Buddying techniques and simultaneous extraction and implantation can reduce harvesting and implantation times in mega hair transplant sessions involving 3000-6000 grafts. Safety is prioritized through measures like limiting anesthetic dose, using body hair grafts carefully, and preventing long graft out-of-body times. Results show good density and coverage can be achieved in one or two day mega sessions through efficient time and space management while maintaining quality.

1. Practical Tips For Carrying
out Mega session
Dr Seema Garg MBBS, MSc, FISHRS, ABHRS
Dr Anil K Garg MS, MA, MCh, FISHRS, ABHRS
Rejuvenate Hair Transplant Centre, Indore, India

2. Hair transplant is one of the commonest aesthetic
procedures with the demand of -
-higher coverage and maximum density in minimum
sessions, even in advance grade of baldness.

3. This need large number
of hair grafts to be
implanted
without compromising
safety of patient
&
It requires gross
management and planning.

4. • If number of grafts implanted are more than 3000
in one session it is called “mega session”.
• If more than 4000 grafts are implanted in one
session it is called “giga session”.
• We commonly implant 3000- 4000 grafts in one
session of one day, and 5000 to 6000 grafts in one
session of two days.

5. Mega sessions requires-
• Time management
• Space management
• Safety of Patient must not be compromised at any
cost
• Quality of Hair Transplant shall be maintained

6. Time
• Reducing over all time of surgery is the main factor
for performing mega sessions.
• It will help to transplant large number of follicles
without fatigue of patient, doctor and surgical team.
• For this we must save time at every step of hair
transplant.

7. To reduce harvesting time-
• Buddy technique of
harvesting,
• good quality punches,
• Comfortable position of
surgeon and patient.
• Excision by surgeon and
extraction by assistant can
be done at the same time.

8. To reduce implantation time-
Buddy implantation i.e two
technicians implant grafts
at the same time.
Premade sites, if properly
done it also helps in fast
implantation.
Anesthesia and
vasoconstriction must be
good.

9. Simultaneous excision and
implantation is the most
effective way to reduce over
all time of surgery.

10. Space Management
We use combination of settings to create enough
room for greater number of persons to work
simultaneously without fatigue.
• Use of Thai massage chair - harvesting is done from
scalp.
• For Beard and chest donor simultaneous excision
implantation can be done on routine operation
table.

11. Use of Thai massage chair -- to
create enough space for working.

13. Our aim is more than three or four persons can work
together.
1. One surgeon, one placer with their assistants.
2. One surgeon, two placer with their assistants.
3. Two surgeon, one placer with their assistants.
4. Two surgeons and their assistants.

14. Buddy technique of harvesting - reduces harvesting time
Simultaneous extraction and implantation- To reduce overall time

15. • Managing scoring , extraction and implantation of
grafts simultaneously, will grossly reduce overall
time of surgery and patients’ fatigue.
• Approximately 30% -50% of the extracted grafts are
implanted simultaneously so it reduces overall time
of surgery, reduces out of body time of grafts and
also reduces fatigue of patient.

16. Safety of patient
• Along with management of time and space we
need to take care of safety of patient, which is most
important for us.

17. Use of body hair grafts
• Excision from safe donor area is our priority, so
combination of scalp and body hair follicles can be
done in one session to get maximum donor hair
follicles in mega session.

18. Two cm of the defined hairline zone, including the transition zone, only scalp hair follicles
are used and implanted as per the standard guidelines described by Shapiro and others.
Then in the three rows just behind the frontal 2 cm area, we mix scalp to beard hair in the
ratio of 2:1.
In forelock area we mix scalp to beard 1:1.
In the mid-scalp area we implant the remaining beard hair mixed with scalp hair follicles.
Figure 1A- After scalp HF implantation in. NW Gr. IV Figure 1B- After beard HF implantation

19. For further reading you can
refer to the Article published in
Hair Transplant Forum
International Volume 28
number 6
November/December 2018
“The Use of Body Hair for
“Combination Grafting” to
Enhance Visual Density of Hair
transplantation and Increase
Coverage in Advanced
alopecia.”

22. Techniques to get best outcome of
hair transplant in Mega sessions-
1. Keeping graft out of body time less than two
hours.
2. Use of autologous platelet rich plasma as graft
holding solution.
3. No touch to root implantation to minimize trauma
to hair follicles.

23. 3
4 ml
ACD
1
4
5
6
7
PLASMA PLATELATE
PLUG
PRP
2
FOR
GHS
FOR
PRP
4 6ml
BLOD
50
mL 25
ml
25
ml
SPIN-I
SPIN-II
METHOD-PLASMA FOR GHS
AND
PRP PREPARATION
We use Platelets rich 3D fibrin scaffold as an autologous graft holding media.

25. No touch to root implantation

26. •Results

27. 4050 grafts in one day – 3000 from scalp + 1050 from beard
Result after one year of hair transplant

28. Result after 10 months of hair transplant
5020 grafts in two days = 3015 from scalp + 2005 from beard

30. 3500 grafts in one days= 2900 from scalp + 600 from beard
Result after 10 months of hair transplant

31. The challenges for the surgeon
during mega session are-
• 1) To harvest maximum grafts from scalp without
compromising donor area.
• 2) Use of extra scalp donor area with all precautions
to keep anesthetic dose within safe limit.
• 3) Implantation of large number of grafts, taking care
of graft out of body time.
• 4) To reduce overall time of surgery to avoid patient
and doctor’s fatigue.
• 5) Achieve optimum results of hair transplantation.

32. • This all is to be done in one session. So, he must
take care of any possible emergency.
• Two days planning for implantation of more than
4000 grafts is a need for safety and success of major
hair transplant procedure.
• Saving of time on every step of hair transplant
without quality compromise is another challenge.

33. • Thai massage chair for scalp hair follicle extraction
and implantation, different comfortable positions for
beard and chest hair follicle harvesting and
simultaneous implantation help in many ways.
• keeping grafts in plasma and no touch to root
implantation improves the results of hair
transplantation.
• Pleasant operating environment, frequent short
breaks and drinks, well trained staff and surgeons
experience are another contributing but essential
factors for success of mega and giga session.

34. Take home message
• Patient’s demand for higher density, more coverage
and natural look cannot be ignored in today’s era of
hair transplant.
• Advancement in techniques of follicle harvesting,
use of extra scalp hair follicles, good quality
punches, more and more understanding of hair
science with proper management of time and
space during surgery has given us liberty to harvest
and implant large number of hair follicles in
minimum sessions without compromising the
safety and outcome of hair transplant.

35. Thanks