'Mega' Session or 'Average' Session?

[Dewayne]

As I've researched, a couple of conclusions regarding the mega vs. average session. I've had three recommendations (two for 2500 graphs and one for 4000):

 

1-Either there is a philosophical difference in what different docs believe about the shock loss, or what your donor area can produce, or

2-Some clinics like to do average sessions, and some like 'mega's', depending on staffing, endurance, etc.

 

Do the 4000 graph sessions tremendously increase a risk? Are two 2000 sessions, spaced a couple years apart better / worse than one 4000?

[thanatopsis_awry]

Docs who do the more "aggressive" sessions do not beleive there is an appreciable increase in the risk of permanent shockloss, or risk in general...when, of course, the sessions are being carried out by a surgeon of the highest skill, with tools of the most fine-tuned nature, with a large enough staff of the highest caliber, and on the patient with the right charachteristics.

 

I made a thread just yesterday about the differing graft quotes from clinic clinic that got some good feedback.

 

Not everyone can get an "aggressive" "mega"-sized session; but, if it is *most* appropriate for you, it is to your disservice if you don't at least try to get it, imo....your physiology, of course, can be a dealbreaker, but that won't be fully known till' the op.

[Dewayne]

you're right, that was an interesting thread. While 2,500 is a sizable session, I've learned, I worry it just might make an average 8 hour day and that's the popular size.

 

Then again, I don't want to go do 4000 if there is a greater risk of some sort by stepping it up.

[Bill - Seemiller]

Dewayne,

 

The bottom line is, the larger the hair transplant session, the more adequate coverage and density you can achieve in a single session.

 

The physicians that quoted you 2500 may believe that you only need that many to give you adequate hair coverage and density. The other physician may be attempting to go beyond that to give you the greatest appearance of fullness possible.

 

It is also true that some physician's aren't comfortable excising strips as wide or as long as other clinics. Each physician could give you a long list of the benefits and risks of removing a wider longer scar in a single session.

 

Though this does not replace a physician quote, feel free to use our animated graft calculator which can help you determine how many grafts you might need.

 

Best wishes,

 

Bill

[Byehair]

the graft calculator doesn't seem to be working too well.

It automatically clicks on Zone 2 & 3.

 

what is up with that?

[TheHairLossCure]

What sort of risk are you talking about? To my knowledge there is no data to suggest that a 2,000 graft session grows/survives better than a 4,000 graft session. As far as the scar, yes, removing twice the amount of tissue might increase the risk of a wider donor scar. There are way to limit this risk though.

 

There can be solid arguments for either plan really. The real question is, how many grafts do you need given your donor hair quality and your specific expectations. You are probably not going to get the answer from a graft calculator (though it can be a good conceptual tool). Have you asked the two clinics about the rationales for their respective recommendations?

[Bill - Seemiller]

Byehair,

 

You are probably in introduction mode. Click "Skip Intro" to utilize the graft calculator.

 

Bill

[Dewayne]

Originally posted by TheHairLossCure:

What sort of risk are you talking about? To my knowledge there is no data to suggest that a 2,000 graft session grows/survives better than a 4,000 graft session. As far as the scar, yes, removing twice the amount of tissue might increase the risk of a wider donor scar. There are way to limit this risk though.

 

There can be solid arguments for either plan really. The real question is, how many grafts do you need given your donor hair quality and your specific expectations. You are probably not going to get the answer from a graft calculator (though it can be a good conceptual tool). Have you asked the two clinics about the rationales for their respective recommendations?

 

Actually, after I posted this I called Dr. Glen Charles on his cell (he answered all my questions on his way home in the car with his family).

 

I would hate to try and quote him but basically he said it was more a matter of philosophy and the potential to have a larger donor scar. His preference is a max size of about 3500, if I remember correctly what he said.

 

Also, there might be a better yield percentage at 2500 rather than 4000. Ex. If you cut 2700 and get 2630 to live, comapared to cutting 4000 and having 3650 to grow - the 2700 would be better.

 

But, he said there are excellent results with docs doing the mega sessions as well. He's been very complimentary of every doc I've mentioned.

 

That's good, because it's quite a turnoff when someone takes a shot at another clinic - to me anyway.

[thanatopsis_awry]

Re: donor scar....I was recently told (and I think it was posted somewhere, as well) that H&W beleive that a larger excision strip can actually be conducive towards less scar stretching.

 

As for yield, it should be just as superb @ 4k as @ 2k with any number of the elite clinics doing such sessions.

[Byehair]

thanks Bill

[spoon]

Originally posted by Dewayne:

As I've researched, a couple of conclusions regarding the mega vs. average session. I've had three recommendations (two for 2500 graphs and one for 4000):

 

1-Either there is a philosophical difference in what different docs believe about the shock loss, or what your donor area can produce, or

2-Some clinics like to do average sessions, and some like 'mega's', depending on staffing, endurance, etc.

 

Do the 4000 graph sessions tremendously increase a risk? Are two 2000 sessions, spaced a couple years apart better / worse than one 4000?

Dewayne - good questions. First of all there are philosophical differences between clinics about things like session sizes and dense packing. Keep reading and researching and you'll quickly learn what those are.

 

Risk isn't really an issue at top clinics and generally speaking it's always better to get as much done as possible in one session. Less downtime, less overall cost. You should know though that a megasession, even 2500 grafts, is a long, long day.

 

However one big philosophical difference can be the question of what constitutes a graft. Unless you know the average graft size of the clinic, on average, over the course of many surgeries, you aren't comparing apples to apples.

 

It has become very clear to me over the past three years or so that the "2.2 - 2.3" hairs per graft benchmark is no longer accurate in many clinics. I am not accusing anyone of sub-dividing FU's however it is very apparent to me (not so much to some others) that different clinics have different ideas of how big, on average, grafts are. I don't think the basis of these distinctions is money, incidentally.

 

By way of example, if your 2500 graft session has 2.2 hairs per graft, you'll get 5500 hairs. If your 4000 graft session has 1.7 hairs per graft, you'll get 6800 hairs. Now, 4000 grafts is 60% more grafts than 2500 grafts. But 6800 hairs is only 24% more hairs than 5000 hairs. To put it another way, if the clinic that estimated 4000 grafts (6800 hairs) was able to generate 2.2 hairs per graft, your session would really be 3091 grafts, which doesn't sound that far off from 2500, does it?

 

Personally I have seen surgical results with reported hairs per graft as low as 1.5 or 1.6. At the other end of the spectrum, particularly with doctor's using coupled FU's, hairs per graft can exceed 2.2 or 2.3.

 

The challenge is to get the data.

[NervousNelly]

Good advise Spoon.

[balody]

excellent spoon,as pat says "count hairs not pizza"

[Bill - Seemiller]

Nicely worded and good advice by Spoon.

 

Overall I agree.

 

The other variable to take into consideration when evaluating graft/hair counts is patient hair characteristics. Some patients simply don't have the average of 2.2 or 2.3 hairs per graft because of their greater number of 1 and 2 haired grafts. On the other hand, some patients have a greater number of 3 and 4 haired grafts exceeding the average of 2.2 or 2.3.

 

That is why, when evaluating the average number of hairs per graft per clinic, one must look at a great number of patients and not draw conclusions based on one or two alone.

 

But as spoon said, the challenge is getting the data.

 

Balody,

 

Hahaha! I don't think that was an exact quote

 

Bill

[Agio]

Originally posted by Bill:

Nicely worded and good advice by Spoon.

 

The other variable to take into consideration when evaluating graft/hair counts is patient hair characteristics. Some patients simply don't have the average of 2.2 or 2.3 hairs per graft because of their greater number of 1 and 2 haired grafts. On the other hand, some patients have a greater number of 3 and 4 haired grafts exceeding the average of 2.2 or 2.3.

 

Bill

 

This sir is why you are the moderator and worth every penny of the 2.75 an hour Pat pays ya

Possibly one of the most overlooked issues when people are exploring surgery is as you stated, hair characteristics.

I think many sites, logically, use pictures of their 'ideal' patients hence why a persons own research is so important including viewing the hairloss blogs.

To get the 'wow' effect in a single HT seems everything needs be in perfect alignment, including the stars and you need to have sacrificed a goat prior to the surgery.

I know in my case the yield was 2 times less of 3 hair grafts as opposed to singles, just the way my hair is. Of course I was too cheap to spring for a goat, used a gerbil instead...

[Bill - Seemiller]

Agio,

 

Thanks bro .

 

And hair characteristics play an even bigger role than I've defined above. Hair thickness and color can also play a significant role in the outcome of the result. Typically those with thicker hair and less contrast between their scalp and hair will be able to achieve a greater illusion of fullness and density with lesser amounts of grafts/hairs than those with thinner hair and a greater color contrast.

 

Cheers,

 

Bill

[Agio]

Welcome. Yes it is true and even though I've yet to post about my experience with Nakatsui, primarily as I want to wait and see even though the technical side was fine one of the keys with me choosing him was the consults prior and we addressed all of these issues. I think consults are under-rated. I personally put more import on them than the surgery itself assuming one has picked a top notch surgeon.

Hair thickness, color, density, scalp laxity , top notch surgeon and team and on and on and on have so much to do with the end results.

I consider this site to be a great help in assisting people with those questions as you have people contributing their experiences be they good or bad.

Many 'surgeons' prey on the weakness of people losing hair and tell them what they want to hear and jacking their expectations to the moon.

[spoon]

Originally posted by Agio:

I know in my case the yield was 2 times less of 3 hair grafts as opposed to singles, just the way my hair is.

 

I think that the discretion and philosophy of the clinic in determining graft size is being underestimated.

 

Your specific yield of singles/doubles/triples is largely dependent on how your clinic cuts grafts. You might have had a very different distribution at another clinic.

 

This is why we turn to statistics and if clinics were willing, they could each show very easily what the average distribution is when they perform surgeries. They could even categorize them by ethnicity which would really provide some insight.

 

It is my very strong opinion that certain clinics systematically perform surgeries with fewer hairs per graft than other clinics. By systematically I mean it is their philosophy and practice to cut grafts smaller than other clinics might. A statistical analysis would demonstrate fairly conclusively whether this is true or not.

[NervousNelly]

Spoon,

 

I fully agree with what you are saying, but there are those that have slightly less 3 and 4 follicular units.

 

Take me for example. I have what appears to be quite dense donor hair, yet my yield was an average of 1.9 hairs/fu. Even though my donor is estimated to be almost 100fu/cm2, it would take a larger strip to harvest a lot more hairs than average. I am kind of a different case as it appears like I just have more 1 and 2 hairs per fu. Damn.

[spoon]

Originally posted by NervousNelly:

 

I fully agree with what you are saying, but there are those that have slightly less 3 and 4 follicular units.

 

Take me for example. I have what appears to be quite dense donor hair, yet my yield was an average of 1.9 hairs/fu. Even though my donor is estimated to be almost 100fu/cm2, it would take a larger strip to harvest a lot more hairs than average. I am kind of a different case as it appears like I just have more 1 and 2 hairs per fu. Damn.

I completely understand that this can happen in a one-off case. But the main point I am trying to make is that these kinds of questions are ideally answered with statistical techniques.

 

With large enough stratified samples we can get a very good understanding of where different clinics fall on the "hairs per FU" map and what their philosophy is regarding how small grafts should be cut.

[Agio]

I think that the discretion and philosophy of the clinic in determining graft size is being underestimated.

 

Your specific yield of singles/doubles/triples is largely dependent on how your clinic cuts grafts. You might have had a very different distribution at another clinic.

 

This is why we turn to statistics and if clinics were willing, they could each show very easily what the average distribution is when they perform surgeries. They could even categorize them by ethnicity which would really provide some insight.

 

Well I guess I went to a hack, hope you have better luck.

As for statistical studies, I'm sure the surgeons are just dying to shell out a bunch of money for the time it would take to create the data base suggested as it will generate so much more business and most of them are starving. Not to mention the lawsuits from a slew of PC organizations if they use ethnic categories.

[Wiz Kid]

Spoon: Very interesting analysis. If Dewaynes comments are correct regarding the grafts that live, a 4000 graft case would result in an extra 6% loss of grafts (2630/2700 =97%; 3650/4000 = 91%). In my case, I put all the numbers together to summarize Spoons and Dewaynes points and got the data as Bill suggested. My session averaged 2.4 hairs per follicular unit .

 

 

 

a). 4000 grafts x 1.7 hairs per graft = 6800 hairs x 91% survival = 6188 total hairs

 

 

 

b) 2525 grafts x avg. 2.4 hairs per graft = 5977 hairs x 97% survival = 5797 total hairs.

 

(Note: 2525 x 2.4= 6060 but my actual hairs is 5977 based on the detail below)

 

 

 

c) Difference in Total hairs : 6188-5977 = 391 hairs / my avg 2.4 hairs per graft = 163 grafts

 

 

 

d) The costs quoted on this site for a 4000 graft case is approx. $13,000 or an extra 35% over a standard sized session. For the extra 163 grafts I would have paid an additional $28 per graft.

 

 

 

In summary, based on the info provided on the previous replies, a 4000 graft session compared to my own would have only provided a hair yield of an extra 163 grafts.

 

 

 

I think I understand a little bit better now why you can get comparable results with different techniques and recommended doctors.

 

 

Wiz Kid

[Bill - Seemiller]

Wiz Kid,

 

I understand where you are getting the 2.4 hairs per graft (since this is what was true in your case) however, where are you getting the 1.7?

 

Are you making the assumption that if you went to another clinic who gave you 4000 grafts that your average would only be 1.7?

 

Obviously this comes back to the debate of patient characteristics verses the size of the grafts clinics cut.

 

If we make the assumption that the clinic who would have given you 4000 grafts cuts the same size grafts, then your average would still be around 2.4 (which is seemingly the characteristics of your hair), in which case your calculations are wrong.

 

If we make the assumption that the clinic who would have given you 4000 grafts cuts smaller grafts, then your average would be lower (however, we still could not pick an accurate number, only make a guess, in which case, you guessed 1.7).

 

The "data" that is difficult to get is whether or not a clinic is cutting smaller grafts.

 

Bill

[NervousNelly]

Wiz kid,

 

Your thinking is in the right direction but ofcourse there are some unknowns and as Bill already pointed out, this is a challenging assessment to make.

 

I will state that I have definitely seen some 3500fu cases that look no better than a 2800fu case given that they had similar hair characteristics. The real variable often overlooked is the hair shaft thickness and whether it has some curl to it or not.

[Agio]

What I fail to understand is the relevance of this entire discussion.

 

First, assumptions are being made that all peoples hair is equal. This is simply not the case as has been pointed out and empirical information exists to support that. However when that very point was brought up the response was that it was a 'one off' occurrence and or that it was the surgeons ineptness or machiavellian designs that yielded less hairs per graft.

Secondly, there is no reliable average count of hairs per graft, only approximations. Think of us all as snowflakes, all different so an 'average hair per graft' argument is baseless.

 

Even assuming my above statements are false and that there is a conspiracy amongst top notch surgeons to hustle us all by doing more grafts than required to bilk us out of our money how can you prove it? You can't, consequently the entire point is moot.

Perhaps one could hire 'professional spotters' who travel with any patient watching the entire process from donor hair removal, graft dissection to planting to make sure we aren't getting screwed.

All of the best surgeons state that the new techniques are NOT cost effective for them so why would they do more labour intensive surgery as they generally charge a minimum dollar amount for a transplant no matter the number of grafts? Typically it's going to cost you 8-10000 regardless. Given how busy these surgeons are and how much money they make, I find them grabbing an extra thousand or two while risking their reputation simultaneously unlikely.

 

After reading this site and others over the past couple of years I think some posts are generated out of fear, uncertainty, anxiety and budgetary concerns or a combination of all. Well, hair tranplantation is an expensive uncertain route with no guarantees of success regardless how many grafts are done or hairs per graft and a host of other things. Numerous posts on this site make this clear and it would serve to read them.

I think one needs to understand and deal with the reality and risks before having a transplant done as opposed to seeking answers to unanswerable questions or validation for an untenable position.