Correlation between mega sessions and Poor growth

[delancey]

Hi All!

 

One trend that I've noticed on this forum as of lately is that many doctors are transplanting 4000-5000 grafts in one session via the FUE method. Many top doctors have a strict protocol set in place that limits the amount of grafts that can be transplanted in a day. We've also seen a lot of failed surgeries coming from countries like Turkey, where it isn't uncommon to see FUE mega sessions being performed in the same day.

 

There appears to be a correlation between poor growth and the number of grafts transplanted in one session. Technician/Doctor fatigue, extraction technique, poor blood supply, and dense-packing are some reasons for poor growth via FUE.

 

1) Is there a correlation between FUT mega-sessions and poor growth? In other words, are some clinics sacrificing strong growth when transplanting 5000-6000 grafts in one session?

 

2) Would you say that poor growth is more related to dense packing than the the total number of grafts transplanted in one session (FUT)?

 

3) If 5,000 - 6,000 grafts are placed over a larger area, we avoid the issue of poor growth due to dense packing. However, lack of blood supply to all of the grafts still becomes an issue. Is lack of blood supply really a common occurrence?

[1966kph]

First off good questions that have been talked about many times but need to be addressed fully so thanks for starting the thread I'm sure its going to be a popular one.

I think all the points you raised are all valid for achieving a good result or a bad result.

What's best less coverage with denser packing or more coverage with less density?

I think drs and technicians fatigue has a big part to play in sub par results I'm sure all of us are aware of tiredness having a major effect on concentration whether its when driving or working ect ect ect.

The different techniques ( fue + fut ) also play a big part in it being the result it could be.

The doc with fut cuts out the strip then does the closure then makes the incisions all told it may be about two hours work its the techs that do the biggest % of work dividing the strip then doing the placing of grafts all told they may have 6-7-8 hours work so the tech is the one more prone to fatigue.

In fue if the doc does the extractions it may take him a few hours to score the fue sites with techs removing them. Both tech and doc have a similar amount of work.

Then the doc does the incisions say for 4000 grafts which takes him a hour or so.Now the techs set to implanting which takes five hours.

With both techniques its the techs doing the majority of the work in the majority of clinics.

So fatigue with the techs would be a big factor thats of course if it was a similar scenario to the example I just gave.

The fact that fue grafts are slenderer than fut grafts also have a baring on the end results with the survivability being higher with fut in most cases.

There are so so so many possible reasons why docs have sub par results.

We all know the best of the best have poor or sub par results even though nothing is different in the way the procedure was carried out from the thousands of previous ops.

I would personally opt for fue with more coverage and less density then a second procedure to address density and I would not have any hesitation in a offer of 4 or 5 thousand procedure in one day as I know its possible to get good results as I've seen them.

Its a roll of the dice having a ht we just hope all goes well but even in the most capable of hands sometimes we see poor results.

Have good day

[KO]

I have not seen successful results with FUE at more than 3k grafts per day.

 

1) it is possible that graft quality is lower in clinics that are doing mega sessions. Think transection etc.

2) technicians could be mishandling grafts during implantation.

3) grafts were damaged during storage. I am not sure it's an issue of keeping grafts out a long time as I know some clinics keep them out for hours and still have success.

4) lack of surgical skill. Perhaps the surgeon is not so good at making recipient incisions. One good way to look at this is to compare a clinics FUE and FUT results.

5) perhaps there is not enough vascularization in the scalp to supports a lot of grafts especially skinny ones.

[1966kph]

I don't quite understand point 4 ko.

The recipient site incision is not going to differ between a fut and a fue graft much if at all.

I think its more the amount of tissue that comes with a fut graft plus the fact its not had to endure the traction forces that occur when extracting fue grafts that make for possible better results.

I dont know about lack of vasculation being a issue as we have seen some massive fut cases especially from h&w which makes me think its more to do with the grafts themselves that carry the answer.

A interesting experiment would to do a large fue session with two equally skilled fue docs Eg Lorenzo and cheuco and their usual teams both work on the one patient and say do a 5000 procedure in the day.

They are both very good fue docs so the result might give some kind of answer to whether fue mega sessions are able to achieve good results and if the result is good then the problem of poor yield lies elsewhere. Fatigue, Dr skill level, Tech skill level ect ect.

Have a good day

[KO]

Yes recipient incisions would not differ between FUE and FUT that is the point of comparing them to find out if it is the difference.

 

Lack of vascularization is a guess as FUT grafts may be able to survive longer as they have subcutaneous fat and supportive tissue.

 

I do not think Lorenzo and Chueco could ever do 5000 grafts in one day given they use manual extraction. It is not clear whether they would want to do this as their larger cases have been through multiple procedures.

[GoForIt]

We see some pretty amazing mega-sessions here. I would view them like home-runs (to use a baseball analogy).

 

Regardless of whether you use FUT or FUE, I believe most of the time two 2500 FU procedures spaced over a year will give a better cosmetic results versus one 5000 unit procedure. Ignoring the technical challenges and time the grafts are outside of the body, the surgeon can see how the first transplant has grown in and then plan the second procedure appropriately; the hairline can be tweaked, whether or not to address the crown can be discussed, and the donor doesn't get too taxed with one procedure.

 

While it is really appealing to get everything done with one procedure, I think only a minority of patients, and a minority of physicians can successfully do this.

 

 

Hi All!

 

One trend that I've noticed on this forum as of lately is that many doctors are transplanting 4000-5000 grafts in one session via the FUE method. Many top doctors have a strict protocol set in place that limits the amount of grafts that can be transplanted in a day. We've also seen a lot of failed surgeries coming from countries like Turkey, where it isn't uncommon to see FUE mega sessions being performed in the same day.

 

There appears to be a correlation between poor growth and the number of grafts transplanted in one session. Technician/Doctor fatigue, extraction technique, poor blood supply, and dense-packing are some reasons for poor growth via FUE.

 

1) Is there a correlation between FUT mega-sessions and poor growth? In other words, are some clinics sacrificing strong growth when transplanting 5000-6000 grafts in one session?

 

2) Would you say that poor growth is more related to dense packing than the the total number of grafts transplanted in one session (FUT)?

 

3) If 5,000 - 6,000 grafts are placed over a larger area, we avoid the issue of poor growth due to dense packing. However, lack of blood supply to all of the grafts still becomes an issue. Is lack of blood supply really a common occurrence?

[delancey]

It's an important topic, especially for > NW5 with a large area to cover. One on hand, it is important to get a large number in the first session because this will determine the amount of donor available for future sessions (FUT). The trade off may be poor growth, as a result of so many grafts being transplanted at the same time. Some clinics feel very comfortable with transplanting so many grafts in one session and have had outstanding results over the years. I do, however, wonder if it carries an additional risk. As a Norwood 5 (going on 6), this is my biggest concern at the moment: poor growth, as a result of transplanting too many grafts in a single session.

 

Is lack of blood supply an issue when so many grafts are transplanted and/or does it carry an additional risk (FUT)?

 

Or is poor growth related more to dense packing when so many grafts are transplanted?

[delancey]

We see some pretty amazing mega-sessions here. I would view them like home-runs (to use a baseball analogy).

 

Regardless of whether you use FUT or FUE, I believe most of the time two 2500 FU procedures spaced over a year will give a better cosmetic results versus one 5000 unit procedure. Ignoring the technical challenges and time the grafts are outside of the body, the surgeon can see how the first transplant has grown in and then plan the second procedure appropriately; the hairline can be tweaked, whether or not to address the crown can be discussed, and the donor doesn't get too taxed with one procedure.

 

While it is really appealing to get everything done with one procedure, I think only a minority of patients, and a minority of physicians can successfully do this.

 

I think this is some good advice here. Slow and steady. The only drawback would be fewer lifetime grafts available via FUT. Higher NW patients need as many grafts as possible. Also, FUT is a very invasive procedure, which requires additional time off from work.

[Blake Bloxham]

There is a theoretical concern for overwhelming the blood supply in a mega session. However, I don't think this is frequently the reason for poor yield. The scalp is highly vascular, and it would take dense packing at absurd rates to truly overwhelm the blood supply.

 

I think we see poorer yield rates with FUE mega sessions for the reasons KO listed above. Long story short, growth yield is simply lower with FUE because of greater stress/strain on the grafts. You really see this play out when 3,000 - 5,000 grafts are implanted at a time. It can happen in strip as well, but I think we see less of it because of decreased graft stress/strain and overall higher growth yield.

[BUSA]

Well I think u need to define MEGA SESSIONS. there is huge difference between someone getting 5000 grafts over a 2 or 3 day period then someone getting 5000 grafts over a 1 day period.

 

its been proven time and time again that having 5000 grafts over a 2-3 day period is successful vs. splitting 2500/2500 over a years time frame.

 

Erdogan use to split most of his larger sessions over a years time frame but has since ceased doing that and does them over a 2-3 day period. if u look at his older threads u will see he almost always split his large sessions over approx. a years time frame. u rarely see him do it that way now.

 

I wud say that if I lived very close to a HT surgeon and was going to get 5000 grafts I wud personally opt to have them split up at least 8 months apart. wud it make a difference? IDN but I can't see it hurting but considering the only affordable HT doctors are in Europe thats just not feasible for most.

 

there is also the argument that scalp laxity will continue to improve after the HT for a period of up to 8 -12 months making the donor hair a little easier to harvest but they may in part due to the skill of the HT surgeon or Tech. can't forget the techs these days since they seem to be performing good results which begs to differ if spending $300k in medical school is really necessary.