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.

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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

Achieving The Density & Coverage Required

When placing grafts a measurement is made as to how many FU´s per cm² are required, this is largely determined by the hair characteristics to ensure light is blocked from reflecting off the scalp and to give the look of fullness

As the head is not a flat surface it is harder to calculate the surface area, it is not as simple as measuring the width and length of the area. The surface area to cover will dictate the number of grafts required, taking into consideration the natural hair characteristics

It is important to understand that everyone is different and different hair characteristics will give different results from person to person

As the recipient area expands it is important aspects such as the hair line design and placement combined with the quality of the donor can sustain a natural balanced coverage over the scalp

The frontal and mid sections can measure around 100 cm², and the crown or vertex also on average 80 to 100 sq.cm. The crown surface area though can open further if the loss spreads to the sides and back, an example of a high Norwood, 6 or 7; larger heads or very aggressive hair loss the area of hair loss can reach closer to 300 cm²

The highest density placed will always be the hair line as single hair follicular units are required; the density can then drop slightly behind as 2, 3, and 4 hair groupings can be distributed to give the illusion of a natural density

On higher Norwood stages the surface area is easier to calculate as hair loss has progressed and unlikely to increase dramatically further

An easy measurement can be made at home to calculate the surface area;

Place a transparent wrap over the scalp and mark out the area of hair loss, then place over the grid sheet to count the number of cm² boxes to give you the surface area; from this it is possible to calculate how many follicular units are required by taking an average density placed multiplied by the surface area total

For example, after judging the hair characteristics an average density required over the area is 35 FU cm²

Surface area 150 cm² x 35 density = 5250 Follicular Units or Grafts

Donor Hair Supply

Regardless of the technique used, FUT or FUT donor hair density is an important factor; FUE is more reliant on donor hair density because the FU´s are removed over a wide surface area, lowering the donor area density

The donor hair density coupled with the average number of hairs per follicular unit (FU´s) can make you a good or bad hair transplant candidate. The approximate average hair density is 75 FUcm², but this can vary dependent on ethnicity and hair characteristics

Almost whatever stage your hair loss is at the time of a hair transplant it should be assumed that has loss will progress and this needs to be taken into account

When treating a low Norwood Scale candidate if the donor hair density is low and hair loss progresses there maybe not enough hair to treat the area or give a balanced coverage, especially if a low hair line is fixed

Donor hair density is one of the most important aspects of hair transplantation; the hair density around the sides and back (donor area) must be able to cope with the demands of the surface area (recipient area)

When planning your hair restoration it is important to have your donor hair density measured prior to making a decision. The density is calculated per cm², with the highest density found around the back of the head; occipital bone area

Treating a high Norwood candidate the density needs to be calculated and then the hair transplant design planned to ensure a balanced coverage can be achieved

Donor hair density is a vital element that needs to be calculated when planning a hair transplant, coupled with the average number of hairs per follicular unit. Whenever you have a personal consultation with a Doctor ensure this is measured.

 

Getting The Most From Each Hair

If your characteristics all fall into the best selections then you are very lucky as the majority of candidates do not. Invariably there will be a mix of characteristics and the doctor will assess how to design based on this

An individual´s hair characteristics play a vital role in the hair transplant result, and can make the difference between a WOW result and one seemingly below par; even make an individual not a hair transplant candidate

When researching hair transplant results try to look at people with similar hair characteristics to yourself, this will give you a better indication to how hair characteristics affect the result of a hair transplant

Also research how hair characteristics will change the way a hair transplant is designed by the doctor: fair skin and blonde hair, tanned skin and coarse dark hair, curly, wavy or straight hair.

Hair characteristics cover a plethora of criteria; hair calibre, hair to skin colour variant, the amount of curl in the hair shaft, the donor hair density and the average number of hairs per follicular unit

Your characteristics will determine the density of hair that needs to be placed in strategic areas of the recipient area; they will determine the hair line design and placement taking into consideration your hair loss pattern

The number of hairs in the donor is going to determine how much coverage can be achieved; the follicular units range from 1-4 hairs, averaging around 2.2 hairs per FU. The higher the average the better as more density and coverage can be achieved

Donor hair density is calculated by the number of FU´s per cm², low density can be around 50 FU cm², a high density 90-100 plus FU´s cm². The density will alter around the scalp so it is important to measure in more than one area.

The calibre of hair can vary from very fine to very coarse hair shaft, fine hair covers less surface area so more hairs are required to gain fullness; coarse hair will achieve more coverage but can appear pluggy especially along the hair line Better the calibre more shadow is created over the scalp, more coverage per hair shaft allowing for a better distribution of the follicular units whilst sustaining the look of fullness

A fair skin complexion coupled with dark hair creates a large contrast between the hair and skin making it harder to create the illusion of thickness; fair skin and fair hair is much easier to create this illusion with fewer hairs.

Straight to curly hair; this will affect the density needed to be placed and the orientation and angle of placement. Curly hair gives more body or volume when grown out, straight hair more longer coverage.

It is important to have your hair characteristics assessed correctly and plan how the hair transplant can create the result you are happy with; understanding this will go a long way a happy patient, short and long term

Getting The Correct Hair Line

Hair line design is different for every individual, there is no designer hair line shape and the natural contours of the facial bone structure will determine how the position and design should be made

The angle of the hair line is important, for example it will differ greatly between men and woman, the height of the hair line above the eyebrow, the temporal recession angle, convex or concave and the lowest part of the hair line

For men the central apex of the hair line is generally lower but the corners or temporal area is higher and creates a more square shape, like an “M” shape; this is accentuated as male hair loss starts to increase the angle between the apex and the temporal region

Variants In Male and Female Hair Line Designs

Variants In Male and Female Hair Line Designs

Largely, men have longer and larger faces compared to women, the male bone structure is generally squarer, and sharper corners for example the jaw and neck line; a woman the features are softer, more rounded

The hairline for a man appears further back than a woman, giving the appearance of a larger forehead. The hairline is also more rounded for a female which further reduces the appearance of the forehead

When reconstructing a male or female hair line theses basic principles must be adhered to otherwise the hair line will not complement the bone structure of the individual and look unnatural

The placement does not always have to be aggressive but sometimes a subtle change can make a huge improvement to the overall result; correct orientation of the hair as it moves around the hair line into the recession and then down the sides

Ensuring the hair used blends with the sometimes softer and finer hair in these areas. As well as hair calibre to take into account other factors such as density placed are important as this will change around the hair line

As a rule the hair line should not be placed lower than the original hair line; even if hair loss is not aggressive and results in a mature hair line almost every male will see the hair line recede a little

If a hair line is placed too low at a young age it will look appropriate at the time but may not remain appropriate as the individual ages; although our bone structure remains the same the ageing process will alter our facial image

Many times, if not always the best surgical hair restoration results are achieved not necessarily by creating the look of a full head of hair but because there has been an understanding between doctor and patient what can be achieved and is possibly with the resources available

 

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Increase Graft Survival, Caring For Follicular Units

 

Ultimately graft survival will impact greatly on the quality of the result from a hair transplant procedure; no matter how well the grafts have been placed if the yield is low when grown out the patient´s result will be thin, patchy and unnatural

Graft care during the procedure is vital, from the initial extraction regardless of the technique used, FUT or FUE, to the cleaning of the grafts and being placed in a holding solution to the placement of the grafts into the recipient sites

The quality of the doctor´s technicians is vital to this process as they will handle the grafts over most of these stages and the doctors will oversee the graft handling to ensure the quality is maintained and at the same time each process is performed efficiently to ensure the grafts are not left out of the scalp for an excessive time period

All aspects of graft handling should be performed under magnification; this ensures no damage is caused, transection kept to a minimum and only good quality follicular units are used and placed

Large sessions and high density of follicular unit placement; the larger the procedure the more time it takes, the longer the grafts are out of the body; a skilled and efficient team will be able to work in placing the grafts in rotation to ensure the well-being of the grafts and patient

Placing at high density is a skill; the instruments used will aid the slit making, customised to the size of the graft. Placing too high a density, the slits too close to each other can impair healing and graft survival

Healing is a vital part to the yield and success of a hair transplant; post-operative care is another important aspect to maximise the growth rate. Little to no pressure should be applied to the recipient area in the first week, the second week slight gentle massage can be applied when shampooing; the grafts are delicate and with scratching or vigorous massage they can be dislodged from the recipient sites

It is important to always follow the instructions given by the clinic, and if any concerns talk with the doctor and take the advice

 

Hair Transplant Education   Hair Transplant Patient Results

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Hair Loss & Treatment

Hair Transplant & Prices

Procedure & Results

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