Due to financial constraints, I've elected to undergo multiple smaller sessions. The first scheduled session is around 1200 grafts into hairline. I probably need around 3000 on the top third of my head to achieve a non-balding look, full coverage and normal density. But that's a long term plan. In the short term, I think a smaller session will make a difference, though it won't be transformative and I"ll still have thin hair and a receding hairline.

The benefit of doing it this way, besides being able to pay for it, is that it's a more gradual, less noticable and sudden change. Another benefit, depending on who you talk to is, higher survival rates. Of course, the liability is more surgery (which sucks), delay of gratification, and possibly greater scaring in the donor site.
Seems that megasessions are in vogue now and I can see why but Dr. Woods and a few others have been able to achieve noticeable, if not dramatic, results with fewer grafts and multiple sessions. Has anyone had more than 1 smaller session (1000 to 1800) in a relatively small area (conservative hairline), gradually increasing the hairline and density levels, and been happy? I'd really appreciate any comments or insights.

Thanks

you r planning fue, I hope.
Strip for multiple small sessions wud not be the best idea.

Sac,

As a follicular unit pioneer, I did three 1,400 graft sessions several years ago and I'm certainly happy with my results.

Of course I do experience some "hair envy" when I see well done ultra refined sessions of 2,500 to 3,500 grafts. For the right patients such bigger sessions can be optimal.


Ultimately, I think the right session size is the one that is optimal for the patient in the LONG run - not the size that is most convenient for the clinic.

We all want to restore our hair as fast and full as possible. But budget concerns aside, ultimately all surgeons can only safely remove a certain amount of donor tissue in one session and achieve a virtually undetectable donor scar.

The huge over 3,500 graft sessions have gotten "big headlines" on the forums. But many patients don't realize that these graft counts are often an apples to oranges comparison. Many of these mega mega sessions are really "sub follicular unit" graft sessions in which naturally occurring 3 and 4 hair grafts have been trimmed into 1 and 2 hair grafts. These huge cases have also created donor scars that are often censored and not publicized online.

Such sub follicular unit grafting generates impressive counts (and billings for the clinic) but ultimately it is the amount of hair that successfully grow in the donor area that matters.

Personally I think that mega sessions of true "follicular units" (not sub follicular unit grafts) should range between 2,500 to 3,500 in order to minimize the risk of visible donor scarring and to maximize the successful growth of the transplanted hairs.

I'm a big believer in ultra refined minimally invasive grafting that enables dense packing and rapid healing. But I believe that if patients want virtually undetectable donor scars and optimal growth in their recipient area they are wise to read between the lines of these "headline grabbing" sub follicular super sessions and be sensible.

In the long run they will get more hairs on top where they need them, without paying the price of a noticeable scar.

Doing smaller strip excision sessions of 1,200 that work with your budget will get you safely to where you want to go. But I would encourage you to save up and do a first session of at least 2,000 grafts if you can really benefit from a mega session.

Do keep us posted.

Best wishes, Pat

Whats a sub follicular graft? Sorry if it has been discussed before. I heard the term for the first time.

I agree with Pat. The first session on a virgin scalp should be at least 2000 or more (personal opinion). You never have any assurances that your scalp will loosen up enough for HT #2. Also, what is the cost difference between 1200 and 2000? Talk to your consultant/doc and see what you can work out. Maybe they will meet you in the middle.

Finally Free,

"Sub Follicular Unit Grafting" is a recent expression coined by hair transplant surgeons to describe the practice of cutting 3 and 4 hair naturally occuring follicular units into 1 and 2 hair grafts.

Sub follicular unit grafting is generally considered to be a practice that inflates the graft count for a particular session, while ultimately transplanting less hair than the graft count would lead a patient to believe.

Thus a clinic and patient can reference impressively large cases of 4,000 to 6,000 grafts when in reality they are moving the same amount of hair as smaller sessions of true follicular unit grafting in which the natural follicular units are not sub divided.

To date only a very limited number of clinics have been actively performing and selling sub follicular unit grafting. Typically these clinics promote their surgeries as follicular unit grafting mega sessions. None of them are recommended on this community.

Hello Pat -

Although I agree with you the some doctors split the 3, 4 hair grafts into 1, 2 hair grafts, resulting into more # of grafts, but same # of hair.

But after doing tons of research I have realized that more 1s & 2s over few 3s & 4s is more beneficial for the patient, even though you'll be giving more money to the clinic. More 1s and 2s give better coverage and the results look more natural, at the same time it makes your hair look much more denser. Just imagine in certain spot, instead of having 25 3s and 4s, having 40-45 1s and 2s, one would get better coverage and the spot would look much more fuller and natural.

KG

KG,

Personally I do not think it is beneficial to sub divide natural follicular units into 1 and 2 hair grafts unless such 1 and 2 hair grafts are needed for dense packing in the hairline areas - even if the patient knows they are paying more to transplant the same amount of hairs. However, given that there are more than enough naturally occurring 1 and 2 hair grafts in the typical patient sub dividing follicular unit grafts is not normally needed.

Some 3 and 4 hair grafts are really needed to build density in the central and midscalp regions. Dr. Shapiro and others have written on how the distribution of such naturally occurring 3 and 4 hair grafts actually creates a greater illusion of density than a comparable number of hairs in smaller 1 and 2 hair grafts. In my opinion and in the opinion of many surgeons who I respect this holds true.

In Vancouver at the ISHRS annual meeting last Fall I saw dozens of sub follicular unit mega session patients up close and from a top down view. Having seen these patients in photos on the forums for years, I was struck by how thin and almost sparse their mega sessions looked. This sparseness was not true for the patients who did large sessions of follicular unit grafts.

When viewed from the front in photos patients doing sub follicular units look very full. But in person I found that when viewed from above their sub follicular unit grafts looked surprisingly sparse.

Many leading surgeons who I respect also commented on this sparseness after viewing these sub follicular unit patients in Vancouver.

Every clinic recommended on this site could easily engage in sub follicular unit grafting and increase the number of grafts they could charge patients for. Their patients would then also report impressive session numbers of over 5,000 grafts on this and other forums.

But these surgeons do not do this because they believe that patients will achieve the best combination of naturalness and fullness by using naturally occurring follicular unit grafts rather than sub follicular unit grafts. They also realize that such sessions provide patients with the best value. I agree with them on this issue.

Does anyone know how many of these 4000+ sessions have to go back for 1 or 2 more surgery's? I ask this because I have looked at hundreds of photos on this forum, and the best results seem to be a couple of 2000 - 3000 HT and possibly a smaller third one as a touch up. This is just my opinion, does anyone have any thoughts? Also, I had quite a few 2-3 fu's placed in the bridge across the top of my head. I think the density will end up being greater than if they had been all split. On my second surgery, I hope to add 1's and 2's in the same areas to really add density.

3100 w/Shapiro
10/7/05

Hello Pat –

I respect your opinion. I think we both know which docs we are referring to here. Let me just clarify the point I was trying to make.

I have analyzed results of many many patients from different surgeons, including my own results. From what I have seen, I noticed that patients getting dense packed 40-45 1s & 2s FUs receive much fuller look than patients who get 20-25 3s & 4s FUs. Let me explain what I mean. I agree that patients who get fewer number of 3s & 4s FUs have dense visual coverage, but the hair looks dead. They don’t stand up on their own because the grafts are placed too apart from each other (you can usually see this hair style pattern in old men, who have good enough coverage to not show a bald spot, but their hair is combed down like it was thinning). For examples, if a doc places 25 3s & 4s grafts/cm2- each graft has lot of hair in it, but once the hair starts growing they slide down as they can not stand on their own because they’re so apart from each other, but if you split these grafts into 1s & 2s, you have much higher number of total # of grafts densely packed together in same size area. They are all 1s & 2s, but they help each other stand up, which gives it much fuller look.

I hope I am making sense. I think the great example of what I am trying to say is how docs like to work in the hairlines. Now we all know that docs put lots of 1s & 2s dense packed in the hairline for naturalness. Imagine a patient getting 50 1s & 2s grafts/cm2 in the hairline! Wouldn’t you agree that the patient would get an amazing, very dense and full natural looking hair line? Now why can’t we apply the same logic everywhere on top of the head? Imagine one getting 40-45 1s & 2s grafts/cm2 dense packed everywhere on top of their head! I think the patient would get much fuller results. I have seen a patient who had a procedure to cover frontal 1/3 (about 80 cm2 area), he had 3500 grafts by the doc we are referring to. His results were amazing!! From what I am assuming he had all 1s & 2s, because of this doc’s way of harvesting grafts. I mean this guy had afro going on, that’s how dense it looked. He roughly had 40-50 grafts/cm2.

Anyway I am not supporting any doc, just expressing my opinion. I am open to all comments.

KG

KG, I see your logic, but do you think that the patient has to fit the program? I know that for me personally, I am looking at 3 surgery's, densing and refining each time. In my case I believe that the girls could have split additional 2 or 3's and brought my total up over 3500. I am not sure it would mean any difference for me personally. I see however IF just a smaller portion of the scalp is being transplanted where splitting could be more effective and necessary when "dense packing" 45 55 fu cm2 over a 80cm section. For me its moot anyway because I was a six, so I needed a different plan. I have watched this forum for quite a while, and am still taking a wait and see approach to these enormous 4000 5000 sessions. I will agree that some of the work you describe is amazing, just not realistic for all of us.

quote:

Originally posted by the B spot:
KG, I have watched this forum for quite a while, and am still taking a wait and see approach to these enormous 4000 5000 sessions. I will agree that some of the work you describe is amazing, just not realistic for all of us.

B spot,
Have you ever heard of a near complete hair restoration?
How many FUs do you think a NW6 has lost?
At a rough estimate, I think 25,000.
Do you seriously think a mere 4000 FU grafts will ever make the difference that we hairloss sufferers want.
These are my pictures after 6000 FU grafts growing.
I have gone for more since.
I do not think its a realistic idea to think that 2000 some grafts are going to make any substantial difference.

Sac as a 15 yr vetern of mulitple procedures, I would say that I had Excellent results over the years even with newer natural procedures to fill in older technique procedures. The downside to multiple procedures is that in the end you might have a 200-300 fewer donor grafts available due to multiple scar tissues. But large sessions sometime have 2-3% less regrowth rate than smaller ones due to blood supply?
I would say if you had the money to do up to 2500 FUs, go for it, but I wouldnt recommend over 2500 (if you need 5000 I would do 2 seperate 2500 procedures). That is from my personal experience. Plus multiple procedures over several years can account for future hairloss progressions.

Thanks for the reply!!

I intend to have a procedure of between 1200 and 1500 grafts as a starter procedure. In a year or two, I'd like to have another procedure of between 2K and 3K and hopefully I'll be done for at least 5 years. I've read a lot of negative posts, suggesting that one shouldn't have a HT unless they can complete the entire needed number of grafts for full restoration, or have the ability to rapidly undergo corrective procedures. But, frankly, I'd rather look better with another 2-3k hairs, 1200 to 1500 grafts, on my scalp now but still need another procedure for full results than not do anything, living with an inferior look, for a couple of years and then have a mega sesssion.

I'm glad to know you had such good results and I really appreciate you sharing your experience. It gives people contemplating HT a frame of reference and helps to us predict results as well as possible complications.

Thanks,

Sac

quote:

Originally posted by sac95816:
Thanks for the reply!!

I intend to have a procedure of between 1200 and 1500 grafts as a starter procedure.
Sac

While you are at it, why not get a small number of body hair transplanted. Say just 50 or so.
That way, you will get a chance to see how your body hair grows.
That is how I came to know about the efficacy of body hair in my case.
Just had 50 body hair grafts placed in an area during my regular ht.
The results assured me about the benefits of using body hair and I have since then, not looked back.

I'm doing the small session route. This past Sept 9th & 10th I had a 1000 FIT session with Dr Rose. Its been a few weeks now. I dont really see any growth as of yet. I assume by the 4-6 month mark I should see something.

jrjr

Do you plan on having more HTs in the future? What is the total number of grafts you need? How much area of your scalp did the 1000 grafts cover?

Thanks for info. I'm scheduled for surgery this Friday and I'm getting cold feet.

Sac

I plan on maybe 2 more sessions of about 1000 grafts each. In total that would be 3000 grafts. I assume thats what I'll need in order to feel happy. Dr Rose mentioned that maybe 2000 or more is what I need.

The 1000 grafts I got were placed into an area of roughly 6 sq inches. I know, not a lot of grafts for the area, but I didnt want to do a mega strip session. I want to take it slow & heal nicely.

I was very nervous too, but my session was actually very pleasant. I would do it again definitely. A trip to the dentist is more dramatic than this was.

What doctor are you planning to use?

jrjr,

6 X 6 seems like a lot of area to cover with 1000 grafts. But with 3000 grafts I've seen amazing transformations. I understand your concerns with strip. It seems crued and barbaric compared to FUE. I'm having 1200 - 1500 grafts placed in a 50 cm squared area on my hairline and top third.

I have great apprehension about the doctor I'm using and I'm getting cold feet about going forward as a result. He's little known on the forums. I was impressed with my interview with him and the little I know about him from the internet suggests he's highly ethical. His name is Rosanelli. I may back out of the procedure if I don't dispel my doubt Friday.

Keep us posted your progress. These forums and the personal experiences of those who've undergone HT are the best, perhaps only, source of accurate info.

Thanks,

Sac

I had 1000 grafts placed in the hairline & in the top third. Actually it is an area about 3 x 2. Which is around 38 cm2. So I suppose it works out to about 22 grafts per sq cm (conservative estimate).

It took two days of about 6-7 hours each day. 500 grafts each day. But I have to say that the days went fast. Especially after having several anesthetics.

I won't worry too much. Seems like you have done your research well.

I'll keep everyone posted with pics at my 16 week mark. Hopefully by then I will be able to tell some difference.

1000 FIT Sept 9
7 weeks so far