How fast can (and should) grafts be inserted?

[Hair28]

I recently had a HT procedure where 2,100 grafts were placed on the front. The graft placement (excluding the removal of the donor site and graft dissection) took little less than 2.5 hours. Is this too fast, too slow or just average for placing 2100 grafts by two technicians, non-stop?

 

I would appreciate your feedback / comments.

 

Heat28

[jmg544]

I'm not sure but compared to mine, I had a little over 3k and excluding the extraction of the strip plus the punching holes in my head and all the breaks I had... I would say it took anywhere between 8-9 hours to insert all my grafts with two techs as well. I say this because I went through 5 'full' lengths movies. Went in at 11am and left at midnight.

[rpachigo]

That seems a little too fast to me. There is some delicacy involved when using the jeweler's forceps to gently grasp the SQ fat around the bulb and gently place into recipient site. I don't think this key step should be rushed - it could mean they are just grabbing the graft and shoving it into the hole as fast as possible. That would reduce likelihood of graft survival - I don't know your particulars of course of what your techs were doing.

[Dr. William Lindsey]

It really depends on the case. We can generally get 3000 placed by 5pm, and figure the strip is out by 8:30. During that time the grafts and donor strip are kept in cool saline; and once cut, they are placed as fast as the patient's scalp will allow 2 placers to move.

 

The key is not how fast, but rather, that the grafts are cut with care, all tissues are kept cool and moist/wet; and placement is with as little trauma as possible.

 

Dr. Lindsey McLean VA

[Dr. Michael Beehner]

I did the math and that works out to each of the two assistants placing a graft every 8.57 seconds over those two and a half hours (no coffee or bathroom breaks!). Some of our faster placers over the years and even myself at times, have had stretches (not 2.5 hrs) in which we were able to put them in that quickly. But that assumes a whole bunch of favorable conditions: Soft, receptive scalp (not rigid, like some are); Patient is not a bleeder; Patient is shiny bald without much hair in the way or agrees to be shaved (we don't shave our patients who have native hair); Patient is not "poppy." And perhaps a correct alignment of the stars in the sky?

The other point I would like to make is that each person who places, whether it is an assistant or a physician, has a natural pace at which they work best and place the grafts in the gentlest, safest way for them. You can make an excellent placer into a poor one by insisting that he or she speed up to some pre-determined rate of speed just for the sake of getting the case over quickly.

Mike Beehner, M.D.

[rpachigo]

What Dr. Lindsey and Dr. Beehner said. Also, the techs are usually wearing loupes which at least for me slows down my hand motions when doing surgery. Everything is magnified 2.5 or 3.5 and so you naturally slow down.

[Hair28]

The surgery was with Dr. Charles just over 10 days ago (this was my 2nd HT with Dr Charles). He told me I had very little bleeding and that the techs did not have any issues inserting the grafts into each hole. I too was amazed at how fast they inserted the grafts, since he also did my first HT about 2 years ago and it took about 3.5 hours back then to insert just over 2000 grafts (excluding strip removal and disection).

My obvious concerns this time were: 1)did I actually get 2,100 grafts, and if I did, then 2)did speed sacrifice the handling -and potential survivor- of my grafts?

I trust D. Charles and I guess (or hope that) I might be one of those patients where everything just goes right, or like Dr. Beehner mentioned above, all the stars were in perfect alignment.

[rpachigo]

With Dr. Charles, you should be absolutely fine. He's excellent and probably you had ideal characteristics and they were on their game that day.

[Manko]

Originally posted by Hair28:

The surgery was with Dr. Charles just over 10 days ago (this was my 2nd HT with Dr Charles). He told me I had very little bleeding and that the techs did not have any issues inserting the grafts into each hole. I too was amazed at how fast they inserted the grafts, since he also did my first HT about 2 years ago and it took about 3.5 hours back then to insert just over 2000 grafts (excluding strip removal and disection).

My obvious concerns this time were: 1)did I actually get 2,100 grafts, and if I did, then 2)did speed sacrifice the handling -and potential survivor- of my grafts?

I trust D. Charles and I guess (or hope that) I might be one of those patients where everything just goes right, or like Dr. Beehner mentioned above, all the stars were in perfect alignment.

I'd say that's incredibly fast. I had a 350 FUE session about a month ago, and the placement of those grafts took about an hour. I would've been very suspicious if you had the surgery done by any one other than Dr. Charles...he does seem to have a stellar reputation.

[Hair28]

Yeah, I must admit that I'm a bit suspicious, despite the fact the the HT was done by Dr. Charles. I don't know if anybody else (whether Charles' patient or not) has ever experienced something similar. The graft placement started at around 11:20 am and it was done just before 2 pm, non stop, with 2 techs (one on each side) placing the grafts.

I'm a little bit worried, but I hope the results in a few months will ease my concerns.

 

What do you guys think?

[Bill - Seemiller]

Hair28,

 

I'd direct your concerns directly to Dr. Charles. He's a stand up physician and isn't going to steer you wrong. In my opinion, try not to worry, but do ask him for an explanation, as I'm sure he has a plausible one.

 

All the Best,

 

Bill

[Dr. Mohammad Humayun Mohma]

Dear Hair 28

 

Generally HT is not as simple as 1+1=2

 

There are multiple factors

 

How soft is the skin?

Oozing and bleeding during the procedure?

Experience of tech?

thin or chubby grafts?

Time of procedure?

Apprehension of the patient?

 

Actually in my books a good and well trained pair of tech should be doing about 800 to 1000 in an hour give and take 200 grafts.

so that means 2100 grafts should take about 1.45 hrs to 2.30 hours difference of about 45 mins or some times if too much oozing it can take as long as 3 hours.

 

In my experience if you are rough and not gentle you cannot place the grafts quickly. Its a paradox, the faster you are the gentle you handle because its all about eye hand co-ordination.

 

Similarly the first time if every thing else was same and you were more apprehsive then that alone can reduce the speed by about 30 mins.

 

If I would you, I would just relax, sit back and wait rather than worring. Dr Charles is of great repute and I am sure he will stand beside your point.

[Hair28]

Thank you Dr. Mohmand for your response.

Your words make me feel much better. I do trust D. Charles and I'm looking forward to seeing some great results in the months to come.