Avoiding the Huge Session Hype and Scar

[Pat - Community Publisher]

Over the past five years of hosting this forum I've tried to be a counter weight to the trendy treatment marketing hype that has all too often put the scalp and pocket book of hair loss sufferers in danger.

 

We all know about the obvious commercial hype such as infomercials that hype the chain operations. But I find it alarming how huge surgical sessions, which take donor strips as wide as 2cm, are being hyped on other forums by patients who have made selling their clinic a side occupation.

 

In many ways such covert marketing on the forums is more insideous and deceptive than infomercial TV ads. At least the TV infomercials are identified as advertisements. That's why posts associated with clinics engaging this type of marketing are not hosted on this forum.

 

I have warned about the downside of these mega mega sub follicular unit sessions in previous topics (see "Is Bigger Really Better in a Hair Transplant Session?" for such a discussion).

 

While these mega mega sessions make impressive forum headlines, I agree with numerous leading surgeons who are seeing evidence first hand that such aggressive donor removal puts patients at high risk for unnecessary scarring in the donor area. In my opinion, the vast majority of these unfortunate huge session donor scar cases have been swept under the rug on other forums and have not been made public online.

 

I urge those considering a hair transplant to not over tax their donor area in any one surgical session. If you are extensively bald and need large sessions consider doing sessions between 2,500 to 3,500 true follicular units (rather than mega mega "sub follicular unit" sessions in which naturally occurring 3 and 4 follicular units are divided into 1 and 2 hair grafts).

 

In my opinion, such safe and true follicular unit sessions not only minimize the risk of donor scarring but provide the highest growth rates and appearance of density. These sessions are also more cost effective for the patient.

 

It would be very easy for other prominent clinics to take larger strips as well as have their techs split 3 and 4 hair grafts into 1 and 2 hair sub follicular unit grafts. These clinics would then be able to charge their patient considerably more for each session. They could also then make headlines on the forums with sessions of 5000 plus grafts.

 

So why don't other clinics pander to the online hype and the their patient's resulting desire for instant gratification and huge sessions? In my opinion the reason is sound surgical judgment, ethics and their commitment to putting the long term interests of their patients ahead of short term profits.

 

Think about it folks. Don't be fooled by the cheerleading hype.

[Pat - Community Publisher]

Over the past five years of hosting this forum I've tried to be a counter weight to the trendy treatment marketing hype that has all too often put the scalp and pocket book of hair loss sufferers in danger.

 

We all know about the obvious commercial hype such as infomercials that hype the chain operations. But I find it alarming how huge surgical sessions, which take donor strips as wide as 2cm, are being hyped on other forums by patients who have made selling their clinic a side occupation.

 

In many ways such covert marketing on the forums is more insideous and deceptive than infomercial TV ads. At least the TV infomercials are identified as advertisements. That's why posts associated with clinics engaging this type of marketing are not hosted on this forum.

 

I have warned about the downside of these mega mega sub follicular unit sessions in previous topics (see "Is Bigger Really Better in a Hair Transplant Session?" for such a discussion).

 

While these mega mega sessions make impressive forum headlines, I agree with numerous leading surgeons who are seeing evidence first hand that such aggressive donor removal puts patients at high risk for unnecessary scarring in the donor area. In my opinion, the vast majority of these unfortunate huge session donor scar cases have been swept under the rug on other forums and have not been made public online.

 

I urge those considering a hair transplant to not over tax their donor area in any one surgical session. If you are extensively bald and need large sessions consider doing sessions between 2,500 to 3,500 true follicular units (rather than mega mega "sub follicular unit" sessions in which naturally occurring 3 and 4 follicular units are divided into 1 and 2 hair grafts).

 

In my opinion, such safe and true follicular unit sessions not only minimize the risk of donor scarring but provide the highest growth rates and appearance of density. These sessions are also more cost effective for the patient.

 

It would be very easy for other prominent clinics to take larger strips as well as have their techs split 3 and 4 hair grafts into 1 and 2 hair sub follicular unit grafts. These clinics would then be able to charge their patient considerably more for each session. They could also then make headlines on the forums with sessions of 5000 plus grafts.

 

So why don't other clinics pander to the online hype and the their patient's resulting desire for instant gratification and huge sessions? In my opinion the reason is sound surgical judgment, ethics and their commitment to putting the long term interests of their patients ahead of short term profits.

 

Think about it folks. Don't be fooled by the cheerleading hype.

[the B spot]

Hear!Hear!

[GuitarPlayer]

I would like to know more about these "sub follicular units." Have these other clinics admitted to doing this?

[Pat - Community Publisher]

Guitar,

 

Doing "Sub Follicular Unit" grafting is not something a clinic would promote as it would divulge that their grafts on average contain less hairs than naturally occurring 1, 2, 3 and 4 hair grafts. Charging more to move less hairs per graft is not some thing that a clinic would typically want to advertise. Rather the large number of grafts is instead promoted.

 

One of the problems with dense packing, in particular in the midscalp region, is that it makes it hard for a surgeon to place naturally occurring 3 and 4 hair grafts. Thus these grafts are often sub divided into 1 and 2 hair grafts, which are then easier to dense pack.

 

Not only does this inflate the graft count but it makes it hard for the patient to gain density in the central regions of the scalp. Thus patients with large sub follicular unit sessions often have an evenly distributed and somewhat sparse look that is especially noticable when viewed from above. This sparseness is typically not seen in photos taken from the front and sides.

[Guest]

Hello Pat,

 

You are right about these 5000+ one day surgery. I have seen two mega sessions by a famous (across-the-border) doctor that left me in shock. Both patient where in their ealy 20 an now have scars that run from temple to temple; in my opinion, these scars are out of the safe area.

[Gorpy]

Thanks for that explanation Pat. I personally think it is unethical to perform these kind of procedures without explicitely and clearly explaining to the patient what is going on. If then, after fully understanding, they choose to go ahead with it, then it is fine. But, I'm afraid most patients don't get the full pre-op understanding of the difference. I consulted with one of the top doctors whose big selling point was dense packing. To his credit, he did tell me that the dense packing he was referring to was only with the ones and twos, not the threes and fours, as they would not fit so densely. So thanks to this wonderful web site, many more people have an understanding of these subtle differences. Thanks again Pat.

[finallyfree]

Originally posted by Pat - Publisher of this Community:

I find it alarming how huge surgical sessions, which take donor strips as wide as 2cm, are being hyped on other forums by patients who have made selling their clinic a side occupation.

 

 

 

I concur with you Pat.

Thanks for some valuable advise.

I think you should also point out that by conventional strip FU transplants, all that can be acheived is about a 10% restoration on anyone above or at NW5. No matter how large the strip.

So, its a good idea to plan beforehand for the real results one will be getting.

 

I personally beleive, (just my opinion), that a complete hair restoration needs way more grafts than can ever be acheived from the scalp donor.

That is where the body hair can and should be incorporated. However, most doctors worldwide are yet to learn the method. I hope, in years to come, true restorations using a combination of scalp and body hair will become the norm.

[GuitarPlayer]

Finallyfree,

 

I believe most of the top hair transplant physicians shoot for a 40-50% restoration.

 

GuitarPlayer

[GuitarPlayer]

Pat,

 

Thanks for your reply. If this is what's really going on at these clinics advertising 5000+ sessions, then this is very deceitful. Let's say a person had a 6000 sub-follicular session, how many grafts would that be of proper follicular units? About 4000? If this is the case, then the patient is getting ripped off for 2000 grafts. Pat, have you inspected the scalps of some of these patients to find that they only had 1's and 2's in the midscalp region?

 

Thanks,

GuitarPlayer

[Pat - Community Publisher]

I think as patients learn more about the differences between transplants using natural follicular units and those using sub follicular units they will not be as impressed by the huge 4,000 plus graft counts - especially when they are paying big dollars for sub follicular unit grafts.

 

The more sophisticated patients are also coming to realize that all surgeons have only scalpels - not magic wands. Thus all surgeons face the same limitations in what they can safely remove from the donor area in one session.

 

In my opinion, those who try to take wide strips over 1.5 centimeters wide are putting the patient at unnecessary risk for scarring in their donor areas.

 

Reasonable sized sessions that use state of the art donor removal and closure consistently produce pencil thin scars that are cosmetic non issues.

 

In my opinion, patients who need large sessions should stay between 2,500 to 3,500 natural follicular units in order to keep their donor areas safe, while achieving optimal density, naturalness and value.

 

If more transplantation is needed later, the patient's donor area should be in good shape to do more as needed. Waiting several months to a year will also enable the scalp elasticity in the donor area to return so that another strip can be safely removed.

 

So for patients who are more interested in getting optimal results and value rather than setting records I suggest not exceeding 3,000 to 3,500 real follicular unit graft sessions.

 

After all who wants to over tax both their donor area and pocket book in a single session?

 

Guitar I have seen the results of these huge sub follicular unit sessions up close in person from a top view and I was not impressed.

 

These sub follicular unit patient's typically look great in photos. But in person I think their even distribution of all 1 and 2 hair grafts across the entire scalp looks too sparse. The illusion of density that physicians using 3 and 4 hair follicular unit grafts can achieve is simply missing.

 

Dr. Ron Shapiro wrote an excellent paper on how he believes such 3 and 4 hair follicular unit grafts are essential to achieving the illusion of density. From what I've seen I fully agree.

[Smoothy]

Any top surgeon will tell you more is not better in HT. There is a "breakeven" point with # of grafts, regrowth, scarring, future donor availability, shock loss, ect. MOst top surgeons would recommend probably no more than 3500 max per session-- now they might do 4-5K range but 2k-3k range usually has slightly better results.

[GuitarPlayer]

Pat,

 

Thanks again for your reply. I would be very interested in reading the article that Dr. Ron Shapiro wrote. Where can I find it?

 

Thanks,

GuitarPlayer

[finallyfree]

Originally posted by Smoothy:

Any top surgeon will tell you more is not better in HT. There is a "breakeven" point with # of grafts, regrowth, scarring, future donor availability, shock loss, ect. MOst top surgeons would recommend probably no more than 3500 max per session-- now they might do 4-5K range but 2k-3k range usually has slightly better results.

That is probably due to the limited donor available from scalp.

While sub follicular grafting is reprehensible, I think doctors should concentrate part of their efforts on learning extraction of body hair to be used as an adjunct to scalp donor hair.

There are doctors that are acheiving a good yeild as well as early growth with body hair grafts on a consistent basis.

 

Any HT basically involves relocation of hair from one part of the scalp to other.

No actual addition.

To really increase the actual number of hair on scalp, you need body hair.

[GuitarPlayer]

Finallyfree,

 

Which doctor did you go to for your 7500 grafts? How long did it take for your body hair grafts to grow?

 

GuitarPlayer

[Bill - Seemiller]

Though I agree with the concern for the most part that Pat is presenting, I can't say that I 100% agree that megasessions are all bad. I admit that it does sound that these megasessions may over-tax the donor area, and where that may be true for some patients, I don't know if that is true for all patients. I have, I admit, only seen photos, no results in person from larger megasessions, but I have seen photos that are quite impressive, both in the recipient areas and donor areas of patients who have received megasessions. I think Pat's post has some excellent information and merit, but I don't think is 100% true in all cases, at least, from what I've seen from satisfied patients receiving 4000+ grafts in a single session. It is true, as far as I am aware anyway, that sub-follicular unit grafts were not used, but natural 1s, 2s, 3s, and 4s unit grafts.

 

I also disagree with the post that someone said that a scar going from ear to ear is in the unsafe zone. Most scars, in order to get a fine thin scar, go from ear to ear, or even a little longer and are still plenty safe.

 

Anyway, just thought I'd be the one to play devil's advocate here. I don't disagree with Pat's belief and approach, but I do think that megasessions do have some merit based on pictures I've seen of satisfied patients.

 

Bill