Mega Sessions

[crow1]

Please take a look at the following link I found on another site discussing mega sessions. This post has made me even more confused. After reading this I have many more questions that start to arise while doing my HT research:

 

http://www.baldingforum.com/showthread.php?t=267

 

Are they calling out the Top Docs that routinely do large 3000+ Ht's? I have seen many results from the Top Docs on this site and no matter what they are doing the results look really good. Although, I have noticed some clinics give a detailed hair breakdown (1's,2's 3's) while others don't, is this important to know? Or is the individual hair breakdown not really relevant, whether it's single or multi?

 

Maybe, this is a Dr. who can't hit the big #'s and is trying to get business from the ones that do? Maybe, he is 100% correct? I just don't know? I'm trying to do as much research as I can so any insight would be helpful and much appreciated.

[crow1]

Please take a look at the following link I found on another site discussing mega sessions. This post has made me even more confused. After reading this I have many more questions that start to arise while doing my HT research:

 

http://www.baldingforum.com/showthread.php?t=267

 

Are they calling out the Top Docs that routinely do large 3000+ Ht's? I have seen many results from the Top Docs on this site and no matter what they are doing the results look really good. Although, I have noticed some clinics give a detailed hair breakdown (1's,2's 3's) while others don't, is this important to know? Or is the individual hair breakdown not really relevant, whether it's single or multi?

 

Maybe, this is a Dr. who can't hit the big #'s and is trying to get business from the ones that do? Maybe, he is 100% correct? I just don't know? I'm trying to do as much research as I can so any insight would be helpful and much appreciated.

[latinlotus]

Crow1:

 

You raise a very good point. This is something i have been thinking lately. It is a fact that sometimes doctors are splitting 2-hair or 3-hair grafts into 1-hair graft in order to put at the hairline. Whether they are splitting those grafts in order to raise the grafts count is unclear.

 

IMO, it is always suspicious when only the grafts count is given and not the # of hair. A member named Grace, who works for Bosley, raised this point and in particular, pointed to the example of Hasson & Wong who do a great deal of large 4000+ grafts session, yet never reveal the # of hair. Like Pat of HTN says, count hairs not grafts, more slices do not make a pizza bigger.

[lost my swagger]

pointed to the example of Hasson & Wong who do a great deal of large 4000+ grafts session, yet never reveal the # of hair. Like Pat of HTN says, count hairs not grafts, more slices do not make a pizza bigger.

 

 

ive very much wondered this aswell... i would love to see a picture of a removed strip that consists of atleast 4000 grafts. to see typical length AND WIDTH of said strip.. H&W is doing this often arent they??? any pics, OR comments jotronic?

 

this is an interesting question BTW..

[Jotronic]

This is a topic that seems to crop up every six or so months but is one that has the same answer as it did five or six years ago when the average clinic was cranking out about 1500 grafts when we were cranking out 3000 grafts as our top end. "It's not possible" was the response behind the scenes and occasionally up front in public. Now, those same clinics are doing 2500 or even 3500 on a more routine basis. What in the world are they doing to get these numbers now when a few years ago they said it was not reasonable? Could they have enlarged their staff? Could they have listened to Dr. Wong and Dr. Hasson at the many conferences where they have made presentations on HOW to do this? Even just this year Dr. Wong gave a presentation on how to take a "big" strip. Could they have worked to improve their strip removal method by taking at least an hour to an hour and a half instead of only twenty or thirty minutes? These are few of the things needed to get these bigger strips safely.

 

Let's examine Dr. Rassman's statement on the thread link that was provided...

 

First, he says that it "cannot be" that some clinics are "routinely" getting 3500 to 4000 grafts. He then says...

 

"I suspect come doctors can't count well enough when there are big dollars in it for them to miscalculate the graft numbers."

 

We do more large sessions like this than anyone so we must be trying to get more money out of our patients with his logic, yes? Dig a bit deeper now.

 

We charge 5.00 per graft up to 2000 grafts in a session where any graft over 2000 in the SAME session is reduced to 3.00. A typical 4000 graft session would be 16,000.00 with this fee structure.

 

If you were to go to Dr. Rassman to get, say, one 2000 graft session with the aim of a second 2000 graft session at a later time you will be charged his rate of (someone correct me if I'm wrong) 8.00 per graft. Those two sessions combined will cost you THIRTY-TWO THOUSAND DOLLARS! Now, who's going for the "big dollars"?

 

Let's now look at the results. Take any of our 4000 graft sessions and place them next to a 2000 graft session of any patient with similar characteristics from Dr. Rassman. Logic would dictate that the 4000 graft session would not look much if any better than the 2000 graft session if these grafts were divided up into singles to get the higher graft count. I stand on record that our result with 4000 will look far superior than a comparable patient with 2000 (with no trick lighting or angles of course).

 

And so everyone here knows, in case you do not, four years ago when the ISHRS conference was held in Vancouver we flew in twenty-five patients from all over North America so that our critics could see our work first hand (Dr. Rassman was among them). It had never been done before and has never been done since. Every year a few doctors are invited to bring a patient and they if they do it's usually only one or two patients. Here is what the editor of the ISHRS newsletter had to say when the next issue came out after the conference...

 

"To say that their hair transplant results are mind-blowing would be an understatement. The rest of us will be a long time catching up with the skills of doctors Hasson and Wong and their wonderful staff of assistants."

 

This is a snippet of his actual impressions after seeing all the patients we brought. There is more to it that is just as flattering. Most of the patients had one megasession of 4000 to 5000 in one session with a few having had two big sessions. These patients weren't on a stage either for viewing from a distance. The doctor quoted as well as at least ten dozen others were picking through the scalps of the patients with their noses only a few inches away.

 

In summary, the accusations made in the above quotes is the typical response by doctors when asked why they don't do big sessions. I know it can be confusing with all of these conflicting reasons but in the end you should use your eyes and brains to look behind the words. As I always say, the truth really is in the results. Period.

[maxhair]

I'd like to see a photo of a strip, especially a mega session strip. I know it's hard to count hairs but would still like to see a photo of this. There is one on Dr Rahal's photo gallery (it's the last picture) but I would like to see the full strip. I'd also like to see a close up photo of cm2 of the donor area (pre-op) and the recipient area (pre and post op).

[crow1]

Thanks for the insight Joe. I have to say your results are amazing. Keep up the great work.

[Jotronic]

Crow1,

 

Thanks,buddy.

 

Max,

 

Here you go...

 

This image is before the strip is removed shown with a measurement of width. In this section the width is 2cm.

 

 

I don't have a photo of the length but it was roughly 30cm long so the overall donor area removed was about 60 square cm. The harvest was 5119 grafts. When you do the math the donor density comes out to be 85.31 per cm2.

 

Here is the donor immediately post-op with staples exposed...

 

 

And here it is with the hair brushed to cover the staples as normal.

 

 

Note that when I say these are immediately post-op, I mean IMMEDIATELY because if you look closely you'll see the patient is still on the table lying prone as is required when we remove the donor strip.

 

 

Again, I reiterate. I/We know what some other doctor's say when the question of megasessions is presented during consultations and splitting grafts is the easiest way to dismiss what we do in order to save face. We know this because people tell us all the time and we know who many of these doctors are. It's a pretty easy rebuttal actually when in consultation and especially when the money card is thrown down, in that we do this to get more money out of the patient. Sorry, but a quick revisit of the numbers shows the opposite to be true. Have advanced hair loss? If you get smaller sessions you're paying more money, period!

 

2000 grafts...16,000.00

 

1 year passes

 

2000 grafts...16,000.00

 

Total...32,000.00

 

OR!!!!!!!

 

4000 grafts....16,000.00

 

1 year passes

 

(sound of crickets)

 

What's the rationale for smaller sessions for advanced hair loss again? One bigger session with us would be half the cost of two smaller sessions with Dr. R.

 

Maybe now some of you will take this information presented above and use it in your next consult. When you look at the numbers you can see that the patient did not have extraordinary density. It was healthy, no doubt, but not on the freakish side. 85 per cm2 is right about average whereas some areas the density could have been in the low nineties which is not super high either or in the high seventies in other areas. Density changes all over the scalp so to compensate we're using relative assumptions. 30cm long x 2cm wide equals 60 square cm divided by 5119 grafts you get 85.31 per cm2 for density.

 

I hope this helps you guys and don't let anyone snow you on this subject. You have the breakdown, with the photos, so bookmark this thread for future reference. Any doctor tell you that megasessions are only for extra golf ball money you send them the link to this thread and ask them why I'm wrong. Then ask them to prove it.

[Bill - Seemiller]

Excellent posts Joe.

 

(sound of crickets)

 

I think there is a place for smaller sessions and can in many cases be appropriate. However, for some doctors to rule out the place for larger sessions only hurts patients who are good candidates for them.

 

Bill

[Mr. GQ]

thanks for the posts jotronic!!!!

[maxhair]

Thanks jotronic for taking the time to post. I don't want to start a flame war but are the any doctors or patients that care to refute what jotronic is saying? And I just want to be clear that he said 5119 grafts, not 5119 hairs.

 

One photo I would like to see is a picture of 1cm2 donor area (shaved or not) and another photo of a 1cm2 recipient area (a previously bald area immediately post-op and perhaps 9 months later or so). This may be a lot to ask but it would be interesting to see a section of scalp with 50 to 100 FUs units of hair, even if it's difficult or impossible to count. As always, I'm scientifically curious!

 

Thanks guys, and happy holidays!

[mmhce]

And I just want to be clear that he said 5119 grafts, not 5119 hairs.

 

yeah...he meant grafts. What Jotronic is trying to say is at 85.31 (FU) per cm2 , this subject had a thick supply of donor follicles in the donor region.

[lost my swagger]

jotronic--- seriously man, did you have to work hard to become such a bad-ass or has it just always come easy for you??

 

thanks for the reply man

[maxhair]

Originally posted by mmhce:

And I just want to be clear that he said 5119 grafts, not 5119 hairs.

 

yeah...he meant grafts. What Jotronic is trying to say is at 85.31 (FU) per cm2 , this subject had a thick supply of donor follicles in the donor region.

 

Thanks mmhce. No, I understood what he meant, I was just clarifying in case anyone wanted to refute.

[thanatopsis_awry]

Embarrassing....Rassman should be ashamed by himself...to cast such aspersions, be summarily refuted, and remain MIA, hoping that the people he comes across are simply ignorant to threads like this.....

[latinlotus]

Jotronic:

 

As always your information is well documented and educational. Thanks.

 

BTW, since a topic similar to this keeps popping up every 6 months, why H&W do not provide information on hair count? If readers have the patient's data on graft count and hair count, this issue will not be raised. Thanks.

[Dr. Bernardino Arocha]

It is very important to maintain the integrity of the follicular units. That, is follicular units should be kept intact. It is difficult to put hair as close as they occur in these follicular units. The more 3,4, and 5 hair follicular units the thicker the hair, there are more of these in the back of the head than there are on the sides or temporal area. The temporal area has a higher percentage of 1 and 2 hair follicular units. One and two hair follicular units make up over 50% of the total. So it is never or very rarely necessary to breach the follicular unit's integrity to soften a hairline.

What permits mega sessions is the harvesting of wider and longer donor strips! How wide a strip is possible to harvest is dependent on the tissue elasticity. This elasticity is greater in the back and less in the sides. Usually, I harvest the widest part of the strip in the back where the density and elasticity is greatest and a narrower strip on the sides where the density and elasticity is less. Recently, I worked on a patient with advanced stage hair loss,who desired to restore as much as possible in one session. He had excellent hair characteristics with very good density and elasticity. We obtained 6166 FU, the strip was 38 cm long, 2cm wide in back (20 cm) and 18 cm long sides x 1.5 cm wide. Note the strip is narrower on the sides to close without tension and obtain a nice and narrower scar.

Is this possible in every patient? Of course not, but it is more possible than some people will have you belief. Even in someone with an advance stage hair loss pattern a NW 7 with thin donor, it is possible to do a mega session of 3500 FU, see my hair loss article titled 'Surgical Hair Restoration of Advanced Stage Male Patterned Hair Loss.' http://www.regrowhair.com/hair...patterned-hair-loss/

[crow1]

Dr. Arocha,

Thank you for your time and your professional insight.

[Dr. Bernardino Arocha]

Thank you all for the opportunity, it is my pleasure to be of service. Happy New Year!

[Dr. William Lindsey]

Jotronic

 

That is a great pic of the strip size and closure. Do you all routinely take a strip that wide? Do you always staple? And do you use a deep layer suture closure?

 

I pride myself on good scar results and note that is a pretty wide strip....wider than I do. But you all get excellent results. So I am not questioning your techniques, just interested.

 

Thanks

 

Dr. Lindsey McLean VA

[Smoothy]

Pros and Cons on Mega Sessions. I think the Cons outweigh the Pros but it depends on your hairloss. Regardless, personally, I wouldnt do a HT over 3500 grafts max.-- that is just my opinion.

 

SMOOTHY

Dr. Shapiro

Rogaine xra-Propecia

MSM/Zinc/Saw Pallmetto

Enlyten anti-oxidant daily

[thanatopsis_awry]

What are the cons of HTs >3500 grafts? If anything, I would say the consistent quality of results across the field is as good if not better in sessions ~3500+. I mean, H&W alone (let alone Feller, Rahal, etc.) basically make their living doing 3500+ day in and day out and produce consistently excellent results.

 

The larger the session that can be done the more options for the patient and the greater chance they can be satisfied -- not just in shorter time with less surgeries, but also in the ability to achieve greater density/coverage.

[lorenzo]

Smooth can you please give you your pros and cons?? The reasons behind it? I disagree with you because I have met many patients that recieved megasessions and they look amazing. Take a look at the pictures of Londonlad, Bobman,Futzyhead, and many other H&W patients that have posted and recieved megasessions. Tell me what would you do different because of the many cons? Do you think there result would look better if they recieved more sessions and less grafts during each session?

 

Regardless, personally, I wouldnt do a HT over 3500 grafts max

 

Good because you are not a doctor. If only H&W had the same opinion as you they would make alot more money since they would have to do more sessions to achieve the final result. As I stated before every doctor has there opinion based on his own experiences and knowledge don't mean they are wrong. H&W have excellent cases of single sessions of 4000 grafts or more that have achieved excellent results with pencil thin scar.

 

Dr. Lindsey congrad on the quality of your work. Did Dr. Feller train you??

 

I hope you do not mind if I give you my opinion of your question. I have assisted many italians and have been present from many surgeries from both Dr. Wong and Dr. Hasson.

 

Do you all routinely take a strip that wide?

 

In my experience which I believe it much greater than the average poster the size of strip is based on many different aspects. Whats able to be done, what the patients wants and what the doctor is willing to do.

The first part what is able to be done. Meaning that if a patient is a repair or has limited donor, or has a tight donor that would influence the size of the strip.

What the patients wants? The doctor has to take this into consideration as well. This will influence the size of the strip.

What the doctor is willing to do? Meaning just because somebody has a excellent donor with good elatisity don't mean that they need to take a big strip. Both doctor are always concerned with future of the patient when they make a decision about that plan to take. I have seen situation where a patients wanted and expected more grafts and they didn't need it therefore a big session was not performed.

 

What I am saying is pretty straight forward so hopefully I am not testing your intelligence by stating this.

 

Do you always staple?

 

Yes

 

And do you use a deep layer suture closure?

 

Yes and no. Dr. Wong does and Dr. Hasson doesn't. Both there scars are excellent and I do not see a different with either ones final product.

 

I pride myself on good scar results and note that is a pretty wide strip....wider than I do.

 

I am sure you know the reputation of H&W. They would never scarifice taking a bigger strip for a wider scar. Maybe you can talk to Joe and be one of the many doctors that have travelled to Vancouver to see there results and surgeries in person.

 

Again I am not a rep for a H&W these are my knowledge and opinion. Maybe Joes is different.