graft survival

[grub12]

about what percentage of grafts typically survive thru either procedure (strip or fue)??

[hair_me_out]

I was also wondering this...

[Bill - Seemiller]

grub12,

 

It depends. Best case scenerio, growth yield is as high as 90 to 95% for both strip and FUE. However, in my opinion, more patients are candidates for strip than FUE. Trying to perform FUE on a patient who's not an optimal candidate will reduce growth yield percentage. Successful hair growth is mostly due to the careful handling of hair follicles from the removal to the placement process. On rare occasions, a patient's physiology may reject a good number of the grafts for some unknown reason.

 

I hope this helps.

 

Bill

[phil mascallpen]

When I had my surgery I asked Dr. Hasson what percentage of the grafts I should expect to grow as I had also heard the 90-95% number thrown around. His answer was I should expect all of them to grow because they take the same exacting care of every graft. And really that makes sense. If each graft is trimmed correctly, handled with care, kept in the same solution and then placed correctly the variance should be almost negligible. I would say if survival was anything less than 99% then other factors/errors would be going on.

[Anouar]

it's called the human factor

[okay2land]

So basically it sounds like its up to the cutters. Maybe there should be a coalition for cutters as well as doctors.

[Maxxy]

There pretty much already is. Unless a doctor does all the work, which I don't know of any, then a large percentage of the final result is down to the techs.

 

Though it may be the doctor's name listed in the coalition/recommended surgeons, it's really the clinic as a whole.

[okay2land]

Interesting never thought of that.

 

What concerns me is the rotation and anonymity of the techs. I good doctor might remain in office for years and have great techs, but if theres a rotation and 'weaker' people are put on all we're left with is the doctors good name?

[Maxxy]

Yeah, that concerns me also. It would be great if clinics listed their techs along with their time at the clinic, experience and other facts.

 

I'd like to think none of the doctors recommended on this site would leave a tech unsupervised for a second until they were 100% sure that they were ready.

[Severn]

The techs are a huge part of it. Believe me, I was kissing some serious arse while I was in the chair lol. They said they appreciated my compliments and that a lot of patients ended being ###holes. Too many of them complaining about how bored they were and wanting the techs to hurry up.

 

I would think that would be a lot like severely pissing off the cook at a resturant before they bring out your food.

[hair_me_out]

I was also very kind to the techs @ H&W. They worked very hard and long hours. I made sure to tell them I appreciated their hard and diligent work. They seemed to be thankful for this.

[okay2land]

Just might send my Dr's techs a little christmas stocking this year

 

Question is will they remember me the next time around?

[Bill - Seemiller]

Guys,

 

Just to be clear, we recommend hair restoration physicians on an individual level however, their staff is clearly a huge part of the procedure. Ultimately, it is the physician's responsibility to hire, train, and supervise their staff to ensure their patients receive the best care and results. Thus, any problems with his/her staff will ultimately reflect poorly on the physician and it's up to the physician to rectify that problem.

 

That said, technicians are seldom given the recognition they deserve for the diligent and impressive work they perform on a regular basis. Kudos to not only the physicians, but to their dedicated team of nurses and technicians who work hard to give us patients the best possible results.

 

Best wishes,

 

Bill

[Dr. Paul Shapiro]

Grub12

There are many factors that influence graft survival. How the grafts are cut, how long they are out of the scalp, the density that they are planted, how carefully they are handled when planting into the scalp, and preventing dehydration are all important factors in graft survival.

To scientifically study graft survival is very difficult. One needs to transplant hair into totally bald scalp in areas of scalp that can be accurately measured and then re-examined over time. In order to do this we have to tattoo one cm sq boxes on the scalp to accurately measure graft survival. There are not many studies on graft survival because not many patients want areas of their scalp tattooed.

To complicate matters further, remember that about 10%-15% of one's hair is in the resting stage of growth and is not visible. So if I plant 10 hairs into a one sq.cm. area that has 10 existing hair, it is impossible in one year to tell what hair is transplanted hair and what hair is already existing hair. And the number of existing hairs can vary from 8 to 12 hairs in that one cm sq area because the percentage of hairs in the resting and growing stage do not stay consistent over time. So a study of hair survival is very difficult.

The studies of hair survival in the Hair Transplant Literature shows anywhere from 90 to over 100% survival. But I would say on average the survival rate is about 95%. These studies are done under very controlled situations. They are done in one sq.cm boxes with densities anywhere from 30 to 60 FU/sq.cm. They are done as soon as the donor hairs are cut, and the best planters or doctors are planting the follicles. This is not the situation in real life. Taking these survival studies into consideration I do not think we can say we get 100% graft survival. I would guess that 95% graft survival is what most good clinics get.

To complicate matters, studies show that graft survival decreases the longer the grafts are out of the body. The most commonly cited study shows that after 4 hours out of the body, the graft survival decreases to 95%, after 6 hours graft survival decreases to 90%, and then graft survival continues to decrease by 2% for every additional hour they are out of the body. If a case is larger than 2,000 FU it is very difficult to have all the planting done within four hours of the strip being excised. And as the cases get large in the 3,000, 4,000, and 5,000 range the cases even go longer than 6 hours. Studies also show that the type of medium the grafts are kept in do not greatly affect the outcome.

Taking all this into consideration I agree with Bill in saying that graft yield is between 90% and 95%. If one looks at the studies done and just uses ones common sense one can see that 100% survival is almost impossible and the we should be happy with 90- 95% graft survival.

I hope this is helpful

Dr. Paul Shapiro

[EpilepticSceptic]

OK, so if the techs' skill in doing the dissecting and planting are a MAJOR factor in the final outcome, HOW does one insure that he/she will be getting the clinic's most experienced and TOP senior super-techs on the day of the procedure ???

 

When I have my procedure I want to know for sure that no newbie techs are working on me. I'll even pay extra if I have to just to insure this !!!

 

Also, I don't want stressed out overworked techs on the day of my procedure either. I'd rather schedule on a monday so that the techs had a couple of days to rest and refresh. The last thing I would want is to have the same techs that just finished a 12 hour 6000 FU procedure the previous day that ended at 9 p.m., and then they have to show up at 7 a.m. the next morning to work on me. No matter how great they are there will be some fatigue issues. Even the very best athletes in pro sports have fatigue issues and cannot perform at the top of their game unrested; I see this as something very similar.

 

So HOW can one go about insuring all of this BEFORE the day of the procedure ???

[shine on]

I've also been curious about how to best ensure the clinic's best techs, and their work load. Other than scheduling on a Monday, or day off, how would you know the prior day's schedule?

[shine on]

Curious about another issue. As we are discussing graft survival, what I rarely hear discussed concerns the telogen phase hairs which get thrown out in a strip surgery. Unavoidable. However, at the end of the day, can't these lost hairs rival transaction rates? Also, I am curious about the number of grafts typically transected during the strip removal. Does a strip doctor attempt to avoid this damage while cutting out the strip? Either way, one would think at least a few are transected. I would like to get the forums take on this while the topic is on the table.

[Dr. Bernardino Arocha]

Dr. Shapiro,

Nice discussion. I agree that the transplant yield is probably 95+%. In our center we perform serial harvesting, in order to minimize the out of body time. When the team completes the trimming of the tissue, then another section is harvested, while part of the team trims, others place and so on. It is a little more work, but worth it.

 

Shine on,

Those are some very good questions! Would love to answer, but I do not want to highjack this thread.

[TheEmperor]

Originally posted by labrat69:

OK, so if the techs' skill in doing the dissecting and planting are a MAJOR factor in the final outcome, HOW does one insure that he/she will be getting the clinic's most experienced and TOP senior super-techs on the day of the procedure ???

 

When I have my procedure I want to know for sure that no newbie techs are working on me. I'll even pay extra if I have to just to insure this !!!

 

Also, I don't want stressed out overworked techs on the day of my procedure either. I'd rather schedule on a monday so that the techs had a couple of days to rest and refresh. The last thing I would want is to have the same techs that just finished a 12 hour 6000 FU procedure the previous day that ended at 9 p.m., and then they have to show up at 7 a.m. the next morning to work on me. No matter how great they are there will be some fatigue issues. Even the very best athletes in pro sports have fatigue issues and cannot perform at the top of their game unrested; I see this as something very similar.

 

So HOW can one go about insuring all of this BEFORE the day of the procedure ???

 

You have to go on the reputation of the clinic. All the factors already mentioned contribute to the outcome.

 

I personally think 95% is the ideal, but that is if all the factors are controlled and nothing goes wrong. In reality, there are going to be cases where a patient gets less. I think the "home run" results represent the 95-100% growth cases.

 

Techs are working with the tissue -- there have to be "oops" cases where they flub a graft or two (or three), either while cutting or placing.

 

I personally think that the skill of the planting tech is the big "x factor". People often see increased or decreased yield in one area or on one side. Techs usually share planting responsibilities. Large procedures will have one tech one each side. The "more growth on right (of left), is probably explainged by this.

 

The dexterity to smoothly insert grafts in tiny incisions without crumpling or crushing them is considerable!

[Severn]

As we are discussing graft survival, what I rarely hear discussed concerns the telogen phase hairs which get thrown out in a strip surgery. Unavoidable.

 

I thought they can still trasplant the follicle even if it is in the telogen phase? If NOT, then that changes everything.

 

For example, if an individual starts taking finisteride or especially dutasteride and goes through a massive initial shed before surgery. If they could not recover the resting phase follicles, then it could be a huge loss.

 

And the assertion that only DHT affected hairs shed on dutasteride is completely false. When I was on duta years back, I had a massive shed that affected every square inch of my head. It was rapidly thinning at the lower back and sides at the same rate as the crown and front.

[shine on]

I thought they can still trasplant the follicle even if it is in the telogen phase? If NOT, then that changes everything.

 

I've read otherwise, over the years. However, I think you take everything with a grain of salt with online BB. Maybe someone can answer what happens to telogen hairs. Maybe in a multihair grafts they might survive vs. a single hair telogen graft? When discussing the issue raised in the initial post, I think it is also imperative to question graft transactions/lost grafts while removing the strip (both those excised, and those remaining in the donor situated next to strip incisions) vs. transection rates for FUE (not just of the graft excised, but also the hairs surrounding the graft remaining in the donor). One would assume as punch size increases, this becomes more likely. Discarded or damaged grafts is something to consider when comparing strip / fue yields. As we all know, we are dealing with a very limited donor supply and we must be very judicious in our approaches.

[Maxxy]

I've read otherwise, over the years. However, I think you take everything with a grain of salt with online BB. Maybe someone can answer what happens to telogen hairs. Maybe in a multihair grafts they might survive vs. a single hair telogen graft?

 

I actually asked this question last year, you can read the responses -here-

[shine on]

Thanks Maxxy

 

The comments raise another issue. I will start a new thread.