Megasessions – A marathon approach to baldness treatment
We have all seen “doll’s hair”, hair plugs that were popular in the last part of the last century. These plugs, more embarrassing and noticeable than a toupee, were the best option for men who were headed towards permanent hair loss. Fortunately, hair transplants have come a long way since the introduction of the hair plug forty years ago. Even the last fifteen years has seen amazing advances. One of the most exciting advances was developed by Dr. Limmer. In 1992, Dr. Limmer demonstrated that 4 mm punch grafts of skin, fat and hair could be taken from one region of the scalp and transplanted to another area. While this was a great advancement and certainly provided more natural looking hair, the process required four to five sessions of 50-100 grafts each, done at 2 or 3 month intervals.
Fortunately we now have the megasession, in which nearly 6,000 grafts can be transplanted in one session. By using ultra-fine blades that can remove follicles in groups of one to four, plastic surgeons are able to completely transform the scalp in one day. This article discusses the details of the megasession procedure that has revolutionized modern hair replacement surgery.
A megasession takes between five and eight hours, and depending on the density of the donor hair (on the patient’s own scalp). It may be possible to move upwards of 5,000 grafts in that time. The hairs are cut out in groups of between one and four - the number of hairs in a grouping is determined by where they naturally grow together. A skilled surgeon follows these natural hair density patterns, rather than allowing speed to dictate the course of the megasession. While grafts of four units can be used for the back and middle scalp, generally only a single unit at a time is transplanted to the front of the scalp and around the temples. The follicular units are staggered at the front of the hairline to give a more natural look (one of the criticisms of early plug use was a very straight hairline on the forehead). While this is a painstaking process and makes for a long megasession, the end result is truly impressive.
As you might expect, a megasession requires a large and competent surgical team. While quality is given preference to time in a megasession, the entire procedure should take no more than eight hours. Beyond this time the grafts removed from the scalp and awaiting placement will produce lower growth rates. This means that the hair will grow unevenly after the procedure.
Not all people are suitable for a megasession transplant. This will depend largely on genetic factors and baldness patterns. In general, the two factors that permit a patient to undergo a megasession are fairly high hair density in the donor area and reasonable skin laxity in the scalp. The scalp needs to be loose enough to safely yield up to a 1 inch wide by 10 inch long strips of skin and hair. While ordinary follicular unit grafts on a smaller scale are available to almost all hair loss patients, in order to be eligible for a megasession, the patient’s hair density should be about 50% higher than normal hair densities. For the right candidates, however, megasessions offer a rapid means of hair restoration that is both natural looking and long lasting.