An important concept to surgical hair restoration is to use the minimum amount of follicular units or grafts to treat the surface area, whilst maintain a natural coverage and density; this ensures good donor management and good for the patient´s pocket
Hair is placed into the recipient area in natural bunches of hair, follicular units, also known as grafts. The scalp can be divided in to the 3 main areas, hair line and frontal third, mid-section and crown.
Total restoration from hair line to crown can require around 7-10,000 grafts, it is not always possibly to safely extract this from all candidates. It is important that prior to your first surgery a long term plan is made and take into consideration aspects such as age, donor supply and progressive hair loss.
The number of grafts required to treat an area depends on a number of factors, hair characteristics and the size of the surface area to cover. Hair characteristics play an important role in how many grafts are required, the better the characteristics will reduce the number needed
Curly or wavy hair, low hair to skin colour contrast, coarse hair will all allow for more coverage per hair, more shadow created over the scalp and reduce the total number of follicular units required
Follicular units are divided into sizes, normally 1 to 4 hairs per FU, averaging out to around 2.2 hairs per follicular unit on a larger hair transplant procedure; much below this will hamper the result and the coverage that can be achieved
The hair line needs to be made of single hair follicular units, 1 hair grafts; the number of single hair units will differ dependent on the density needed to be placed and the hair line design, behind the hair line 2,3 and 4 hair units are placed in the frontal third
The mid-section is the area between the frontal third and the crown, the surface area will vary dependent on factors such as how broad the head is and whether the lateral humps are showing signs of miniaturisation
The crown or vertex can have an insatiable appetite for hair as it can open on both sides and drop down the back of the scalp, from a classic NW5 to NW7.
If the crown expands aggressively the surface area can reach the same as the frontal and mid combined, making total restoration impossible in some cases and in others a reduced density may have to be placed. It is common even with a smaller crown that a lower density needs to be placed to give total coverage.
The distribution of grafts is a vital component to hair transplantation and being able to treat high Norwood scale hair loss sufferers. Especially when starting to treat minor hair loss and it is not possible to assess the future pattern of hair loss