatigue" has indeed become a major factor with the recent phenomenon of "mega sessions". I read on one of the photo albums that a patient's surgery took 16 hours, I thought about that clinic's next day patient as well as their techs. I will also admit we have had patients at our clinic for around 12-13 hours. Don't kid yourself that a session of 4000 to 5000+ grafts takes only 8 ??“ 10 hours, or that "fatigue" applies to only the patient. I think if a surgery is being done within 8-10 hours for the number of grafts being discussed here, there's something amiss. Quality of the procedure is most likely compromised.

 

The most we can fit around a patient at one time is three techs. This is for only a portion, then it does down to just two planting as to avoid getting in each other's way (the third is always squeezed out). The head is only so big. I think if you check with the top techs that have been around for many years, they will admit this type of work will take its toll on their bodies. It has nothing to do with how much they care about their job or care about their patients.

 

TomA, I think you brought up a real legitimate concern. Being the manager of our techs, the hardest part of my job couple of years ago was getting enough hours to all of the full and part time techs. Now, a rotation of "late techs" has to be implemented to cover the late hours. So now those same techs welcome a day off. To give each patient the kind of service he deserves, whether they're getting a relatively small procedure of just hairline work or a full mega session, you cannot cut corners. Even as a tech, cutting and planting is painstaking work, especially if you're doing it for 8+ hours. There's no secret, or magic to quality, it's simply honest, hard work. I'm not wearing the doctor's shoes to speak of their fatigue factor, but it's reasonable to say they have to experience it.

[Bill - Seemiller]

Janna,

 

Of course I don't mind that you disagree...we are all entitled to our opinions . Besides...you ARE in fact in the front line as a tech, so you would know more than me what YOU feel and what you don't feel.

 

Fatigue is a very human thing, and certainly everyone has different points where they reach the state of being fatigued.

 

I would argue, however, that fatigue is different from being tired....or at least, a more extreme form of tiredness. I believe when someone reaches a state of fatigue then personally, I feel that they should not work anymore since it can affect their performance in their job...whereas people who are tired can still work but maybe a bit more slowly.

 

This is why breaks and rotations are extremely important for extremely long sessions.

 

Bill

[Rhodeman]

When I had my recent procedure with Dr. Wong, the techs [at least 4] would relieve each other to provide a break when necessary. I'm guessing that it would be tough to consistently work mega-sessions without this rotation.

[Janna]

We rotate and take breaks as well. I'd like to know just how many clinics keep their full staff for the full duration of the surgery. You'll find after a certain number of hours or after a certain time there are fewer number of techs remaining. Maybe you don't realize it so much when you are working on a patient at that immedidate time, however, as soon as you get home, you're pretty wiped out. After awhile it has to take it's toll. This is one of the reasons why we space our mega session out.

[Bill - Seemiller]

Janna,

 

I'd like to know just how many clinics keep their full staff for the full duration of the surgery.

 

 

That's a good question...obviously every clinic would probably have a different answer...however...

 

Personally, my third surgery took about 12 hours and the last 3 hours only 2 techs and Dr. Hasson were left working with me. Of course, it was also nice to have Joe there to talk to as I was getting operated on later in the evening.

 

But certainly there was some rotations of techs so they could take their breaks.

 

I am certain that everyone was tired though...a long day is a long day...no doubt about that.

 

But fatigue can be serious...and I'd like to think that the physicians and/or techs are NOT to the point of feeling fatigue while they are working since it could impact performance.

 

One thing I can say is the results yielded from Hasson and Wong and Shaprio Medical (as well as other clinics) doing megasessions certainly haven't been affected as a result of anyone's inability to work...so I guess all is well . But certainly each clinic should have some sort of fatigue plan for these longer sessions, so in the event of a problem, somebody can be relieved and replaced to finish the surgery.

 

Bill

[MrJobi]

Hi

 

Fatigue is a subjective topic.. What one person thinks is painstaking might be "normal" for another.. I had 3 techs working on me during my last HT odf 2124 and it took about 8 hours. I would think your eyes and hands get a bit tired. My old girlfrieds mother was a dentist and had to retire at 40 due to problems with her hands so this is a legit concern

[Guest]

Good luck, TomA. I will follow your transplant avidly.

[TomA]

Jenna,

 

What is the minimum time that 4000 grafts would take at Dr. Shapiro's office?

[Janna]

TomA,

 

There are number of factors to consider when estimating session time, but most likely between 10 to 12 hours.

 

In regards to "fatigue" or "tiredness", you are correct Jobi when you said it's subjective. Some people may consider it the same thing. We do have a rotation when we have the full staff for breaks, and we have a rotation each day for those who will complete the surgery. If it turned out the two tech's stayed really late the night before, they will be able to leave early the next surgery day.

 

We have more techs on staff than most clinics. We've always been on the side of "more is better" for staffing. It's just that now it seems having 7-8 full timers is no longer adequate since session sizes are bigger.

 

I guess I misunderstood Bill when he responded to TomA. I understood it as no one got "tired" during the mega sessions except for the patient.

[TomA]

Ok, the Doc I am considering estimated about 10 for 4000 so that's in the low end of your ballpark. He said that around 4500 took 11, too, so again that seems about right.

 

(Their team is 12 people.)

 

Thank you VERY MUCH for your input, Janna!

[Janna]

No problem, TomA.

 

Staff of 12 techs are all working on you only, right? That's great for the cutting of the grafts, but the placing/planting is different since you can only max out at 3 techs at one time. But you certainly have more people to rotate with. You'll find at most clinics that there is a variation to the skill levels of planters and cutters. It would be nice if everyone posessed the same.

 

Which clinic are you going to?

[hairbank]

TomA,

 

Great questions and great discussion by everyone. I'll relate my personal experience.

 

Arrived at H&W and met Dr. Wong around 6:30am. I had not consulted with him before but rather with Mike Ferko via internet pics through email and talking on the phone. Most of my work was in the crown with some filling in other areas.

 

<UL TYPE=SQUARE><LI>Talked strategy with Dr. Wong<LI>Brought out the clippers, clipped down hair on top of my head leaving me with the dreaded "clown hair" on the sides<LI>anesthetic applied to donor area<LI>cut and harvest donor strip & close (this took around 1 hour)<LI>restroom break.....asked Master Wong if I could bend down to look where I was aiming as back of head was tight.....he smiled and said no problem....whew!!<LI>back in the chair, anesthetic applied to recipient areas<LI>Told Doc Wong by head felt akin to a block of wood<LI>Doc Wong started cutting slits.......I have poor hearing but could still hear the little "crunch" sound it makes<LI>several techs in the room dissecting grafts....tech started placing grafts<LI>lunch break...food from restaurant below was wonderful<LI>enough of crown done to lay on back........watched The Matrix, Reloaded, loved it!<LI>more incisions from Dr. Wong<LI>tech's switched of 2-3 times placing the grafts as I could tell it got tiring for them after awhile<LI>finished up around 4:30, got my blue H&W cap, headed for Granville Island Hotel, watched TV<LI>Took T3, I believe, more preventative than anything, I really felt no measure of pain<LI>keep getting out the mirror to look at the whirl in my crown.....amazing!<LI>got up early and went to H&W for my first cleaning of the grafts<LI>caught a plane for home<LI>The End

 

 

BTW, I had a 4-hour flight followed by a 4-hour drive............no problem.........just made sure i didn't bump the grafts at any time entering/exiting the plane and vehicle.

 

Wonderful time.................as Jotronic once mentioned I had a bad case of "perma-grin" going on while in the chair...........I'm not sure it ever went away

[TomA]

Originally posted by Janna:

No problem, TomA.

 

Staff of 12 techs are all working on you only, right? That's great for the cutting of the grafts, but the placing/planting is different since you can only max out at 3 techs at one time. But you certainly have more people to rotate with. You'll find at most clinics that there is a variation to the skill levels of planters and cutters. It would be nice if everyone posessed the same.

 

Which clinic are you going to?

 

 

Dr. Pathomvanich, who apparently uses 2 assistant doctors, 3 nurses and 6 surgical assistants (the surgical assistants probably rotate).

[TomA]

HB: Thanks for everything except this...

 

Originally posted by hairbank:

]Doc Wong started cutting slits.......I have poor hearing but could still hear the little "crunch" sound it makes

 

Ugh!

 

++Shudder++

 

I might pass out over something like that!

[Bill - Seemiller]

TomA,

 

Sorry bro...but it is true. You won't feel anything, but you will hear crunching.

 

Bill

[hairbank]

Originally posted by TomA:

HB: Thanks for everything except this...

 

Originally posted by hairbank:

]Doc Wong started cutting slits.......I have poor hearing but could still hear the little "crunch" sound it makes

 

Ugh!

 

++Shudder++

 

I might pass out over something like that!

 

I actually thought it was kind of cool !!

 

TomA - Just think of the hairs that will soon be filling those areas...........should make any butterflies in your stomach exit quickly!

 

Seriously............I was so psyched that I was going to have hair covering my crown again I did have a serious case of perm-a-grin going on the whole time. The whole experience for me was exciting!

[Bill - Seemiller]

I actually thought it was kind of cool !!

 

LOL...only you Hairbank . I thought it was definitely strange...knowing my head was making that noise. But the fact that I'd have a good head of hair when i was done DEFINITELY detered my thoughts

 

Bill

[Janna]

By and large, patients seem most apprehensive about donor strip harvesting. It's too bad there's no getting out of hearing crunching of celery or styro-foam, not to mention all the little crunch sounds during incisions. Despite all that, it's amazing how quicky the patient forgets and is relaxed enough to enjoy rest of the procedure.

[sanjayahair]

I am interested to do this mega session but cannot find a doctor in Texas who does the mega sessions. I will travel but I dont want to if I can find a physicin in Texas who does the mega sessions. Thank you.

[Bill - Seemiller]

sanjayahair,

 

LOL...nice name.

 

You may want to consult with Dr. Bradley Limmer or Dr. Bobbie Limmer as they are in TX. Personally, I have not seen much by them, however you can see the below link to read Pat's review and see some photos of a surgery I believe he witnessed:

 

http://hair-restoration-info.com/eve/forums/a/tpc/f/209...431000313#9431000313

 

HOWEVER, I have two things to say.

 

1. Currently I have some reservations about both of these doctors as they to date remain affiliated with a malicious site attempting to disempower patients. Details of this are being worked out as we speak but we are unsure of whether or not they will remain affiliated with the site.

 

2. It would be in your best interest to select doctors based on their ability to perform and NOT location. I understand it is everyone's preference not to travel...BUT...some minor inconvenience of travel to a lifetime commitment of new hair seems pretty worth it to me

 

Bill