Do FUE MEGA SESSIONS produce decent yields?

[MAGNUMpi]

Hi All,

Is it smarter to go for a FUE mega session 2500 (over 2 days) or do half now and half in 6 months? Ive had 2 different suggested approaches from 2 different good doctors. I dont see how just one day between would help the trauma of the operation much if that is a factor in preserving high yields.

Does the trauma factor into what the yield is in the end for FUE?

Do FUE mega sessions work out well (most) of the time?

Thanks!

[aaron1234]

FUE is only as good as the doctor/clinic providing it. I think SMG does the 2 day thing for FUE patients around the 2K graft mark and their FUE results are coming in great. I think it's all about preventing fatigue from all of the manual extractions. More fatigue puts more grafts at risk during the extractions.

[Spanker]

I agree. Anything over 2k should be broken up over 2 days, in my unqualified opinion.

[PupDaddy]

Some docs have stopped doing consecutive day FUE because they have found that the second day yields are comprised.

[chrisdav]

I think you would be better going for half now and half later in my honest opinion.

 

In an ideal world, I would have had fue myself and would continue to have it if my hair loss progresses as I get older as a lot of people would.

 

But being realistic from being present on the major forums for over a year now and reading large amounts of information ,looking at hundreds of before and after’s, I soon realised that the best,most consistent results by the best surgeons to date that cater for all types of patients with all types of hair loss are from strip and is also the most efficient way of utilising the donor supply.

If we had an unlimited donor supply, then it maybe different.

 

Dr Feller, who I had my strip surgery with was one of the very first surgeons to perform fue with some of the best results but yet he is a strong advocate of smaller sessions and the limitations of it which I do genuinely believe in his opinion. Conversely, you have another surgeon on the opposite end of the spectrum and one of the first in fue from Atlanta with the completely different perspective who believes it is a superior procedure and that none of the drawbacks exist but you only have to take one look at his website to see his unethical, marketing tactics which to me are very questionable and the added factor that when surgeons who perform strip and fue with better results than him don't agree with him, you tend to favour their opinion.

 

There has been a lot of discussion regarding this and if the problems which have been stated before had been overcome, there wouldn’t be the need to finesse the procedure but it is still an issue and hence why different surgeons are trying to come up with innovative new methods to harvest the grafts e.g Bernstein, Harris, some breaking the procedure down into smaller consecutive days, new solutions e.g Gho being used to preserve the grafts to increase yield etc etc.

 

Only the other day , we have seen an unhappy patient having a larger fue session performed on one day by one of the worlds best surgeons regarding the yield.

 

We don’t see this with the gold standard strip as the procedure doesn’t have any of these problems and this may well be due to the fact that fue has only been around for approximately 10 years against strip which has been around far, far longer.

 

You cannot honestly compare larger fue sessions for example to larger sessions from Hasson&Wong for example-it is a no contest.

 

I would stick to smaller sessions personally.

Edited July 22, 2012 by chrisdav

[scar5]

I think slow and steady sounds safer, but I don't know. I assume the doc, one doc, will be doing the extractions. If techs are used then you could do more in theory, just as if neograft is used. But these two modalities are far from proven to work. I've had all-tech extraction FUEs and the variation between techs was great. I wouldn't trust them yet.

 

There is an element among composite clinics (that do strip as well as FUE) that will warn you, that once you do an FUE procedure and allow it to heal, the subsequent scarring makes it more difficult to extract follicles in following operations. To this way of thinking, mega sounds better, but IMHO, this argument is mostly a lever, to swing you over to a strip frame of mind, by hinting that FUE only is good for little jobs.

 

So knowing what we know, which frankly isn't very much, I'd steer towards smaller unlessthe doc has great reasons to suggest otherwise.

[RCWest]

I would rather shave down once and do it over 2 days. I don't like the idea of going back into an area after only a 6 month period. There could be dormant follicles in the recipient area that could get damaged.

[orlhair1]

Based on what I have seen, I believe that the smaller FUE sessions produce better results on a consistent basis. I had scheduled a 1500 graft FUE with SMG and was going to have that done over 2 days. I decided to cancel the procedure, but will likely do it in the next year or two. If it were me, I would take the conservative approach with an FUE session of 2,500 grafts. I am no expert by any means, but that seems like a lot of prolonged trauma to the scalp over 2 days.

[HARIRI]

I strongly agree with chrisdave. What I love about Dr. Feller that even he is so talented in FUE procedure, he still does not agree to do more than 2000 in a day. IMO, FUE mega sessions aren't good enough as it always safer to give a break between them. 2000 grafts FUE is enough and anything more than that is quite risky despite which sugeon is it.

[PupDaddy]

If nothing else, this thread shows that FUE protocol and technique are still evolving. I think the trend (at least with manual punches or hand-held motorized punches) is away from consecutive day sessions to increase total numbers and towards multiple sessions separated by about 8 months. Dr. Rahal is an example of a world-class doc who used to offer consecutive day FUE sessions but now has gotten away from it because of compromises to yield from the next day’s session due to trauma from the first day. The closest thing we currently have to a proven mega-sessions doc looks to be Dr. Lorenzo in Spain, although even he achieves his big FUE numbers via 2 fairly large procedures separated by 8 months.

I am really interested to see how the ARTAS is going to impact FUE practice and protocol. It appears to offer major advantages in terms of making the excisions: computer mapped excision pattern, computer-determined angle of the punch to precisely match the growth angle of the FU, speed, and precise robotic repetition of the ideal movement and depth to excise the FUs. And the excision tool itself is a modified Harris SAFE, which combines blunt and sharp excision and has become the motorized punch of choice for a number of top docs. It will be interesting to see whether ARTAS will significantly up total consistently achievable FUE one-pass numbers with the predictable yield of strip, or nearly so.

For now, I personally would stick with 1,500 – 2,000 max for any single-session FUE, and if I needed more, I would space the sessions apart by eight months or so. I’m also not convinced that it really matters whether the doc or techs extract/remove an FU after the doc has cut/excised it, so long as the tech is trained how to do it. If it means the doc can devote more of his time and attention to the critical task of cutting/excising the FUs and making recipient sites, and that the FUs can more quickly be segregated by numbers and implanted into those recipient sites, I don’t have a problem with it.

[Mickey85]

Lorenzo caps his sessions at 2,000 grafts per day. I do believe he allocates a healing period until the next desired procedure(I think it's a year?).

[Bobilero]

Ive seen a lot of Stellar results from Dr Bisangas office of 2500 - 3000 FUE over 2 days and the other Belgium clinics.. I think that is the Max though.

 

Certain high profile clinics love to downplay the effectivness of FUE these days purely as they do not want to do it anymore and Strip is far more economical for them to perform.

 

FUE being too labour intensive for the DR amoung other things they frankly could not be arsed and are investing in all kinds of motorized tools which dont work very well.

 

Unfortunatly i believe they are pushing young guys down the strip route who probably shouldnt do strip. The fact is in the right surgeons hands FUE can be potentially as good as strip.

 

Especially as the HT landscape could be very different in 5-10 years. Even if new technologies are not mainstream by then and there is a good chance they could be. You can be sure the FUE technique will have been refined much more to a 'Gold standard' tenchnique by then.

[MAGNUMpi]

I do hope they perfect FUE one day soon. Ive read so many posts and seen too many pictures of poor yield results and "see through" hairlines. It seems the only really good ones are young guys who did a small procedure, had thick hair, and had hairlines that looked pretty good before the OP (or other guys that took 2-3 trips to the doc). I wonder if waiting a few years before pulling the trigger might be a good idea if at all possible to save donor hair. This industry IS moving fast and the procedures should only get better over the next few years.

[s2thoudriver]

A good FUE surgeon and team will have no problems doing 2,500-3,000 in a day.

 

Where i had my FUE (approx 2,800, frontal region and dense packing), they said that 4,000 is really the limit they would do in any one session, but if a customer really wants more, they would go slightly higher.

 

They did say that they stopped doing sessions over 2 days due to the results not being good enough. The scalp is already healing by the second day and further transplants cause too much trauma.

 

Basically, their advice is... if you want multiple sessions, have at least an 8 month break in the middle.

[Spanker]

Is there a definition for what a megasession is now? What number are we looking at to consider it that?

[Sean]

Is there a definition for what a megasession is now? What number are we looking at to consider it that?

 

Spanker, I always thought 2000+ grafts was enough to be termed a megasession under certain circumstances. In the past when extractions were a lot slower, people mentioned 1500-2000 grafts in one day as megasessions. I guess as technology perfected speed, the term megesession changed for some. Some doctors handle the entire procedure themselves and some have 5 employees helping. What's mega for some may not be for others. Today, I still think any procedure 2000 grafts or above on a patient's scalp in one day could be in that megasession category.

 

Regarding yields, I just don't know anything anymore.

 

Good luck to everyone that has a megasession.

[marcin872]

I had 3,400 grafts done in one day in india. I dont know if i believe the doc got that many as everyone is saying that 2,000 is the limit. He used a tool he designed that was a automatic punch and it was super fast and did have alot of staff working in the room. I dunno hopefully i will get good results in the next few months

[MAGNUMpi]

Is there a definition for what a megasession is now? What number are we looking at to consider it that?

 

Hi Spanker, I was thinking 2000-2500+ could be considered a "Mega session".

 

From what Ive been reading more people are taking the option of around 1,500 in one session then an 8 month wait for the rest (3000 for instance).

It seems that sometimes that splitting a big session over 2 days back to back is just too much trauma for the scalp and the yield is compromised.