One Pass Hair Transplants

For individuals with a high Norwood pattern, Nw4 and above a normal goal is to cover as much of the balding surface area as possible and ideally in a single session to achieve a result in one pass

The terms Mega and Giga sessions have been used to denote the large movement of grafts in a single session; much is dependent on the quality of the donor zone characteristics on how many grafts can be removed safely and maintain the quality of the donor area as best as possible

Individuals suffering from advanced Male Pattern Baldness (MPB) will require anything from 4000 to maybe as much as 8000 plus grafts or follicular units to achieve total restoration; some candidates will not be able to achieve these numbers due to deficiencies in the donor hair safe zone, other may require multiple sessions

Technical ability and planning is required to ensure the grafts can be harvested, divided into the natural follicular units, the recipient sites made and the placement of the grafts administered efficiently. This requires a skilled team that work together and understand each other’s role within the process

A hair consultation can measure the quality of the donor safe zone and the recipient area to be covered, from this the plan can be made; when researching always request to see a number of results the clinic has achieved with high graft numbers to ensure they have a consistency and proven track record in achieving restoration on advanced hair loss candidates

A master plan must be made between patient and doctor to ensure this can be achieved and if there are any compromises they are calculated and agreed upon; for example the overall density that can be placed from hair line to crown

The patient must also be prepared when undergoing a large hair transplant procedure; the day will be relatively long and the individual will need the virtue of patience to allow the medical team to perform the operation with efficiency but care

Prior to any surgery the donor and recipient area will have their best properties; the donor having the best density, laxity, no scarring and the recipient has also never been touched or impaired.

Large hair transplants when performed to the highest standard allows the individual to achieve the maximum aesthetic result in the shortest time frame, less down-time away from work and excuses to friends, family and colleagues, as well as it being financially more agreeable to the wallet.


Open Donor

A hair transplant relies greatly on the capacity of the donor area to supply enough hair to cover the surface area of hair loss; the more times the donor is entered or harvested the quality of the area will be impaired

Donor management is vital to a successful hair transplant; older techniques such as punch grafting would leave large cylindrical scarring across the donor area and greatly reduce the amount of hair and density that can be safely harvested and leave obviously visible scarring

Planning is critical, both from the donor and recipient, to prioritise on what supply is available to what the demand is in the recipient area; as the number of follicular units available is a finite resource they need to be distributed in optimum approach

When dealing with a depleted donor it is important to prioritise how the hair that can be harvested can then be used in the recipient area; very often a depleted donor also means a less than successful recipient hair result and this will require planning to get the most from the donor to give a cosmetically pleasing result in the recipient

Known as an “open donor”, the area has been depleted of hair, either due to excessive scarring by previous operations or the donor hair quality not being adequate to be used, either miniaturised or simply a low density, possibly signs of DUPA

In cases where the donor is open with punch scarring, and assuming the skin laxity still allows it can be possible to excise the scarring using the FUT technique, or strip method; this allows for the strip to be taken and then sutured leaving a single line, opposed to multiple punch scarring

A depleted donor can also occur prior to any hair transplant being performed; if the area has a high % of miniaturised hair, or a low density or hair count. If the case a hair transplant is very possibly not the answer, short or long term it is unlikely a successful result can be achieved

Research is important, having the donor area checked and examined, especially with repair hair transplant surgery so a master plan can be made and both the candidate and doctor understand the goals, priorities and limitations

How Hard To Extract Grafts With FUE

FUE, follicular unit extraction, is a blind hair transplant extraction method; meaning that as the punch enters the skin it is not possible to see the follicular unit depth or direction

Understanding the direction of the hair as it exits the skin is vital, as is depth control of the punch; as it is impossible to see with the eye so a great understanding of anatomy is required

Regardless of manual or motorised punch tools due care must be taken as any damage caused during the extraction process needs to be kept to a minimum, with around a 5% transection rate; if the transection rate gets too high then a decision has to be made whether the process should be continued

The depth the FU sits in the scalp can also alter, some more shallow or deeper than other; in general most individuals there is a small variant in depth around the head but in some cases the depth can alter dramatically, even in the same areas, making depth control of the punch harder to be consistent

If depth control is not managed correctly it can impair the quality of the graft being removed and potentially create more visible scarring with the post operation healing

The angle of the hair will alter dependent on the area of the scalp it is position in, the sides and back of the head; when punching the FU´s the positioning of the hand and body needs to change to compensate for the changes in direction; generally the sides being more acute and the back the hairs facing down

The direction of the hair as it exits the scalp can differ from how the follicle is directed under the skin; if this is not understood it can lead transecting the follicular unit, best case scenario is the FU is split and the healthy hair count reduced, worst case scenario the FU is worthless due to being divided

As FUE is becoming more and more popular it is important that the aspects mentioned are controlled. Donor management is vital the ensure the least amount of damaged is caused to the area

As each follicular unit is removed or attempted to be removed the density of hair is reduced, on smaller procedures the changes are less but if larger numbers are required there is a greater danger of over harvesting and leaving obvious scarring or areas of obviously reduced hair density

A Balancing Act

Before undergoing surgical hair restoration the donor resources need to be measured, hair density, average number of hairs per FU, skin laxity and general hair characteristics, hair to skin colour contrast, curl of the hair for example

These aspects will determine how good a hair transplant candidate an individual is, a good estimation how many grafts are available from the first procedure to future interventions, and how much coverage can be achieved

A balanced coverage does not necessarily mean total restoration with even density throughout, it simply means that from the hair line to the crown the placement does not leave a larger hair less surface area than treated

To achieve enough density on a higher Norwood scale candidate can require 7-9000 grafts from the hair line to the crown, a number that not every individual can achieve so it is important the hair transplant is planned

It is important to achieve a certain density of hair to create a shadow so the light is blocked from reflecting off the scalp; this is the basic principle that makes a hair transplant work and look natural

The hair line is generally the first area to be restored; the hair line frames the face and can have a great impact on how you look, but then behind is the frontal third, mid-section and then the crown or vertex

A hair line placed too high will reduce the potential surface area that needs to be treated but can appear unnaturally high, especially as the hair line will be perfect with no signs of thinning hair, that a receding hair line would have

A too low hair line can create two issues; as we age the hair line pattern does not match our age and changes in facial features; and if placed too low will fix the point of restoration permanently potentially making the recipient surface area too large to treat effectively

The better the characteristics the greater options are available, hair line placement and design can be more aggressive if desired and still maintain a balanced coverage even if hair loss advances to a high Norwood stage

If the hair characteristics are average or slightly below treating minor hair line hair loss may not be appropriate and it would be prudent to wait until a more obvious pattern of hair loss is evident; this will allow for a long term plan to be made to ensure a balanced coverage

As the hair resources are finite a master plan must be made from the first surgery to ensure in worst case scenario a balanced coverage can be achieved and the donor can sustain hair restoration

Along with graft placement, hair angles and orientation, and using natural follicular units an important aspect to a hair transplant looking natural is achieving a balanced coverage from the hair line to the crown.

Decision Time For A Hair Transplant

Deciding when to commence surgical hair restoration can impact of how successful over time the result achieved will be and the individual’s long term happiness; starting too early when hair loss is minimal can result in long term consequences

As not all individuals will suffer from advanced hair loss some will require less restoration than others, but it is important that the donor supply, which is finite is not totally depleted to ensure restoration in the future can be carried out

If total restoration cannot be achieved in a single procedure then it is important there is no demarcation line between the native hair and the transplanted area; as this will leave an unnatural pattern of hair growth

When initially planning to restore an area of hair loss the surrounding areas also need to be assessed, weak, miniaturised hair that may still be giving coverage will recede in the future; placing into miniaturised areas will help to ensure the first hair transplant achieves a solid result

Restoring relatively small area of hair loss can result in chasing hair loss on a constant basis, requiring small touch-up sessions to camouflage small thinning areas; this can deplete the door area and long term reduce the total number of grafts available

Planning is vital from the first procedure, understanding hair loss for the majority of men is progressive; a genetic hair loss pattern can be a guide but not the rule and it is a gamble to just rely on this information

For the vast majority of men hair loss is progressive, only a small % of men will only recede to have a mature hair line; male pattern baldness follows stages of progressiveness, frontal third hair loss to total loss of hair over the top of the scalp

Only a very small % of men can ever achieve total restoration of a high NW scale hair loss pattern in a single operation; and normally the crown even if covered will have a lower density of hair placed

Planning to cover the largest area possible gives the advantage of restoration in a single procedure and maintains the donor safe zone in the best quality if future procedures are required

For many this approach is considered the best, even with a lower crown density as they achieve full coverage from hair line to crown and a natural looking pattern of hair growth. If further density is desired it is still possible to achieve this with a another hair transplant in the future

The age of an individual and hair loss pattern will play a large part when a hair transplant doctor assesses how to approach surgical hair restoration; an ethical clinic will have the individual´s long term well-being in mind and make known any concerns they may have if they feel the goals are ill-advised

Is Hair Transplanting All Good?

Is a hair transplant a cure for hair loss? NO; it simply allows for the transfer of genetically strong hair from one area, known as the donor, to the area of hair loss, known as the recipient area

It is impossible to replace like for like hair lost, and especially as hair loss progresses the need for hair becomes higher as the surface area increases; to be able to cover extensive hair loss requires medical and artistic skills

Surgical Hair Restoration has greatly moved on over the last 15-20 years and now has two established techniques for harvesting hair, Follicular Unit Transplant, or FUT, and Follicular Unit Extraction, FUE

A successful hair transplant relies on the quality of hair in the donor; a high density of follicular units and good natural hair characteristics. Combined with the ability of the medical team to utilise the attributes available

A con is not everyone is a candidate, so it is important to research carefully before entering into surgical hair restoration, contact multiple clinics for a professional consultation and advice

Factors that may make an individual a non-candidate generally revolve around the quality of the donor area; if there is a high % of miniaturisation or low hair density, poor skin laxity, a skin complaint to name a few

If the case it is advised not to commence surgical hair restoration, even when the procedure is performed to a high standard the result maybe under par due to the limitations of the donor hair characteristics.

A major benefit to a hair transplant is when performed correctly the hair is genetically strong so will permanently grow when transplanted and mimic natural hair growth before hair loss occurred

When the techniques are used well with an educated harvesting protocol on an average candidate it is possible to reach over 6000 grafts, and a good candidate 9000 plus grafts, achieving total restoration

This permits candidates with advanced hair loss to achieve a natural looking density and coverage, sometimes under the right conditions in one procedure.

It is important to create the illusion of fullness; this can be achieved by strategically placing the FU´s, watching the angle and orientation as well as the natural curvature of the hair shaft. Using the natural hair characteristics can create a visually full density

It is often a compromise between patient and doctor when designing a hair transplant, weighing up your objectives against hair characteristics and long term hair loss potential to ensure over time a natural result can be maintained


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Realistic Results From A Hair Transplant

Prior to undergoing surgical hair restoration it is important to understand a hair transplant is not a miracle cure; as positive it can be on the right candidate it does have limitations that cannot be overcome

As tempting as it maybe to jump into hair restoration it is always better to take a step back and rethink your goals long term. A hair transplant is not something that can be reversed if you do not like the result

Understanding the limitations and accepting them it is then possible to set your goals accordingly; this will go a long way to ensuring your long term happiness and well-being, and not being another “repair case” statistic.

The goals of the individual have been met but what happens as hair loss progresses over the years and the balance of hair to bald area becomes disproportionate and unnatural with a hair line fixed in a low position

Of course it is possible to have multiple hair transplant procedures but the donor hair is a finite resource and needs to be managed well to ensure the maximum number of follicular units can be safely removed as hair loss advances

As the donor hair is key to the long term result, especially as hair loss is progressive over our lifetime, it is essential to have a clear plan in the worst case scenario what the donor resources can give

Have the donor hair density measured, calculated the approximate average hair to FU count, good, bad or fair hair characteristics, skin healing and laxity, donor safe zone size, the best techniques to use now and in the future

How realistic your goals are in relation to your hair characteristics and potential for advanced hair loss. A man in his early/mid 20´s with minor hair line recession wanting to rebuild the hair line to its original position; can this be achieved? Yes of course, with a relatively minor number of grafts the hair line can be rebuilt, 1000-1500 FU´s needed.

A common response is “I will shave if I do not like the result or cannot have more procedures”; shaving is rarely an option as there will always be some signs a surgical procedure has been performed. This is not a good plan to enter into surgical restoration with.

Create a plan based on these qualities and then review your goals to ascertain whether at your stage of hair loss now your goals can be sustained over the longer term as the hair loss advances. Be aware that to rely solely on family “hair history”, especially at a younger age is ill-advised as hair loss does not always follow the genetic pattern of our paternal, maternal or siblings; it is a guide only.

In the early stages of hair loss important factors such as potential for future loss, recipient surface area, the size of the donor safe zone are impossibly to determine accurately. In more stages of hair loss compromises may be required on hair line placement.

It is important to be realistic and objective, if your goals cannot be met and the reasons are explained logically it is sensible to come to terms with this and either not undergo a hair transplant or revaluate your goals to fit with what is possible with the hair resources available.


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