With the trend of the “mega session”, we’ve started seeing thousands of grafts being transplanted in a single session. 4000, 5000, 6000 (!) grafts being transplanted in a single day of surgery. That’s quite a feat! This means, in theory, that patients are able to restore their hair quicker and by spending less calendar time. But one question comes to mind when so many grafts are transplanted in a single session: how do the results compare?
There are a few variables to bear in mind when considering this.
Firstly, we have to consider the quality of the donor area. Is the donor area large and dense enough to withstand having 4000+ grafts extracted without damaging adjacent follicular units and/or being subject to excessive scarring, or even worse, necrosis?
And this is not just for one session VS two sessions. This is for one procedure versus multiple procedures. It’s better for healing and donor preservation to be gentle with the donor area. Not to risk over-harvesting and depletion. When we plan multiple procedures, we have a clearer view of the donor area and can achieve better homogenization.
We need to also consider the team. How big and experienced is the team. Fatigue is a real thing. We must consider this when planning a strategy for a hair transplant. A larger team will get less tired, but it’s harder and more expensive to gather a team within which all members are very experienced.
Still on the subject of fatigue, we must not forget that patients get tired too.There are only so many hours a patient can patiently (pun intended :)) withstand of surgery. When the patient starts to get impatient (I did it again :P), or worse, when complications arise (popping, bleeding, etc), you still have all theses grafts you’ve extracted to implant. And they absolutely have to be put back into the patient’s skin. Which makes us think of the next thing to bear in mind: Ex-vivo time.
Ex-vivo time, time grafts spend out of the body. The more grafts you extract, the longer the surgery is going to take, the longer those grafts are going to stay out of the body. After a certain amount of hours, survival starts to decrease. We must consider this as well.
When I’m performing surgery, my goal is to have the last graft extracted and implanted with the same quality and mindfulness as the first one. When we have more time to do the same work (and mind you, surgeries are still pretty intense) we tend to do better work. The team’s happier, the patient’s more relaxed, the whole experience is just much better and easier for everyone. And, of course: results are better!
That’s why I much prefer to divide surgeries larger than 2000-2500 grafts into 2 sessions. It gives us time to think, to double-check, to not rush, to have a chat and a laugh between ourselves and with the patient. I think it’s better to transplant 4000 grafts over 2 days and have 100% of those grafts survive than to transplant 5000 grafts in one day and have a fraction of those survive. It’s definitely not as profitable, but profit is not our priority. Results are.