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How are international clinics/surgeons able to take 5k+ grafts without destroying the donor?


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One of the biggest gripes stated about international surgeons are that they will destroy donor area since they are willing to do mega fue sessions. This logic makes sense to me however in the review section there  is  constant stream of people who had mega sessions with fantastic looking donor areas.

 

Why are north american doctors so hesistant to do bigger sessions?

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Some suggestions:

- graft survival peaks around 2k grafts, so small conservative sessions are probably better if you have the funds/time

- Most US docs by law have to do the incisions/extractions themselves, so doing more than 2k in a day would prove difficult (particularly if its FUE)

- FUE tends to thin the donor out quite quickly as you are extracting the best hairs/grafts thus effectively leaving the leftover hairs to provide enough density for the donor. Some cautious/ethical surgeons dont like doing more than 1500 in a session because of this

- the "all your eggs in one basket problem"; say you do a 5k megasession and you get no growth, or your donor is not respected and you suffer from scarring or donor depletion etc,, then what the hell are you supposed to do next? Given the average donor is roughly around 6k, youre essentially leaving yourself with little options should that one operation go wrong

-  The donor also thins over time, and MPB is unpredictable. So given this (and the fact getting a HT is a long term commitment) each surgery should be planned to get the maximum coverage while always leaving you options. Look up halo of baldness in the literauture (basically guys got their crowns done, only to continue to bald and be left with a bald rim). 

- Generally speaking there are only a 2 or 3 clinics that I've seen are consistent with their megasession results (and no i dont include Asmed).

- there are also a constant stream of patients with crap donors from budget clinics

I think its an industry where caution should be preached at every step, because its really fucking awful to see some poor guy out of options just from one bad choice.

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Usually when a large number of grafts are harvested for an individual, it is extracted from the beard as well. Since beard has a good survival rate too. For someone with a good scalp donor and beard donor, it is easily possible to cover even a Grade VII grade bald scalp. Needless to say, the expertise and skill of the doctor and the performing team dictate the whole procedure.

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In other countries, technicians perform the extractions, not just one, but several- this allows the clinic to extract thousands in one sitting. In the US, it is illegal for technicians to extract grafts. That’s one big difference, and to answer your question, if you have a huge mega session and you get no growth, you’re pretty much outta luck. 

I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

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2 hours ago, Louisjams said:

1) Results posted are often cherry picked.

2) Lots of overharvested men out there.

This is applicable to us patients and surgeons as well

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10 hours ago, Melvin-Moderator said:

In other countries, technicians perform the extractions, not just one, but several- this allows the clinic to extract thousands in one sitting. In the US, it is illegal for technicians to extract grafts. That’s one big difference, and to answer your question, if you have a huge mega session and you get no growth, you’re pretty much outta luck. 

Just for clarity, is “extraction” is defined as once the strip has been taken out, they extract the follicles from the tissue? Or is extraction something different like taking the strip out entirely? 

I also am curious about this, as a popular Canadian clinic in this forum has quoted me 2k+ above all other of the top rated US clinics here and since it will be a while before we can go to them, trying to figure out why the major difference. 

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I assume Melvin meant extraction process (i.e. extracting the grafts with FUE, or removing the strip with FUT).

The difference in graft number estimates will always vary from clinic to clinic - and can often change dramatically from that of online estimates from physical examinations - but if i were to guess it might come down to their philosophy; some HT clinics do restorative HT's (only transplant the balding areas), while others provide a preventative approach (transplant the bald areas and go further into areas of future balding). This can lead to massive differences in graft counts. It might also come down to hair type; patients with thin hair might be suggested they need far more grafts to achieve an illusion of density than those with coarse hair. It all really depends.

Probably helpful to ask the clinic themselves why specifically in your case

 

 

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This issue really comes down to the regulations in place and to the "ethical" ethos of the clinic. Harvesting more than 3000 follicles in one session of FUE is overly exhausting- to everyone working. So the main issues to look at in such scenarios is the out of body time of the grafts and the comfort of the operators. It is usually difficult to have more than 2 or 3 technicians during the implantation phase. Therefore, even large numbers will have to go back in using the same number of technicians in all clinics. It is therefore unquestionable, that 4000 or 5000 grafts will take few hours more per day. It is convenient for the client and the clinic (to maximize their turnover), but it might not be the best practice for graft survival. 

Ofcourse, we are assuming that they actually harvest such big numbers. I do see personally a lot of cases where clients are told that 5000 grafts will be transplanted, when in fact 2000 were harvested and divided into singles and doubles. This is ofcourse an ethical problem which is quite hard to fight because it is simply built on lies. 

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Great points

I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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