Written for Houston Health and Fitness Magazine
The last five years, or so has witnessed an explosion in the number of men seeking surgical hair restoration. Today, hair transplantation ranks number one as the cosmetic procedure performed on males. The reason for this statistic is simple. The results of the procedure are much better than they use to be, and the reason for superior results is equally straight forward; refinement in technique. Interestingly, the basic concept and surgery is pretty much the same as it was , when hair transplantation was first performed.
The major difference in hair transplantation as it is done today, relative to way it was done years ago, can be summed up in two words, graft size. Oftentimes, an individual, transplanted by the older technique, can be spotted a mile away due to the all-to-characteristic “Barbie doll” or “corn row” appearance of his hair, as a result of the transplantation of larger grafts (or plugs). These larger size grafts were the standard for the time. About ten years ago, transplant surgeons looked critically at their work and correlated their results with graft size. They correctly deduced that smaller grafts would provide better results. The reason is that smaller grafts contain fewer hairs and, therefore, less clumping (of transplanted hairs) which is responsible for that undesirable surgical look. Thus ushered in, a new era, that of minigrafts and micrografts.
Though graft size is the single most important factor in hair transplant surgery, it is not the only consideration is the planning and execution of the surgery. Surgeons will argue that a particular technique is best, however, in many instances it really is a matter of which technique works best in his hand. An example of this would be the controversy as which is the best way to prepare the donor sites (where the grafts are placed), holes or slits. Pros and cons can be presented for each, but bottom line is that excellent results are produced by either. Given the fact that smaller grafts represent the standard in hair transplantation, practically speaking, the only real significant controversy in hair transplantation today is staged restoration verses mega-sessions.
Traditionally, surgical hair restoration has been staged, that is, planned in multiple surgical sessions. A typical session might average between 150 and 300 grafts. The sessions are spaced three to four months for each other. Depending on the patient’s degree of balding three, four or even more sessions were performed. Recently, there has been a trend in the smaller or staged sessions to place more grafts per session, perhaps redefining “mega-session”.
Many physicians would define a mega-session as a single session in which 1000 or more grafts are placed. In some instances, the number of grafts exceeds 3000. The appeal of the mega-sessions, or at least the concept, is obvious: fewer surgeries to achieve hair restoration in a shorter period of time. Since many physicians charge less per graft when larger numbers are placed, there may also be a financial incentive to go this route. If a person is traveling out of town to have his surgery performed, to want to have as few sessions as possible is understandable.
Attitudes amongst hair transplant surgeons towards mega-sessions range from state of the art to state of the market. While the proponents will point to the advantages, some of which have already been mentioned, the opponents will point out their objections. For instance, it is felt that in the very large mega-sessions where grafts are packed very close together, the overall graft survival is not as good. The opponents will also point to the fact that hair loss is an ongoing process and planning multiple smaller sessions allows more flexibility for the future. Actually, even in the case of mega-sessions, a repeat procedure is often necessary for optimal result. Thus, the process of restoration is not completed in a single session.
From a technical point of view, mega-sessions are definitely more demanding with a slimmer margin for error. They are quite lengthy and require more personal: a very large session, two thousand grafts or more, may take over eight hours and require up to four or five assistants. In most cases, the physician will remove the strip of hair and then suture close the resulting wound. He then hands the donor hair to the assistants who are responsible for both preparing the grafts for transplantation and placing them (usually the doctor will make the holes where the grafts are to be placed) Thus, the bulk of the procedure is done by the assistants, necessarily, and the success of surgery is directly dependent upon their level of skill. To state the obvious, any facility offering larger sessions must be equipped to handle them.
With such wide diversity amongst the experts, how is a potential patient to make a decision concerning hair restoration?
To provide an answer to this question, a good analogy might be a major remolding job on one’s house. The following hold true in considering the remolding job. It is a very major undertaking and commitment that is expensive. It is something that one most definitely wants done right the first time around. Though most would want the job to be done in as short a time as possible, the emphasis is on it being one as well as possible. After all, one’s home is an integral part of his life. All of these factors certainly hold true with transplant surgery. One very major difference is that an unsatisfactory construction job is easier to redo (as much as one would hate to do this). Unlike the various materials used in construction, however, the available hair that can be transplanted is limited. Once it is gone, it is gone forever.
The point being made by the author is that the main focus of potential hair transplant patients should be the quality of the end result.. This statement is made in full awareness of the fact that many hair loss patients are distressed over their situations and would like to get to the end point as quick as possible.Physicians who have been doing staged hair transplant surgery for decades, continue to do so. The question must be asked “why is this?”.
There is an old saying that goes “if it ain’t broke, don’t fix it”. As discussed earlier, a qualitative leap in hair transplantation was seen when the older, larger grafts were substituted by smaller (and more numerous) grafts. In this case, clearly, the procedure was “fixed”. In the author’s opinion, other than possibly getting to the end point quicker, the very large mega-sessions offer no real advantage (what is “broke” with the more traditional technique?).
As in any surgical procedure, the real decision is in picking the right doctor; one who is experience, honest and dedicated to doing what is right for you-no matter what the technique. This is where the real difference lies.