Are all Grafts succesfull?

[steve Scott]

or do a certain percentage go dormant. If so, what percentage are likely to work out?

[steve Scott]

or do a certain percentage go dormant. If so, what percentage are likely to work out?

[nile]

Unfortunately all keep growing if you get a bad job.

I had plugs years back. And all of them are growing to this day.

I pray that some or all of them go dormant.

[hairworthy]

There is no straight answer to that. It depends on many factors, like the procedure, the instruments used, the time the graft is left out of the scalp after extraction.... and of course the doctor! Apparently the survival rate is still higher for the strip procedure than for FUE. Dr Seager has some interesting info on that on his website, explaining why he does NOT do FUE.

[arfy]

<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR>Apparently the survival rate is still higher for the strip procedure than for FUE. Dr Seager has some interesting info on that on his website, explaining why he does NOT do FUE.

 

That all depends on which doctor is doing the procedure. All doctors are not equal in skill, experience, and aesthetic ability. Right now there's not that many doctors doing FUE and even fewer are able to get consistent results, so in that regard your post is correct, but it all depends on picking a doctor with documented consistent results.

 

To the original poster:

Having a high rate of graft survival is what separates the competent doctors from the incompetent doctors. Getting the grafts to survive is just the bare-minimum baseline qualification, after that there are many other factors (naturalness, good long term planning, good design abilities, etc) but the doctors with poor or "just okay" graft survival should get out of the business, they are harming people.

[Smoothy]

Most grafts go dormant for a few months before regrowth, but about 10-20% keep growing after surgery. Also, graftcyte seems to help keep grafts going dormant maybe increase up to 30-40%.

[Robert_]

<BLOCKQUOTE class="ip-ubbcode-quote"><font size="-1">quote:</font><HR>Apparently the survival rate is still higher for the strip procedure than for FUE. Dr Seager has some interesting info on that on his website, explaining why he does NOT do FUE.

 

That all depends on which doctor is doing the procedure. All doctors are not equal in skill, experience, and aesthetic ability. Right now there's not that many doctors doing FUE and even fewer are able to get consistent results, so in that regard your post is correct, but it all depends on picking a doctor with documented consistent results.

 

To the original poster:

Having a high rate of graft survival is what separates the competent doctors from the incompetent doctors. Getting the grafts to survive is just the bare-minimum baseline qualification, after that there are many other factors (naturalness, good long term planning, good design abilities, etc) but the doctors with poor or "just okay" graft survival should get out of the business, they are harming people.

 

I understand both of these points but I have to step in and say that I think the reason that many physicians won't offer FUE as of yet is that to them, the pros don't outweigh the cons enough yet. FUE is still an area that is being perfected. Though it is great to see pioneers work at exciting new techniques, a more conservative approach cannot be construed as "incompetent."

 

-Robert

[metro]

mostly all take..unless you have a certain medical condition!!

[Dr. Michael Beehner]

I'll jump in and share some of the research results that have actually been done on this subject, since I recently had to review this to write the chapter on the subject in the new textbook ("Hair Transplantation", edited by Walter Unger and Ron Shapiro, 2004, Marcel Dekker Publishing).

In the 15-20 studies that have been done to date on either "combination-FU" grafts (minigrafts/ 4-8 hairs each) and FU grafts (1-3 hairs each), the percentage of survival has been close to 100% in the combination-FU grafts and has varied all over the board in the FU studies,mostly averaging around 90% survival.This is most certainly because of the fact that the slightly larger grafts have more "protection" and buffering with the extra tissue that is present. It is simply harder to dry out or traumatize an individual follicle in such a graft. Dr. Seager and I conducted separate studies a few years ago comparing survival of very "skinny" FU's versus "chubby" FU's (ones with a fair amount of the connective tissue left around the FU) and we obtained similar results, with 113 and 133% survival of the "chubby" ones and survival in the low 90% for the skinny ones. At the 2003 ISHRS meeting in New York, Dr. Kim of South Korea and myself presented separate studies of FU survival and we both got identical 90% survival rates.

A big factor in FU survival is whether or not one is studying the first transplant session on a virgin scalp. In a study I conducted three years ago, when I went in a second and a third time and measured survival in small tattooed "study boxes", the cumulative survival of the hairs in the FU's dropped from around 95% to 75% after the second session and down to 59% after the third session. This study was done with 18 gauge needles and most of us use slightly smaller recipient sites now or the small lateral slits. In as study we did on 2-hair FU's in 1cm2 boxes planted at 20, 30, 40, and 50 FU's per cm2, using 20gauge needles and a "stick and place" method (with myself making the holes and placing the grafts), we obtained 95% survival at 30/cm2 and 89% survival in the 40 and 50/cm2 boxes. Prevous studies by Dr. Mayer and others had shown that with 18g needles, lower survival occurred when one tried to place 30 or 40 per cm2.

The bottom line on survival with FU's has to do with the fact that the FU is a somewhat vulnerable graft in terms of drying and being handled (trauma), so the care, dedication, and skill of the assisting staff of the transplant surgeon is what determines whether 50% or 100% of them survive.

Mike Beehner, M.D.

[Curious]

How can you have 133% survival of the chubby grafts? It's either 100% or some percentage lower than that. Please explain.

[Dr. Michael Beehner]

Dear Curious,

Individual follicles (the portion of hair which is alive and resides under the skin) pass through three different life phases. For 4-5 years at a stretch they are in "anagen" phase or the growing phase. Then there is a brief "catagen" phase during which the sheath holding the hair base separates away from the dark bulb and dermal papilla at the bottom of the follicle, and then the follicle enters a 3-4 month phase called "telogen."

Getting back to your question, when a hair surgeon and his staff cut up the individual grafts, if those follicular units (groups of 1-3 hairs) are trimmed "down to the bone" so that there is no fatty or connective tissue seen around them, then the odds of any "hidden" telogen phase hairs being present are pretty low. Whereas, if the grafts are trimmed slightly "chubby" with some of this connective tissue present, then there is a greater chance of some of these telogen phase hairs being present, even though at the time of donor harvest they really can't be seen or counted as being one of the hairs planted on top. So if there are some of these hidden telogen hairs adjacent to the more visible hairs, then later on, when these telogen hairs grow into the anagen phase, you get a higher number of hairs then you started out planting, and thus a percentage of hairs surviving that is actually higher than 100%. There are 5-6 studies in which the person conducting the research came out with a survival rate over 100%. Some observers think that after a transplant surgery that all of the hairs are synchronized together into the anagen phase, and that probably with the passage of time (years) they gradually randomize into both anagen and telogen phases and the percentage of hairs that are present at some future point would drop by a small percentage.

In a small 4-6 hair minigraft, there is even a greater chance of these telogen hairs occupying some of the space between the FU's contained therein. Obviously, in creating a natural looking transplant, if these kinds of grafts are used, they must only be placed in the front-central region, where they are hidden behind all of the surrounding FU's and contribute a dense look to the final product.

I hope this helps clear up how you could obtain a survival of greater than 100%

Mike Beehner, M.D.

[Curious]

Dr. Beehner,

 

Thank you for the answer.

[gillenator]

Dr. Beehner,

 

I applaud the posted findings of your clinical trials regarding yield and/or graft survival. This is the type of release we all appreciate and I for one have been insisting on this type of documentation for microscopic dissection methods of strip harvest and even more so for isolated extraction methods i.e. FUE, FIT, FUSE, etc.

 

Since transection has always been one of the main concerns regarding yield for this technology, not to mention the higher graft prices, why do you think there are not more clinical documentation being released? Possibly there are very few tracking this on their patients. Your method is very defined by identification of recipient area in cm2 surface areas. Are you utilizing a video telescope to aid in the count? I also heard of some medicinal trials using an ink that was colorless and can only be seen with neon lighting so tatoo ink would not show. I know some docs use "dots" to mark the areas but just in case the patient were to shave their head one day? I wonder if you have heard of it.

 

The yield results sound outstanding to me in the 90% and higher. Alot of us encourage larger sessions on the first procedure for the very reasons you pointed out (virgin scalp), and yet it is very interesting to read about the drop in yield when the number of recipient incisions are increased within the same surface area along with the decrease in subsequent sessions.

 

How much of a factor do you believe the effects of ischemia reprofusion have on graft survival? In those large clinics where three or more procedures take place on the same day utilizing the same staff, and the specimen sits outside the body, sometimes for hours before placement. Some say it has a pronounced effect, others say it's not that big of an issue. Still the isolated extraction techniques provide the ability for quick placement (sometimes seconds) into the recipient sites unless single hair grafts need to be cut.

 

Lastly, congratulations on the impressive yields and you have must have some very experienced and talented techs with microscopic dissection. Keep the data coming!

[Dr. Michael Beehner]

Gillenator,

We use a tattoo gun which has disposable sterile needles and sheaths at the end of them, and use a combination of white and light brown tattoo ink, which, when placed on the scalp, is not that detectable, but is easy to find by the physician with magnifying lens on. It is rare that a patient asks for us to later remove it.

As to the effect of ischemia reperfusion injury, there has been some research by Dr. Cooley and by the members of the Moser Clinic in Austria/Germany on the subject, and apparently there are some chemical products released which do have some effect on the cells of the follicle and probably have a little to do with the follicle immediately going into the telogen (rest/hibernation) phase after transplanting. Dr. Limmer did a classic study a number of years ago which showed that the yield of grafts kept outside the body didn't start to decrease till after 8 hours, if kept cold and moist during that interim.

As to the difference between clinics doing 3-4 sessions, versus those that do a single procedure, usually the size of the staff is proportionate to the amount of work being done, and I don't know and have never heard of any clinic that "stacked" their patient's workload in such a way that the grafts were held outside the body while other patients were being worked on, so I don't think that applies to any hair restoration physicians.

As to FUE/FIT, etc. I am not aware of any studies yet that have been completed concerning follicle survival with that method. Hopefully, we will be seeing some results in the next year or two.

Mike Beehner, M.D.

[Joe HT]

Wow, I see now. Thought my doc was referring to the added propecia he recommended when he spoke of a success rate close to 110% being possible after a HT.

[gillenator]

Dr. Beehner,

 

Thanks for the response. I know of one surgeon who claimed his post-op application bore an anti-oxidant to help retard the effects of ischemia reprofusion. I kept asking him if he was tracking the yield differentials but he never provided me a satisfactory response. Possibly there is some merit to his product and at least there was some effort in developing a retardent to promote graft survival.

 

Independents do not tend to "stack" procedures on the same day. This takes place more with the hair mills and believe me it has and still exists. It is called itinerant surgery scheduling. You see some mills have the same doctor covering as many as three clinic locations in the states they are licensed. They then break-up the month with the doctor in one city for a few days or even a week. They stack all of the enrolled procedures for those few days and will do as many as 8-10 cases in two days. They typically have their surgical staff travel with them from city-to-city. The techs are jumping from patient-to-patient, from one OR to another to get the grafts cut and placed. Having the same staff start at 7:30 am and not quitting until 9pm or so. The staff is worn out and yet they come back the very next day and do it all over again. They work on quotas because they have increased overhead to cover, namely the satellite office and the traveling expenses of the doctor and staff, not to mention the huge media advertising costs. I still hear about it every now and then, but not as prevalent as over the last decade (nineties).

 

Then the entire staff leaves until the next two weeks or next month and the only person left in the office is the sales rep who all along is selling as many procedures as they can for next month. No one there for post-op issues except the sales person who many times is more concerned about earning their next commission than post-op care of the patients.

 

You may not be as aware of this itinerant procedure approach, but it has and still does take place. Hopefully this is subsiding but I feel there should be some some limitations on caseload per day in the interest of quality and patient care.

 

Thanks again for your feedback.

[Peter Mac]

We use a tattoo gun which has disposable sterile needles and sheaths at the end of them, and use a combination of white and light brown tattoo ink

I am interested in conducting several studies on myself. Where could I purchase this tattoo gun and inks?