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The idea of a Megasession frankly scares the hell out of me. I am an executive of a large company and fairly bald. I want to keep my vanity problems to myself. If I have a Megasession, how long will it take me to look normal so that I can go back to work. Will everyone ask me where all of the hair care from?

The healing is best answered by looking at two patients with megasessions. The photos here on the left and middle are of Patient A (3,628 grafts) immediately after the procedure; the photo on the right is Patient B (4,676 grafts) one day after his procedure.

Most patients will have no sign of a transplant within a week or so. Some will have no sign of a transplant in a day or so. There is a difference in the way we heal, but with that said, today’s good clinics use very small needles so that the “tracks” of a transplant heal with amazing speed. I tell the patients that they can resume full activities in 5 days (except for heavy lifting, sit-ups and body presses). I have had one patient enter a 120 mile bike race on the 5th post operative day.

The average patient returns to a normal look in about a week, then the hair stubs that are there fall out and by the 3-4th week, most patients look totally like they did the day before their hair transplant. Then in 2-5 months, the hair starts to grow, very insidiously. It is rarely picked up by anyone, even by those who sees the patient daily, much like watching a child grow (never sees it happen). The two examples shown above are two different examples, one with some hair (Patient A) and one almost completely bald (Patient B) except for hair in the middle of his head. A famous celebrity (who shall remain nameless), told me that after his hair transplant, everyone knew something changed, but no one, not one single person pegged the hair as the cause of his change. He was 48 years old when I did his hair transplant and people thought he had a face lift because he looked so much younger. He told everyone he just lost some weight after working out a bit more and no one questioned that.

I was told by my doctor that I need 3000-4000 grafts, but it would take at least 3 surgeries. He said that their maximum per day is 1000-1200 grafts. He said that limiting the number of grafts is better for graft growth and for patient comfort, since each surgery will take 7 or 8 hours. What do you think?

In your doctor’s hand, if his comfortable number is 1000-1200 grafts, than that is what he should do. Seven hours of surgery is a lot, so the number he is quoting is reasonable for him. In our practice, we often perform 3000-4000 grafts in a single session and it takes usually about 5 hours or so. The reason we can do this is because:

1. We have been doing megasessions for 13 years, originating the technique back in 1992.
2. We have very experienced team members who do this every day. Many of our staff have been with us for up to 10 years.
3. Our staff is very efficient. Having enough efficient staff allow us to do more work in less time than most medical groups.
4. Better growth reflects the issues of quality control and the time it takes to get the grafts into their recipient site. Keeping them out of solution for more than a few seconds, damages the grafts during the placement process.

In conclusion, three sessions of 1200 grafts moves the same amount of hair as one session of 3600 grafts, but it would not be in your best interest to push your doctor’s estimate of what he will transplant in one session for it will, almost certainly, reduce graft growth in his hands.

A recent post I made about large sessions has lead to another good question:

What about multiple smaller transplant sessions… are they better?

In the hands of experienced doctors who understand large session hair transplant surgery and the nuances in performing them, the larger sessions are better than multiple smaller sessions. Each and every time the donor area is harvested, scarring to the deep structures are the inevitable result. I am not talking about visible scarring at the skin level, but deep invisible scarring below the skin. This scarring increases with each subsequent procedure. Fewer procedures produce less deep scarring.

Simply, I will answer your question with another question: Why have two surgeries if you can do it just once?

Here’s a question I get quite a bit from people that just start doing their research…

Hi Dr Rassman,
I have been reading a little about hair transplantation but I am still very new to this stuff. I was wondering why all hair doctors can’t transplant a high number of grafts in a single procedure?

Not all physician teams are equal. In our medical group, we (NHI) pioneered the large graft session transplanting as many as 4400 grafts in 1994. So performing a large hair transplant session is a function of experience and the skill of the surgeon and his team. If a doctor routinely performs sessions in the 3000+ graft size, then it would be safe to assume that this doctor has mastered the skills required for large session. Unfortunately, not all doctors have either the teams or the skills to accomplish the feat on a routine basis. For us, we have been doing sessions of over 3000 grafts for almost a dozen years and are performing sessions of this size almost every day. If a doctor must limit the size of the session to under 2000 grafts, it may take more surgical sessions to accomplish the same goal as when twice the number is transplanted.