Another member that I chatted with today said he was thinking about a mega session and it got me thinking maybe that would be the route for me to go. Is there a danger of the grafts transecting? I assume most doctors that perform mega sessions charge a lesser amount per graft after a certain number correct? I just think as a NW 5 I'm going to need more than the 2520 I had in July. It looks like Hasson and Wong and Shapiro might be the best for mega sessions. I'd love to hear what anyone has to say about this subject good and/or bad. Thanks

When you refer to transection are you referring to the transection of native hair or of the transplanted hair during the dissection process?

Regardless, the size of the session should not have a real impact on either of these possibilities as long as the team is experienced and the recipient area is properly prepared.

Good question. I'm not really sure. I just read where transection is a potential problem with mega sessions. I see you work for Hasson & Wong. What's the exchange rate like these days between the US and Canadian dollar?

The exchange rate is something I prefer not to look at lately but you don't need to worry about it since you're in the US you pay in US, for now anyway.

Regarding the type of transection, perhaps you could refer me to what you read by providing a link. I'd be better positioned to address the issue if I knew the context in which this claim was made. I mean, bottom line though, what I said above in my first post still applies.

TTDS,

Assuming we are talking about a first-rate hair transplant clinic with proper staffing - the hair transplant session size has little to do with hair transection.

Where the risks increase for natural hair transection is when a lot of transplanted hair is being placed around a lot of natural hair. The greater number of natural hairs will simply mean that extra care must be provided. This is why proper angling of the incisions is important so that the natural hair follicles are not damaged by the cutting instrument as it penetrates the scalp.

Hair transection is one of the major causes of permanent shock loss

This is yet another reason why physician selection is key to minimize these risks.

Falc

I don't remember exactly where it is but I'm sure you can find it on google like I did. I did chat with another member in a private message who said the following: "However most docs say that such a large session results in alot of transection....I dont know whom to believe". Is there anyone out there who is not a representative of H & W who can comment on this? Thank you.

TTDS,

See my post above. I am not a rep of H&W and have commented on it

Falc

Thanks Falc, I did see that and it is good info. I'm just looking for others out there with an opinion. I have read more since I made the last post and it appears that if done by a skilled doctor like H&W it shouldn't be a concern.

TTDS,

I'm glad to see you are doing your research and not just taking one person's word for it...including mine .

Research is the key and knowledge is power!

Falc

quote:

Originally posted by Time to do something:
Thanks Falc, I did see that and it is good info. I'm just looking for others out there with an opinion. I have read more since I made the last post and it appears that if done by a skilled doctor like H&W it shouldn't be a concern.

TTDS-

Sure, follicle transsection can happen, but I think you are correct in assuming that the liklihood is less with a skilled surgeon. Anytime you dense pack around native hairs I assume the risk is greater, but with a skilled Doc, since they will be taking all the necessary steps to mitigate risk, I believe it is less of an issue than you may think.

As far as damaging harvested hair goes...
Transection is a product of technique or difficult patient characteristics. It is not related to the size of the surgery unless time constrains are forcing the staff to rush their work. In order words, it is not an issue if you go with a good clinic.

Falc et al:
Permanent hair loss does not occur with transection of the hair when utilizing the cutting instrument. ALot depends on where the hair is cut as the instrument is going through the scalp. If it is in the upper third, you will get shock loss because the hair shaft was cut, but the matrix cells which produce the new shaft is still intact and will regrow. Even if you cut throught he hair follical matrix cells, you can get regrowth of the hair. You will cause a temporary hair loss ( telogen effluvium), but the hairs will regrow. To get permanet hair loss you would need complete destruction of the follicular bulb and "the area of the bulge" ( another area above the bulb which hs matrix cells to grow new hair). As you said, it is still very important to maintain the right angles to mimimize any injury. ANy small partial permanent destruction of the follicular bulb could affect the diameter and caliber of the hair, but it will regrow.

Transection studies have been done where the hair follicle was removed and cut in thirds and transplanted back into the scalp. The middle and lower thirds produced a growing hair.

A trichophytic closure of the donor area is in essence a transection of the upper hair shaft and epithelium. The lower hair follicle and bulge area is tucked under the scar to get it to regrow.

Being careful to remove the donor strip helps minimize the transection. How carefully you dissect doing slivers under the microscope and having a good team will help minimize the transection and loss of grafts.

I do not believe you can make a generality statement that a large megasession will produce more transection then a small session. It all depends on the surgeon, and the team. Answer this and you will know.

Which surgeon produced more transected hairs?:

Surgeon A: 10% transection rate of 4000 graft seesion or

Surgeon B: 20% transection rate of 2000 graft session.

Ricardo Mejia MD
Jupiter FL
561-748-0510

Dr. Mejia....

You said something fascinating.....You said that a hair follicle was divided into three parts and two parts of it produced a growing hair separately...

Please could you elaborate on this....

Thanks !!!!!!!

Dr. Mejia,

Thank you for clarifying permanent shock loss and its relation to folliclular transection. Transection typically refers to a break in the hair which may not cause permanent shock loss however, as you stated, if the bulb is transected on penetration of the cutting instrument, this will cause permanent shock loss.

Falc

quote:

as you stated, if the bulb is transected on penetration of the cutting instrument, this will cause permanent shock loss.

No this is not what I said. IN order to cause permanent hair loss, you need complete destruction of the area of the bulge and the matrix cells where Stem cells reside to grow new hair. It is unlikely you would cause complete destruction of both areas with the one time pass of a cutting instrument. You can also not assume that to cut part of the bulb equals destruction of the bulb. If it were that simple, I could save women and men lots of money and put laser hair removal out of business.

On the contrary, this theoretically leads to a whole seperate issue of hair Multiplication where researchers including myself have attempted to purposefully cut or transect portions of a hair follicle while leaving the hair follicle intact, reimplanting it and then see if it could reproduce additional hairs. The theory was that perhaps in dividing or transecting the hair follicle stem cells, the hair follicle would produce signals to regenerate new hairs from the divided portion of the stem cells and grow additional hair follicles. Suffice it to say, it has not been reproduced successfully in controlled experiments.

In summary, it is unlikely a single pass of the cutting instrument that transects any part of an in vivo hair follicle will cause permanent hair loss.

Want Hairs:

The ability to regenerate a hair follicle depends on the location of the stem cells. which have been studied and found scattered from the area of the bulge to the bulb. (once I learn to add pics, I will post a nice picture of the hair follicle) Physicians have done studies looking at cutting or "transecting" hair follicles in halves and thirds and reimplanting the divided portions seperately to see how the follicles grow.

In summary according to Dr. Kim's study from Korea.
1. the lower 2/3 and lower 1/3 of a hair follicle was was able to produce a complete hair follicle with normal caliber.
2. The upper 2/3 follicle produced a complete hair follicle.
3. The upper half of a hair follicle produced a hair but finer in caliber.
4. No hair follicle was produced from the upper 1/3 or lower 1/3.

Hence as you can see from my previous post about transection, it is very difficult to damage the hair follicle especially in vivo to produce permanent hair loss. The above data is proof the hair follicle will survive even when you take it out of the body and transplant them seperately.

Ricardo Mejia MD
Jupiter FL
561-748-0510

Dr. Mejia,

Sorry for the misunderstanding.

I am under the impression that if the bulb is damaged or destroyed, the hair will no longer grow Perhaps I am wrong in my assessment.

There has been much discussion about transection of the hair follicles over the years and all posts have pointed to the fact that transection can cause permanent shock loss. Of course, the "what" that is transected can make all the difference and may not result in permanent shock loss.

From your post however, one might get the impression that a hair restoration physician need not worry too much about minimizing risks of transection because the risks of complete matrix cell and bulge destruction in order to stop a hair from regrowing is already extremely rare. One might conclude therefore that a hair restoration physician not need be as careful when making an incision into the recipient area. I believe you would agree that this assumption would be unfounded.

Of course, you state that it is rare in a single pass of a cutting instrument, but as you well know, dense packed sessions are all about surrounding existing native hair with transplanted hair which would mean multiple incisions around the same native hair not to mention the great number of native hairs there may be.

The point I am getting at is that incisions still have to be very carefully made in order to minimize the risk of damaging or destroying the areas of the hair follicle that will prevent it from growing - aka: permanent shock loss.

If I am incorrect in my assessment, please feel free to let me know.

Falc

Falc:

In general, you are partially correct. Unfortunately, from a scientific standpoint, the devil is in the details and it really depends on the what and where and how it is damaged. The issue of transection, regrowth survival is a complex issue which requires a proper understanding of stem cell biology and hair follicle anatomy. If you were to say the "bulb and the area of the bulge is damaged permanently, the hair no longer will grow" then this is absolutely true. But just the bulb itself, not necessarily based on previous studies. I could also accept If the bulb is destroyed, the hair may not grow, but "will not" is to strong of a statement to be accurate from a scientific standpoint.

There are many truths that Hair restoration surgeons abide by based on limited controlled experiments that have helped us gain better understanding of the biology of the hair follicle. Yet there are also many uncertainties as well which have not been clearly studied or proven and it is difficult in some situations to make strong conclusions applied to other situations.

I do not know how much "permanent damage" if any is produced by transection from cutting instruments from mega sessions. This to my knowledge has not been studied or proven. However, as a general rule, I personally avoid transection and am careful with my incisions to avoid any unnecessary trauma to the hair folicle. This is a general truth which I believe the majority of physicians would also agree. I would agree there is the possibility of causing permanent damage.

Some Transected hairs can survive if reimplanted based on Dr. Kims study and others. This is accepted by the majority of physicians. We are comforted by these studies that reassure us of follicular survival even if transection occurs.

How much damage do you need to cause "permanent damage" in mega sessions or any other session. That's a good question which has not been studied due to the complexity of trying to do hair counts and not knowing where exactly in a hair follicle do you transect with the pass of an instrument and how much actual damage occurs. We just do not know, but it is best to avoid it. As you stated, the risk increases with higher dense packed sessions around native hair.

We worry about transection of the hair follicles during donor excision and graft preparation also because of waste and inefficiencies. We like to utilize all the available donor hair. If you have a sloppy staff that is transecting too many follicles in order to get a good follicular unit, it can lead to lost grafts.

Overall, we are in agreement with being careful, minimizing trauma, minimize risks, and avoiding unnecessary injury to the hair follicle that could lead to any type of injury to the hair follicle.

Ricardo Mejia MD
Jupiter FL