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H
o w m a n y g r a f t s w
i l l y o u n e e d ?
 One
of the most frequent questions asked by potential hair
transplant patients is: "How many grafts will I
need?" The answer should:
•Take
realistic expectations into consideration.
•Reflect the patient's degree of hair loss, donor
supply, and hair characteristics.
•Be consistent with a long-term Master Plan to
address future hair loss.
•Address the number of potential procedures and
time commitment required.
•Consider
the short and total long-term cost for the patient.
An
individual's goals must be realistic. For example, if
a person has significant balding (i.e., a Norwood Class
6 or 7 pattern) and fine hair, then he should not expect
a full head of transplanted hair. If he does, dissatisfaction
will be inevitable. With at least 65-75% of hair lost
(the typical loss in Class 6 and 7 patients), a thin
head of hair is a realistic and achievable goal. Although
a thin head of hair can dramatically improve patient's
appearance, if he were to attempt to achieve his original
density, he would run out of donor hair before the process
could be completed and an unnatural appearance would
result.
 |
Not
a good hair transplant candidate |
| |
|
 |
Not
a good hair transplant candidate |
| |
|
 |
| 1st
Procedure |
Incl
Crown
|
| 800-1000 |
- |
| 2nd
Procedure |
Incl
Crown |
| 900-1500 |
- |
|
| |
|
 |
| 1st
Procedure |
Incl
Crown
|
| 1300-1600 |
- |
| 2nd
Procedure |
Incl
Crown |
| 1400-2200 |
- |
|
| |
|
 |
| 1st
Procedure |
Incl
Crown
|
| 800-1000 |
1100-1300 |
| 2nd
Procedure |
Incl
Crown |
| 900-1500 |
1300-2000 |
|
| |
|
 |
| 1st
Procedure |
Incl
Crown
|
| 1100-1400 |
1500-1800 |
| 2nd
Procedure |
Incl
Crown |
| 1200-2000 |
1700-3000 |
|
| |
|
 |
| 1st
Procedure |
Incl
Crown
|
| 1700-2100 |
- |
| 2nd
Procedure |
Incl
Crown |
| 1800-3600 |
- |
|
| |
|
 |
| 1st
Procedure |
Incl
Crown
|
| 1500-1800 |
1900-2400 |
| 2nd
Procedure |
Incl
Crown |
| 1700-3000 |
2100-4000 |
|
| |
|
 |
| 1st
Procedure |
Incl
Crown
|
| 2000-2400 |
- |
| 2nd
Procedure |
Incl
Crown |
| 2000-4400 |
- |
|
| |
|
 |
| 1st
Procedure |
Incl
Crown
|
| 2000-2400 |
2400 |
| 2nd
Procedure |
Incl
Crown |
| 2200-4600 |
3000-5600 |
|
| |
|
 |
| 1st
Procedure |
Incl
Crown
|
| 2000-2400 |
- |
| 2nd
Procedure |
Incl
Crown |
| 2200-4800 |
4000-6600 |
|
|
Working
within reasonable expectations, the total number of
grafts required for any one patient will depend upon
hair and skin color, donor density, scalp laxity the
thickness of each hair shaft, the number of hairs in
each graft, and the character of the hair itself. The
physician must consider these factors and the expectations
of the patient in order to calculate the amount of work
required. Even when these considerations are combined
with the expectations of the patient, the amount of
work required to make a person satisfied is sometimes
difficult to predict.
Naiveté
of the physician, even in those who specialize in hair
transplantation, seems to be more common than many care
to admit. The failure of the physician to establish
realistic expectations often leads to an unhappy patient.
This can only be prevented by providing a clear explanation
of the hair restoration process, and specifically defining
the benefits that the patient may expect to achieve.
How
Many Grafts Will Make Me Happy?
When patients ask how many grafts it will take to make
them happy, what they are really saying is, "give
me back what I lost and I'll be happy." When this
is the case, what the bald man really wants is unrealistic;
therefore, one must address how much work needs to be
done to make the patient satisfied. Satisfaction should
be addressed in relative terms to make this problem
understandable.
A
man who is accustomed to his balding will be easier
to please, and will accept a less full appearance than
a young man who is starting to lose his hair and who
remembers the days when he looked in the mirror and
saw the vibrant, full hair of a teenager. The young
patient wants his adolescent hairline and density back
and will often be satisfied with nothing less. Since
surgery is permanent, the hair-restoring surgeon must
plan a hairline that will be appropriate for the patient's
entire life and he must transplant a density that is
consistent with long-term donor reserves. Because of
these factors, some young patients are not good candidates
for surgery.
The
older patient with significant hair loss, on the other
hand, will often be ecstatic with his mature hairline
restored and a modest amount of natural-looking hair
covering his head for the first time in years. For the
majority of patients between these two extremes, the
physician's careful guidance will help the patient understand
what goals can realistically be achieved and whether
hair restoration will be worthwhile.
With
an understanding of human nature, hair dynamics, and
practical issues, we have concluded that it is not always
wise to recommend a specific number of grafts as though
this number is an absolute amount. Instead, we often
recommend transplant sessions of the greatest number
of grafts that can be reasonably and safely moved within
the confines of four important constraints listed below.
1.
The patient's goals.
2. The projected pattern of hair loss in a worst-case
scenario, as determined by heredity, age and physical
examination.
3. The amount of hair in the permanent zone (donor
area) that can be safely transplanted (this is related
to a number of physical factors including donor.
density and scalp laxity and should be assessed
by the doctor at the time of consultation)
4. Economic and time constraints of the patient.
The
Physician's goal is to help the patient understand how
close he or she can come to meeting personal needs and
expectations, how much the hair restoration will cost,
and how many sessions it is likely to require. Do not
start the hair restoration process unless you understand
what it will take to finish it. With proper planning,
satisfaction is easy to achieve.
Keep
in mind that the transplantable hair numbers generally
reflect an average amount of total hair that can be
moved and applied to one's hair loss. This movable hair
can be transplanted in one or multiple sessions depending
on the four factors above and your doctor's skill and
experience. For example, if procedures are limited to
only 100 grafts each, then patients will be committed
to an extended number of surgical sessions. Possibly
not obvious at the onset, such extended treatment sessions
often end with the patient losing interest. Financial
or personal reasons may also cause the patient to fail
to complete the treatment course. Just as important,
multiple, small procedures move hair inefficiently and
waste precious donor supply.
The
impact of the transplant depends both upon the distribution
of grafts as the absolute number used. Nonetheless,
it is still useful for the patient anticipating surgery
to have a general idea of the numbers required, both
for the initial procedure and for subsequent sessions.
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