2x 2000 vs 1x4000 Session - less scarring for first option?

[SoSoz]

I've watched one material about ht and the person said it's better to get 2x 2000 FUE procedures split between years instead doing 1 session with 4000 grafts because it will cause lot less scarring, is this really the case? At the end we will have extracted 4000 grafts, but how come it can cause less scarring if splitted? 

Edited December 25, 2022 by SoSoz

[NikosHair]

2 hours ago, SoSoz said:

2x 2000 FUE procedures split between years instead doing 1 session with 4000 grafts

What about 8 X 500? Almost zero scarring, can anybody beat that?😊

[mister_25]

I’ve actually heard the exact opposite, that the mega session will get you less scarring in the long run.

[HugoX]

Did 7000 first time (over, 2days), 10 months later a bit over 3000 grafts... 

[mister_25]

2 minutes ago, HugoX said:

Did 7000 first time (over, 2days), 10 months later a bit over 3000 grafts... 

Your scars are invisible, you have the best donor management I’ve ever seen.

[Gatsby]

The issue isn't scarring at all. The issue is that if you split the procedure into two surgeries, one year apart, you can see how well the first surgery goes. If it goes pear shaped then you haven't blown all of your grafts in one hit. All the best!

[NikosHair]

44 minutes ago, Gatsby said:

The issue isn't scarring at all. The issue is that if you split the procedure into two surgeries, one year apart, you can see how well the first surgery goes. If it goes pear shaped then you haven't blown all of your grafts in one hit. All the best!

I agree,  but the staged approach also ties in with scarring. From the 1st surgery you get to see if you are genetically predisposed to scarring. For patients that want to have short hair/tight fade, the prospect of more scarring in the 2nd procedure maybe a deal-breaker.

[Gatsby]

Whether you have 3k grafts in the first of two procedures or one procedure of 6k grafts in a one and done approach, you are going to scar regardless. If you want to know how bad you are going to scar (keloid, etc) then you are better to just have a biopsy and give it a year to see how it heals.

[NikosHair]

18 minutes ago, Gatsby said:

you are going to scar regardless

It's not really as cut n dry as that, genetics play a significant part in the level of scarring.

I agree that at some level everyone scars but there is a full range from hardly visible to highly noticeable. The staged approach allows someone at the 'highly noticeable' end of the scale to take stock.

 

[Gatsby]

Ok. But why risk thousands of scars compared to risking only one? 

[NikosHair]

13 minutes ago, Gatsby said:

Ok. But why risk thousands of scars compared to risking only one? 

Risk/reward. For example the allure of a full looking front third maybe worth the risk of scarring. Take another 3000 graft and the cumulative effect may become disfiguring and not worth the risk. The staged approach allows them the option to take stock.

Re. Biopsy: If it's small enough to replicate an fu extraction then you have a tiny single scar in isolation. You spend a year looking at it but no real way of knowing how good/bad it will look with 3000. 

 

[Gatsby]

5 hours ago, NikosHair said:

Risk/reward. For example the allure of a full looking front third maybe worth the risk of scarring. Take another 3000 graft and the cumulative effect may become disfiguring and not worth the risk. The staged approach allows them the option to take stock.

Re. Biopsy: If it's small enough to replicate an fu extraction then you have a tiny single scar in isolation. You spend a year looking at it but no real way of knowing how good/bad it will look with 3000. 

 

Have a look at @DrTBarghouthi’s thread on vertoporfin. Have a look at the title of the study. You seem to find less scars more acceptable than more. No surgery is scarless. You would sooner find an honest man in parliament than a scar free hair transplant. Anyway all best with it. 

[NikosHair]

3 hours ago, Gatsby said:

Have a look at @DrTBarghouthi’s thread on vertoporfin.

Looks promising.

I think we risk losing track about what we disagree on🙂

To summarise:

1. We agree that a staged approach is better. It allows us to evaluate the first procedure before proceeding.
2. We agree everyone scars.
3. You believe that we all scar to the same degree. I believe it varies from person to person based on genetics including ethnicity and age. I believe it would be a factor in the decision to proceed to a further procedure. You believe it's irrelevant.

[Gatsby]

I never said we all scar ‘to the same degree.’ I don’t believe it’s irrelevant either. Ethnicity (genetics) plays a role (ie keloid scars) in how much a person scars. As to point number one yes we are on track. 👍 And with that I will leave the fate of this thread with you. 🙏

[NikosHair]

13 minutes ago, Gatsby said:

I never said we all scar ‘to the same degree.’ I don’t believe it’s irrelevant either.

Which is why I said at the start:

12 hours ago, NikosHair said:

I agree,  but the staged approach also ties in with scarring. From the 1st surgery you get to see if you are genetically predisposed to scarring. For patients that want to have short hair/tight fade, the prospect of more scarring in the 2nd procedure maybe a deal-breaker.

Something must have got lost in translation along the way🙏

[ciaus]

21 hours ago, SoSoz said:

I've watched one material about ht and the person said it's better to get 2x 2000 FUE procedures split between years instead doing 1 session with 4000 grafts because it will cause lot less scarring, is this really the case? At the end we will have extracted 4000 grafts, but how come it can cause less scarring if splitted? 

 

Seeing this topic started yesterday, wondering if the poster got the idea from a youtube video posted yesterday as well. Its by a HT doctor in NYC named Dr Linkov. He's reacting to a guy that is shaving his head after he lost alot of hair behind the frontal area he had work on. 

At about 7:40 minutes the doctor says the larger mega sessions do leave more visible scarring than the same amount of grafts done across smaller procedures. The numbers he gives as an example is 4000-5000 grafts vs two sessions of 2000-2500 grafts. He doesn't go into more detail at that point in the video, but earlier at about 3:30 minutes he says for this guy his grafts were harvested too close together which lead to some of the scarring merging during the healing processes.

In my unprofessional opinion this makes sense. The key factors being

 
1) Smaller procedures do create less trauma which is less demanding on your body's healing capacities, improving your chances for optimal healing results. 

2) The lower the quality and density of donor hair the scarring severity risk goes up. Because the doctor has to do extractions closer together where the scarring has a higher chance of merging together into larger spots. 

3)Your Doctor's skill and ethics. You want him only extracting close enough as necessary and not giving into the temptation to take those best hairs when they're too close together. Unless you've agreed to the increased risk of more severe scarring.

Here's a link to the original video if its alright to post. If not just go to youtube and search on Dr Linkov

 

[NikosHair]

22 minutes ago, ciaus said:

The numbers he gives as an example is 4000-5000 grafts vs two sessions of 2000-2500 grafts.

The problem with that statement is how can he know. Every patient scar formation is unique to them.

If you take 2 patients:

Patient A has 2 X 2500 session

Patient B has 1 X 5000 session.

A year later you examine them:

Patient A has less scarring that Patient B so multi sessions do cause less scarring - Not quite - Perhaps Patient A if they had a 5000 mega session would have had the same level of scarring. They just scar less due to their genetics.

[ciaus]

3 minutes ago, NikosHair said:

The problem with that statement is how can he know. Every patient scar formation is unique to them.

If you take 2 patients:

Patient A has 2 X 2500 session

Patient B has 1 X 5000 session.

A year later you examine them:

Patient A has less scarring that Patient B so multi sessions do cause less scarring - Not quite - Perhaps Patient A if they had a 5000 mega session would have had the same level of scarring. They just scar less due to their genetics.

 

The only things anybody can know 100% going into any HT is afterwards you're going to have less hair in your donor area and some degree of scarring.

You're always playing the probability odds with everything else. Plan for the worse. Research for the best. And keep your fingers crossed until 12-18 months later.

 

[NikosHair]

34 minutes ago, ciaus said:

1) Smaller procedures do create less trauma which is less demanding on your body's healing capacities, improving your chances for optimal healing results. 

This might be counterintuitive but the older you are the less you scar. Optimal healing does not mean less scarring. In fact, a wound that heals quicker is more likely to scar. The slow, sub optimal healing in an old person actually benefits them in that respect (not so great for protecting the wound from infection). You may have come across silicone gel for scars. The idea behind the gel is it slows the healing process down.

 

42 minutes ago, ciaus said:

3)Your Doctor's skill and ethics. You want him only extracting close enough as necessary and not giving into the temptation to take those best hairs when they're too close together. Unless you've agreed to the increased risk of more severe scarring.

This is definitely a factor. You want a skilled doctor on the tools. Additionally, we are all only human. The mega sessions require intense concentration for an extended period of time - standards may slip.

[ciaus]

15 minutes ago, NikosHair said:

This might be counterintuitive but the older you are the less you scar. Optimal healing does not mean less scarring. In fact, a wound that heals quicker is more likely to scar. The slow, sub optimal healing in an old person actually benefits them in that respect (not so great for protecting the wound from infection). You may have come across silicone gel for scars. The idea behind the gel is it slows the healing process down.

That's interesting and one of the few cosmetic advantages we can look forward to as we get older. Hopefully verteporfin or some other drug gets perfected enough soon to make the scarring variable no longer a consideration.