Question about 7700 graft session at H&W

[the B spot]

Hey Guys, just throwing out something here to see what everyone thinks----

 

First, I really only post here on this site, for whatever reason, but I do spend a lot of time on hair loss help, just reading posts, keeping up with things, etc... Anyway, I spotted a guy who just had 7700 grafts in 1 session at H&W, so I checked out his before and afters, being curious.

 

Second--- I would like to hear any comments about this, maybe from Jotronics, or anyone else who has seen this as well.

 

I have reservations about this and I just want to see what anyone else thinks/feels, or any insight anyone else has to offer.

The reason for this is this guy has almost EXACTLY the same type of donor I have, and while I am all for large sessions, I can't help but wonder about the placement/size of his scar. My scar ends right over the top of my ears almost exactly in the middle of my donor hair with hair above and below the point of removal. Should I retract down further from the top, further lose in the temple region, or lose from the nape of my neck, it will still remain unnoticeable.

I try to keep an open mind about all of this, realizing that we have to keep looking to get better. I just want to see what all of you might think about this surgery.

Again, the purpose of this site is to allow us to view work and question/comment as we see fit.

Anyway, check it out and let me know-----

[the B spot]

Hey Guys, just throwing out something here to see what everyone thinks----

 

First, I really only post here on this site, for whatever reason, but I do spend a lot of time on hair loss help, just reading posts, keeping up with things, etc... Anyway, I spotted a guy who just had 7700 grafts in 1 session at H&W, so I checked out his before and afters, being curious.

 

Second--- I would like to hear any comments about this, maybe from Jotronics, or anyone else who has seen this as well.

 

I have reservations about this and I just want to see what anyone else thinks/feels, or any insight anyone else has to offer.

The reason for this is this guy has almost EXACTLY the same type of donor I have, and while I am all for large sessions, I can't help but wonder about the placement/size of his scar. My scar ends right over the top of my ears almost exactly in the middle of my donor hair with hair above and below the point of removal. Should I retract down further from the top, further lose in the temple region, or lose from the nape of my neck, it will still remain unnoticeable.

I try to keep an open mind about all of this, realizing that we have to keep looking to get better. I just want to see what all of you might think about this surgery.

Again, the purpose of this site is to allow us to view work and question/comment as we see fit.

Anyway, check it out and let me know-----

[bayscholar]

I believe he started in the chair after 7am and finished by 1am. I will say b-spot I agree with you(which is becoming a trend) it looks like a 35cm strip and being one who had 32cm it really pushes the envelope (good or bad could be argued here). But in terms of you and him having the same donor hair, realize pics can be very misleading. Nothing in his (pre op) donor hair pics, from a denisty stand point, gave my the impression of 4k being their to harvest let alone 7+...but that is why pictures don't always tell the whole story. Again patients of Dr.Hasson are made aware of their options of session size, I think it is often assumed Dr.Hasson does not do smaller 1-2k session which he does expecptionally as well... though I realize this is not exactly the point of the thread I still wanted to mention it. In terms of will you have enought vascular blood flow to grow that many grafts go back to hlh forum and search nicnitro and your jaw will drop...kudo's Dr.Hasson the work looked amazing, this guys life will never be the same.

[the B spot]

Absolutely Scholar---- my point here is that I think his scar is outside the safe zone. Also, if you look at his nape, he has thinned there as well. Given his level of baldness would it not be a safe assumption that he might have temple retraction or lose his lateral humps in the next 5 to 10 years?

Aside from the scar itself---- the length of time in the chair is of a concern as well. At what point do the techs/docs suffer exhaustion, burn out, low concentration, etc.. ALL of which contributes to potential complications. I guess I look at Bobman and see his transformation and wonder what is wrong with that : 5000 to the front and as much as possible in the crown on the second? Hairtransplantation is NOT a instant reward under-taking and I wonder if we are simply sitting by and OK'ing these staggering sessions without real concern. Forget the damn haircount for now, and what about growth percentage and waste during the session?

I get the need for 4000, 5000, graft sessions, maybe even more at times, but is it realistic to think that a 7700 graft session yielded 14000 plus hairs, given the length of surgery, given the potential scarring issues, given potential waste, future hairloss, is this an ACCECPTABLE RISK?

Everyone has to admit that the larger and longer the session the risks of lower yield, waste and scarring issues INCREASE exponentially.

I don't know Guys, I think I am going to withold support for these 6000+ sessions, as I have serious doubts as to the long-term ramifications of these patients.

[nikkop23]

Jotronic can't really do anything but come on here and back his clinic's work, but I'd still be interested to hear what his responses to all of these concerns are.

[bayscholar]

Guys with all do respect, if you just look at their results with 6k+ patients it will rest most of your fears. I do not agree that Dr.Hasson jeopardized this patients safe zone, I do think he may have maxed it out some...and if that means a full head of hair in 6-8months this guy will be beyond jubilant with out a need for crown work in the future (he could keep what he has left in his donor region for touch ups every 5-10years). Is the Bobman approach better, again that could be a point of argument... but was has to be remembered is that this same discussion circled around his near 5K session 4 years ago...again I agree B-spot larger sessions do have more strain on everything from grafts, scar width, to crucial execution done by techs working on the patient for so many hours. However with that said, I personally had Jody and Rebecca (same techs worked on this patient) place my grafts I will say they are second to none, I remember asking Jody how she could do such detailed work so patiently with the same steps every time, she told me this job is for those that are passionate to help people enough said (she was telling me this at 8pm night of my ht), I can not overstate the team at HW. I called that night of this procedure to bother them with endless question on shampoo's to you name it (they are good people that always have time to answer my question and see how I am progressing) and sure enough everyone was at the office at 8pm working. To a man you could feel the excitement in the air for this guy, not because they wanted a record number of grafts (which I think this is 2nd highest) but because they love what they do, helping people overcome hair loss. Again may be I am biased because Dr.Hasson was my doctor and I think the world of him and his staff, but if a guy has that kind of laxity and density he should have more grafts in the bank, so maybe he is a freak, lets face it only a select few have touched 6-7k+ with HW though Joe could more accurately answer this as I am just making an educated guess.

[bayscholar]

http://www.hairlosshelp.com/forums/messageview.cfm?cati...DBTABLE=&STARTPAGE=1

[troy]

That may be a record in one sitting Ht graft count, but it also looks like a record long strip. B, I would way rather have 3-4 Hts than a strip from one side of my head to the other. I also think that the scar could fall out of the sweet spot and one day the scar become an issue. My scar is small in length and I wouldnt want it any longer.

[bayscholar]

I don't disagree that you could go 3-4 times as troy is suggesting, but don't forget that means four times the down time (4 years of your life vs one. he is 27 so he will look amazing by 28 vs 33)...Also your best growth % comes in your first HT and diminishes slightly each time there after...So I think there is no conclusive right or wrong answer... it is a patient doctor decision to make, in this case I believe it will work well...could he have taken the rest of his twenties hiding in a hat taking each ht nice and slow, sure he could (slow and steady wins the race), but this guy will not have to wait much at all. If needed he can visit Dr.Feller and fue the final 2cm of the scar on both sides in one lunch time fue session if he has temple recession so I think that is a mute point personally.

[Guest Landen]

If needed he can visit Dr.Feller and fue the final 2cm of the scar on both sides in one lunch time fue session if he has temple recession so I think that is a mute point personally

 

 

Strip excision should not take place in such an area. It is not a moot point.

[Guest MisterChris]

Originally posted by bayscholar:

he is 27 so he will look amazing by 28 vs 33.

 

OK, we've got to draw the line somewhere. I have been researching HT for the past 6-7 years and had it narrowed down to shapiro, epstein, H&W.

 

There's been much talk about ethics (and lack thereof) in this business and given this patients young age and degree of baldness, I see this agressive a surgery as more unethical than the youthful hairlines Alvi was building. People complained "what if" these guys lost more hair? In this case, the guy is already a nor5 at age 27 and will be a nor6-7 in the next 15-20 years.

 

 

I'm looking at the pics and doing the math and I just cant see any way this guy is not going to have problems in the future. I remember how anxious I was about HL when I was 27 and could easily see myself being suggested to go that agresssive.

 

I have to cross H&W off the list. His temples are going to recede some more and that strip will be visible.

[bayscholar]

Landen,

 

Again there is a lot of information we are speculating about in regards to this case...so while it may not be a moot point, we don't have enough info to answer right or wrong...your opinion is given in your response, as is mine. Being as neither of us is a Doctor (unless you are, then my apologies) I still feel that it is a doctor patient decision. .Simply not enough info for us to conclude based of photos. And being that you have a tendency to try to polarize a topic I will leave it at that.

[John_in_NC]

that is one scary scar http://www.hairlosshelp.com/forums/attachments/DSCN5326.JPG , but then we have to consider how he will end up.

 

With that said, I wonder if it would been better with say 1000 less grafts but end up with a not so wide scar? That is too close to comfort on the sides and I have a feeling that it will strech.

[Dr. Victor Hasson]

I have read this thread with interest and I understand some of the concerns that have been brought up by some members of this forum.

 

Firstly, regarding yield; There is no scientific evidence that substantiates the myth that hair survival is related to the size (and for that fact the density) of a hair transplant procedure. When we were first performing sessions of three to four thousand FU people were concerned with our final yield. It is now almost common for physicians to perform these sized surgeries and it was in fact those very same physicians that had expressed their concern over the size of these surgeries. We have now performed hundreds of sessions greater than 5000 FU, and dozens of greater than 6000 FU. In none of these surgeries have the results given us any reason to be concerned with graft yield. Having now performed multiple surgeries of greater than 7000 FU our results have been in my opinion quite remarkable. I think that with time and the following of London Lad's progress that it will be shown that these very large megasessions remain an excellent option for those patients with suitable hair characteristics.

 

The facts do however support the potential for decreased yield occurring with multiple surgeries. This has to do with scarring in the donor area after multiple harvests. Also, in studies performed by Limmer, the cumulative hair counts after multiple passes in the same recipient area showed lower than anticipated density suggesting that yield becomes compromised with each successive surgery.

 

Secondly, I would like to address the length and positioning of the donor elipse: On the initial assessment of any hair transplant patient possibly the most important assessment that is performed is to determine the final hairloss pattern. This is important as it affects our entire "gameplan" for that patient. To determine the hairloss pattern I closely examine the back and the sides of the scalp to determine the degree of miniturization and it's boundaries. It is important to know that most people suffering from male pattern hairloss will not in fact progress to a stage NW7. The areas that we determined to lay within the "safe" donor zone are areas in which we see virtually no miniturization of hair follicles (up to ten percent finer hair would be acceptable as this would represent early anagen follicles). The ideal area to harvest from would be that area which contains the most dense and non-miniturized hair. In the area above the ear this does not necessarily correspond with the area directly above the ear and forwards of this point. In fact, to the contrary - with male pattern hair loss often extending in an upwards direction in the zone above the ear.

 

In the case of London Lad the donor strip was positioned in the area of the most dense and healthy hair. I do not believe that this area in his particular case will EVER be affected my MPB.

 

To those who do not and "like" the side area being used as a source of donor hair I would say that there are also those who do not "like" the idea of a strip scar. The fact however remains that the sides are an extremely important source of good and viable donor hair in most cases requiring hair restoration surgery. I hope that my explanations have been somewhat helpful and I thank London Lad for generously sharing his experience with others online.

[the B spot]

Guys, first off, thanks for keeping it scientific and not emotional, I REALLY appreciate that.

Scholar--- I understand your view, and I was in the chair for 10hrs until a little after 8 myself so I am with you there. However, we must recognize the difference between 8pm and 1am in the morning.

 

Troy--- I agree I would rather do more sessions than have that long of a donor strip removed. I do NOT want to have to go through more than 2 large sesssions and a possible smallish 3rd, and I am in complete aggreement that 2 larger sessions are the way to go, maybe3 to 5000 for #1 and whatever for #2. I think the industry has progressed that maximum possible restoration for each patient should occur in a relatively short period of time, say 2 years, which is a reasonably SAFE period of time.

 

My question is why not do 5000 grafts now? Lessen the length/width of the strip? This guy would still be completely satisfied, and the he would have a CHOICE to do more later if choose to do so. What if 10% of these grafts don't grow? Could ANYONE tell with 7700 grafts planted what overall yield is?

I remain unconvinced that 11, 12, 13, 14, 15, 16, 17, and 18 hours in surgery does not produce complications or issues. We are human, period.

 

The point to all of this is I believe the amount of tissue removed, the amount of grafts implanted, and the amount of naturally occuring grafts being split, represents a high risk factor that is potentially a physical and possibly an ethical risk to the patient.

I am NOT arguing results. Nor do I wish to take away from the brilliance of Dr. Wong or Dr. Hasson. But just because we CAN do 7500 grafts, doesn't mean we SHOULD do these sessions.

 

I want to know if either doctor at H&W have cases of poor yield, stretched scars, or other complications attached to these sessions. I think we should be able to see BOTH sides of the potential argument. We see the very best results and believe me, they are truly amazing.

But while we were caught up with hair count versus graft count, we failed to ask whether or not these sessions are in the best interests of the patient both NOW and in the FUTURE.

[bayscholar]

Thank you Doctor Hasson for taking the time; I think this thread needed your response. B-spot, yes 8pm is not 1am by any means so point taken.

[the B spot]

It is important to know that most people suffering from male pattern hairloss will not in fact progress to a stage NW7. The areas that we determined to lay within the "safe" donor zone are areas in which we see virtually no miniturization of hair follicles (up to ten percent finer hair would be acceptable as this would represent early anagen follicles). The ideal area to harvest from would be that area which contains the most dense and non-miniturized hair. In the area above the ear this does not necessarily correspond with the area directly above the ear and forwards of this point. In fact, to the contrary-with male pattern hair loss often extending in an upwards direction in the zone above the ear.

 

In the case of London Lad the donor strip was positioned in the area of the most dense and healthy hair. I do not believe that this area in his particular case will EVER be affected my MPB.

 

Dr. Hasson, I have to question the thought that MOST people will not progress to a NW7? When those of us who are 27 to 35 are already 5's and 6's, how can we be SURE? I have been a rather strong supporter of yourself and Dr. Wong, and I have to wonder why we even need 7000 graft sessions? I think all of us would admit that we would like a second chance to revisit our first attempts and correct any issues, which is how I view HT's. I am in complete agreeance with 4000 and 5000 graft sessions, maybe even a bit more, should the candidate possess exemplary characteristics, but doing 5000 first, and then adding 2500 or 3000 in a second sessions allow you or any other doc to really address needed areas affected by shockloss, poor yield, or specific areas targeted by the patient.

I realize you are an expert and a leading physician, but I think at some point we have to know the HARD facts about this before we embrace a solution whole heartedly.

 

You are right no scientific evidence exists regarding yield. You are the only surgeon performing these sessions, so we should look for you to provide this data the empirical evidence that greater risk does exist or not.

I just think we would be hard pressed to find poor yield in a 5000, 6000, or 7000 grafts session, even if 10% of the grafts placed died, unless they were localized to a specific region.

I know this is not a fun topic, but I feel I have to broach it.

[Guest Landen]

But while we were caught up with hair count versus graft count, we failed to ask whether or not these sessions are in the best interests of the patient both NOW and in the FUTURE

 

I asked this question

 

As a matter of fact, your post is a summary of much of what I discussed in that thread.

[the B spot]

Yes Landen, you did hedge the subject in the other thread, but you engaged in a bit of a jousting match with other members, thus taking the focus from some of your good points.

In addition, I have NEVER viewed a donor strip in the size or location of London Lad's, which is what prompted me to address the issue. I also felt he while he still retained his lateral humps, in the future they could fall out or be shocked out, and would need additional surgery anyway, dispelling the notion of a "one-pass" surgery.

[John_in_NC]

Thanks for the reply Dr Hasson. I agree that we all have to make choices and this patient chose between a full head of hair with a large strip or ...we know the other one.

 

Dr., do you mix the grafts randomly, so if some hair falls it will not be in patches but a few here and there? (Just in case he was destined to be an advanved 6 or 7.)

[Dr. Victor Hasson]

B spot ,

 

The progression of mpb patients to stage 7 is not a "thought". It has been scientifically studied and documented by both Norwood and Unger, who found that 13-21.9% and 11-13.4% respectively, of men who reach 80, will ever progress to NW7.

 

This particular patient (LondonLad) wanted both front and crown coverage in one session if possible. Since his particular hair characteristics permitted this to be done ( safely and reliably) it was performed as he wished.

 

It is important to realize that this is not in any way an average case. The majority of our patients have sessions of around 4000 FU on average.

 

People asked when we started performing sessions of 4000 FU and more why we were doing this. This is now come to represent a standard required by HT surgeons to meet the needs and expectations of educated patients.

 

Btw, I do happen to have a family that I would rather spend my evenings with. It is my dedication to my patients that keeps me working till late into the evenings.

 

Victor Hasson MD

[Guest Landen]

Yes Landen, you did hedge the subject in the other thread, but you engaged in a bit of a jousting match with other members, thus taking the focus from some of your good points.

 

The B spot, you are right.

[the B spot]

I guess what you are trying to tell me is that you "think" this is OK, and that in your OPINION he exhibits characteristics that are conducive to a 7000+ session.

 

You are one of the BEST surgeons in the WORLD, and I think it is a safe statement to make, period. But how is it that YOU lead the field in density, session size, length and width of donor tissue, documented results,etc... and yet you have not researched this information? You have pushed this to the point where people are simply astounded, forget 3, 4, or 5 thousand grafts, because people realize that a 28 to 31 cm X 1.7 to 2cm will yield these numbers.

I want to know how taxed your STAFF is? I want to know how taxed any staff is after 10, 12, 13+ hours of precise, highly concentrated work. I think it is reasonable, because we are not robots.

 

BTW, I work 6 days a week EVERY week, sometimes 7, and I am working towards a Law Degree, because I love my family, so I understand wanting to spend more time with them/balanced with the needs of clients.

 

Thanks Again Dr. Hasson. Although I still reserve my opinion, I appreciate your taking the time.

[Bushy]

Everyone has to admit that the larger and longer the session the risks of lower yield, waste and scarring issues INCREASE exponentially.

Really? Whe ever said that?????

 

I don't know Guys, I think I am going to withold support for these 6000+ sessions, as I have serious doubts as to the long-term ramifications of these patients.

OK, no problem. I happen to trust Dr. Hasson's opinion more than yours.

[the B spot]

That's fine Bushy, as long as it is recognized as OPINION.

 

As for your other comment, I said it, and once you remove any emotional reasoning and replace it with logic, you have to arrive at the same deduction. Remember, we are not talking about just Dr. Hasson, but his entire staff, so for someone to state that NONE of the factors or potential negatives I presented exist, is fallacious and poorly thought out. Please note, we are arguing RISK FACTORS, not the results that we have been presented.

 

Regardless of what you may think or believe, it is important that a counter-balance exist, especially in a field like Hair Transplantation, so when clinics such as H&W present/prove themselves as innovators, pioneers, and leaders in the field, they also set themselves up to be scrutinized frequently as well.

That is why I asked if they could provide any alternate data on patients who experienced less than perfect results, and what contributed to this. Why not ask this of other clinics? Because other clinics are not doing 7700 graft sessions.