Now that smaller grafts represent the standard in hair transplantation, the only major controversy in the field today is staged restoration versus megasessions. Traditionally, surgical hair restoration has been staged (planned) in multiple surgical sessions. A typical session might average between 150 and 300 grafts. The sessions are spaced three to four months apart. Depending on the patient's degree of balding, four or more sessions might be scheduled. Using staged sessions, it can take up to two years or so before the full effects of the transplant can be seen.
Recently, there has been a trend toward placing more grafts per session -- as many as 3,000! Technically, surgeons say, megasessions are more demanding and allow a slimmer margin for error. They are lengthy and require more staff. For example, a large session of 2,000 grafts or more may take over eight hours and require up to four or five assistants. In most cases, the physician will remove the pieces of hair-bearing scalp and then 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).
Proponents of the megasession say its appeal is that it requires 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 financial advantages to this option. If a person is traveling out of town to have his surgery performed, he probably would want to have as few sessions as possible.
Doctors who are opposed to megasessions say that in the very large megasessions where grafts are packed very close together, the overall graft survival is not as good. They also say that, since hair loss is an ongoing process, planning multiple smaller sessions allows more flexibility for the future. Even in the case of megasessions, a repeat procedure is often necessary for getting the best results.
We'll take a closer look at some of the other different types of surgical procedures for hair replacement in the following sections.