2015 Annual ISHRS Scientific Meeting Chicago, USA

[Dr. A. Emre Karadeniz]

The International Society of Hair Restoration Surgeons (ISHRS) annual scientific meetings and workshops are an excellent environment for surgeons to meet, share experiences and have fun. Although this is supposed to be an international organisation, it is based in the USA and most meetings are organised in this country. It may be a 1-2 hour flight for most US members and a good occasion to meet colleagues, but for the rest of the world, especially Europeans, it costs a lot of time and energy to attend these meetings which may require two 25-hour journeys. When you consider the jet lag, in order for us to join these 4 day meetings we have to spare about 10 days from our daily life.

Together with my personal enthusiasm on the field of hair restoration surgery and sciences it is related with, the significant effort to attend ISHRS meetings motivates me even more in taking a more active role in these events, rather than taking this easy and seeing it more like a touristic opportunity. I would not feel that the goal of my trip were accomplished if I didn't make at least one or two scientific presentations each time.
Fortunately, the organisation committee has been giving me the honour by inviting me for two presentations each meeting since 2013. I would like to take this opportunity to briefly mention the topics I am going to talk on this year. I may share some other experiences later after I am back from this event.

Topic 1
ARE TRANSECTED FOLLICLES WITHIN FUE GRAFTS WASTED?

This was a question that I have been trying to answer for the last couple of years. It is very important in determining whether FUE is a sound surgical technique or not.
The transection rate (the rate of transected follicles in FUE versus the total number of follicles attempted) in FUE is a sensitive topic. It is very unlikely that any surgeon in the world discloses his/her actual average transection rate and the transection rate he gets in each surgical session. Until recently, we were used to hearing some surgeons report 1-2% transection rates which most experienced surgeons knew was too good to be true. In practice it is very rare to get a transection rate below 10% with usual punch sizes between 0.75-0.85 mm in diameter. In my opinion 10-15% is a reasonable rate. For example, in the 2015 Mediterranean FUE Workshop held in Istanbul, I observed that there were a few sessions where the faculty surgeon was able to get around 10%; at the same time there were some sessions that I estimated this rate to be over 30%.

Anyway, the objective in this study was to find out what happens to these transected follicles, which is unavoidable. Do they die, or do they have the potential to yield mature hair? Please note that I am not talking about totally transected grafts; these are grafts that originally contained 2-4 follicles and some but not all of these follicles were transected. We can call these partially transected grafts. I will not go into the details of this study before I actually get the chance to present it, but my conclusion was that roughly half of the transected follicles within FUE grafts had the potential to yield mature hair at the recipient area. Some of the transected follicles that are left at the donor area may have the same potential (this was not evaluated in my study). If a transected follicle has the potential to grow mature hair both at the donor and recipient areas, this means that we have actually achieved surgical duplication of some follicles. This may be the main reason why it is possible to get results with FUE that are comparable with FUSS (strip surgery).

Topic 2
MEDICAL ETHICS IN HAIR RESTORATION SURGERY

This is another very sensitive and important topic. I will not go into the sub-topics I am planning to discuss in this panel before the event is over. However, if anyone has an important topic in mind that he thinks is worth discussing, I would like to hear it. I will share the details of this discussion later.

 

[Westcoaster]

It's an interesting choice of topics that are actively talked about on the forums right now. I'll enjoy reading your presentation and findings after the conference. Real good of you to share this information with the general population.

 

[Bigmac]

Thanks for sharing this Dr Karadeniz, I`ll look forward to reading the information.

 

[janna]

Sounds like important topics to present. Looking forward to seeing them soon in Chicago. Safe journey!

 

[ahujas88]

Cool Dr Karadeniz,Thanks for this great news

 

[Dr. A. Emre Karadeniz]

Topic 1: Are Transected Follicles Within FUE Grafts Wasted?: A Case Study

Here is a screenshot of the poster presentation that I did about transected follicles within partially transected grafts in FUE.

The summary to this initial study is that transected follicles within partially transected grafts in FUE have about 50% potential to grow mature hair. In other words, only about half of the transection rate in FUE actually corresponds to amount of the wasted hair, assuming that none of the transected follicles left behind at the donor area grows back mature hair.

Interestingly, there was another poster presentation by Dr. Jean Devroye which was aimed at investigating what the growth rate is at the donor area with these transected follicles. He totally transected the top half of follicular units to find a 60% growth at the donor area. He stated that this was a bad consequence of transections. However, if we combine the two studies we actually see that there may not be any loss of hair caused by partial transections in FUE at all.

Now we must make a study to evaluate the growth of partially transected grafts at the recipient area, while calculating the growth at the donor area from the remainder of these partially transected grafts. I hope I will be the first one to do this!

 

[Dr. A. Emre Karadeniz]

Topic 2: Medical Ethics

Unfortunately none of the subtopics that I was intending to discuss were mentioned by the moderator of the discussion table. I was asked to submit my topics of discussion before the meeting and the topics were talked over by the panellists 2 days before the actual panel, however the topics were not mentioned at the actual discussion panel. I will list these topics here.

1. Should methods like mesotherapy, PRP, LLT and cell therapy, thatdon't have proven effects when used in MPB or in combination with a hairtransplant, be offered as a 'treatment'?

2. Is it ethical to promote medical instruments and devices that areused to do a known technique, as 'new techniques in hair surgery', i.e. 'NewGraft Technique' or 'Jason's FUE Technique' or 'MyGraft Technique' ?

3. FUE does not work on every patient and this may be evident only afterdoing an FUE test. Is it ethical to actually be an 'FUE-only clinic'; offerand do FUE on every patient?

4. Regulations are different in every country with regards to who is'entitled to do what' during a surgical procedure. Putting aside localregulations, from a scientific and ethical standpoint, should techniciansnever be used for graft extractions in FUE or could this be allowed providedthat the patient is fully informed about who is doing what?

5. Is a surgeon responsible for explaining treatment options that he/she canoffer and the consequences of these options, or is the surgeon responsiblefor explaining all treatment options that are available according to current science and technology, even if he can not offer these?

 

[Westcoaster]

Dr. Karadeniz wrote:

Topic 1: Are Transected Follicles Within FUE Grafts Wasted?: A Case Study

Here is a screenshot of the poster presentation that I did about transected follicles within partially transected grafts in FUE.

The summary to this initial study is that transected follicles within partially transected grafts in FUE have about 50% potential to grow mature hair. In other words, only about half of the transection rate in FUE actually corresponds to amount of the wasted hair, assuming that none of the transected follicles left behind at the donor area grows back mature hair.

Interestingly, there was another poster presentation by Dr. Jean Devroye which was aimed at investigating what the growth rate is at the donor area with these transected follicles. He totally transected the top half of follicular units to find a 60% growth at the donor area. He stated that this was a bad consequence of transections. However, if we combine the two studies we actually see that there may not be any loss of hair caused by partial transections in FUE at all.

Now we must make a study to evaluate the growth of partially transected grafts at the recipient area, while calculating the growth at the donor area from the remainder of these partially transected grafts. I hope I will be the first one to do this!

How many grafts would you transect to make the study feasible

 

[Westcoaster]

Dr. Karadeniz wrote:

Topic 2: Medical Ethics

Unfortunately none of the subtopics that I was intending to discuss were mentioned by the moderator of the discussion table. I was asked to submit my topics of discussion before the meeting and the topics were talked over by the panellists 2 days before the actual panel, however the topics were not mentioned at the actual discussion panel. I will list these topics here.

1. Should methods like mesotherapy, PRP, LLT and cell therapy, thatdon't have proven effects when used in MPB or in combination with a hairtransplant, be offered as a 'treatment'?

2. Is it ethical to promote medical instruments and devices that areused to do a known technique, as 'new techniques in hair surgery', i.e. 'NewGraft Technique' or 'Jason's FUE Technique' or 'MyGraft Technique' ?

3. FUE does not work on every patient and this may be evident only afterdoing an FUE test. Is it ethical to actually be an 'FUE-only clinic'; offerand do FUE on every patient?

4. Regulations are different in every country with regards to who is'entitled to do what' during a surgical procedure. Putting aside localregulations, from a scientific and ethical standpoint, should techniciansnever be used for graft extractions in FUE or could this be allowed providedthat the patient is fully informed about who is doing what?

5. Is a surgeon responsible for explaining treatment options that he/she canoffer and the consequences of these options, or is the surgeon responsiblefor explaining all treatment options that are available according to current science and technology, even if he can not offer these?

1. I would say no.
2. No they should not as it confuses people.
3. Not sure as some clinics claim all patients are suitable.
4. I think techs should be allowed as long as a qualified doctor monitors and check.
5. If a surgeon is ethical they should let the patient know which treatment they feel is best option.

What a shame they never discussed your topics. Did they give a reason why?

 

[Dr. A. Emre Karadeniz]

Westcoaster wrote:

How many grafts would you transect to make the study feasible

I don't understand the question.

 

[Westcoaster]

If you were to carry out a study would you purposely transect a certain number of grafts from the same area?Then would you plant them all in one area to monitor the growth?

 

[Dr. A. Emre Karadeniz]

Westcoaster wrote:

If you were to carry out a study would you purposely transect a certain number of grafts from the same area?Then would you plant them all in one area to monitor the growth?

Right, to be able to monitor growth at both sites I would have to purposefully extract partially transected grafts from a certain area and then plant them in a certain area.

 

[Westcoaster]

Do you have a set number of grafts in mind? ie 100 grafts.