What allows some doctors to more grafts than other docs can or will?

[olmert]

Take the case where there is plenty of recipient space and that this is no constraint at all on the number of grafts.

 

The way I am looking at it logically, what would limit the number of grafts a doctor can do would then be your laxity, donor density, and perhaps the size of your head. (I figure the number of grafts you can pull is the area of the strip times your density.)

 

Anyone who has had a few consults knows that every doctor will give a different estimate of how many grafts he can get. And you have a few doctors whose practice is centered around mega sessions.

 

So in the case where there is an abundance of recipient area, why exactly can one doctor get more grafts than another doctor? Are the mega session doctors cutting a larger strip and suturing the wound more tightly? If so, why would one doc be better able or willing to do this with a larger strip? Is there some other reason one doctor would do more grafts than another doctor?

[1978matt]

As far as I know it is all about the size of the team available and the skill of the technicians.

 

Grafts need to be transplanted from strip to head in as short a time as possible. If you don't have a big team then performing megasessions would be unwise

[RCWest]

Some docs have large extremely talented techs who have been in the business for many years. Some doctors prefer to remain fairly limited in the number of grafts they can do to keep overhead costs down.

[olmert]

If you wanted maximum graft survival, how many tech's should be working at once on your case?

 

Is the number of tech's different for different numbers of grafts?

 

If so, how many techs for 1,000 grafts?

If so, how many techs for 2,000 grafts?

If so, how many techs for 3,000 grafts?

If so, how many techs for 4,000 grafts?

If so, how many techs for 5,000 grafts?

If so, how many techs for 6,000 grafts?

If so, how many techs for 7,000 grafts?

 

Also would you get more graft survival if you didn't take a break for lunch?

[Blake Bloxham]

I don't know if there is an easy conversion to equate the number of technicians with the number of possible graft implantations. Remember, there can always be an overabundance of people working at once as well, and unless physicians are reserving a huge number of technicians and "substituting" during long procedures to keep people fresh, there are only so many people who can be in one room, dissecting grafts and implanting follicular units at once.

 

As far as difference in graft estimations is concerned, I'm not entirely certain it comes down to a doctor's ability to extract more than another (assuming both are top-notch physicians, like the ones we recommend here ).

 

Frankly, it's going to come down (in my opinion) to the donor characteristics - laxity, hair characteristics, etc, and how the surgeon operates - do they prefer smaller sessions spread out; one large session with a huge number of grafts; what type of closure they like to use on FUT wounds; whether or not they prefer FUE or FUT; preference for temporal restoration while rebuilding hairlines; etc, etc.

 

Also, I don't think a lunch break affects graft survival too severely, and it's probably necessary to keep both the patient and team comfortable and focused.

[PupDaddy]

To my understanding, there are several additional factors (at least) at work to explain different graft estimates by different ht docs for the same patient:

 

1. Unless I am mistaken, some hyper-session docs take a varied shaped strip rather than a purely rectangular strip, which, purportedly, yields significantly more grafts without significantly increasing tension on the wound closure. I seem to recall a video somewhere of Dr. Hasson explaining how he takes a strip that is widest at the rear, narrowing towards the back of the ear, and widening above the ear. Jotronic?

 

2. Some ht docs are simply more conservative in their per-session approach than others and believe in taking a smaller strip (for scar purposes or to preserve donor for future needs) or implanting at lower per-session densities per square cm of recipient area (for yield purposes or for naturalness as the patient's surrounding native hair thins with age) than others, and vice versa.

 

3. HT docs can differ in their assessments of a particular patient's future hair loss and, therefore, decide to take a more aggressive strip or a less aggressive strip accordingly.

 

Other factors? Interesting topic!

[Shampoo]

I agree that it's mainly about techs and to some degree the endurance, passion, and skill the doctor has for large sessions. I've been on several consults where it was obvious there was one main technician. There is just no way a clinic like that can compete with a clinic that is deep with talented, skilled technicians that do large sessions on a regiular basis. One consult I had I met the technician who actually lived hundreds of miles away and flies in for surgery sessions. Is there any doubt which type session is easier to perform for a doctor and a limited staff?

[Dr. William Lindsey]

I agree with most of the guys above. In a situation where you really do have as much hair as you want....take strip size and scalp laxity out of the equation---figuring you have really dense hair and "could" get 4000+....I think its a question of manpower and comfort for the doctor.

 

For example.... when I was just "dabbling" in hair and didn't have a committed group of technicians, we'd do 1000-1200 grafts and take all day doing it. And its tough to do a great job with that. Even if you can pull down 2000 grafts, most patients need more than that...so you are stuck either doing little cases or more surgeries than one.

 

A bunch of years ago though I decided to do hair right, and got enough staff. Then there is the problem of training them, as you can't train staff for a 3000 graft case on a 700 graft case...So all of my techs would go work with my associate Dr. Feller for a week at a time. Soon we had a stable full of competent techs and we could do ever bigger cases. I can still vividly recall our first 2000 graft case. Even with 6 techs it took all day.

 

Now, with 4 techs (assuming someone is out sick or pregnant or answering the phone) we can easily pull down 3500 grafts by 3pm and nobody is really rushing or exhausted.

 

It just takes a commitment by the doctor to do bigger cases and techs who are willing to continually improve their skills. That costs money for the doctor to keep the good techs....but it pays dividends to the recipient patient.

 

Dr. Lindsey McLean VA