What Graft Count Is Required?

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

NW5 Diffused Hair Loss Pattern Treated with 3994 FUT. Hattingen Hair Transplantation

NW5 Diffused Hair Loss Pattern Treated with 3994 FUT. Hattingen Hair Transplantation

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

 

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Hair Graft Extraction And Care

The first technical aspect of hair transplantation is the extraction of the follicular units from the donor area, either by FUE, Follicular Unit Extraction or FUT Follicular Unit Transplant techniques.

The donor zone has to be assessed as to, skin laxity, hair density, hair characteristics, and size of the safe zone; these factors will determine how many grafts and how easy it is extract the follicular units

Skin laxity affects each techniques, FUT the length and width of the strip that can be safely removed. FUE can affect the punch extraction quality; skin type physiology can make for a good or bad candidate. Skin characteristics will also affect the healing process and either hamper or help how visible scarring is left over the donor area

Extracted Follicular Units In A Holding Solution

Extracted Follicular Units In A Holding Solution

Hair characteristics, can affect the quality of extraction, fair or white hair makes it harder to visualise within the skin tissues, even under magnification, and curly hair makes it harder to divide the individual FU´s with FUT

With FUE as the extraction is blind, difficult hair characteristics can reduce the numbers that can be extracted otherwise the transection rate can spiral. Curly hair can make it harder to determine the direction under the skin

Hair density; the follicular unit density is generally measured per cm², the density will differ around the sides compared to the back which has the highest density and greater number of multiple FU´s

The density should be measured in points around the extraction zone to take an average reading; with FUE to ensure an educated extraction pattern to leave an even density throughout and FUT to determine the length and width of the strip

The safe zone is the area around the sides and back of the head that the follicular units are not susceptible to genetic hair loss. The size of the safe zone will be determined by the long term pattern of hair loss.

A conservative approach is advised especially with FUE, in younger candidates with minor hair loss as the true pattern of hair loss cannot be gauged and the only indicator is family history, which cannot always be followed.

FUE especially as this technique relies on a wide safe zone to reach high numbers otherwise over harvesting may occur with obvious hair less areas and loss of density. FUT the safe zone is isolated along the occipital bone, approximately in the centre of the donor region therefore in the centre of the safe zone.

From the very first procedure the donor safe zone and hair characteristics need to be assessed for the long term harvesting protocol. To ensure the donor is left in the best condition possible and to maximise the number of FU´s available as hair loss progresses to a natural result and balanced coverage can be sustained.

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2236 FUT Hair Transplant Result Female Patient

FU’s               Hairs

1.       467                   467

2.     1205                    2410

3.     477                       1431

4.         87                       348

Total   2236                 4656     2.08/FU

2236 Graft Placement. Hattingen Hair, Switzerland

 

 

Before and Grown Out Result, 2236 FUT. Hattingen Hair Transplant, Switzerland Hair Line Reconstruction. Hattingen Hair Transplantation, Switzerland Female Hair Transplant, Before, Post Op. Placement  & Grown Out Result. Hattingen Hair, Switzerland Before and Grown Out, 2236 FUT. Hattingen Hair Transplantation 1 Before and Grown Out Result. 2236 FUT. Hattingen Hair Transplantation, Switzerland

 

 

 

The Decision To Undergo Surgical Hair Restoration

As hair loss affects individuals in different ways there is no right or wrong answer to whether hair restoration is essential, to one it may not have any influence on their life, but to another it can be traumatic and impact greatly how they socialise

Hair loss can be an emotive issue for many, men and woman, the desire to look and feel young, not ageing maybe beyond our years and attractive, to feel good about one´s self

Peer pressure is something that surrounds us every day, from sales marketing to what friends, family and work colleagues say and do and how it is perceived we should or should not live our lives

No one should influence you when deciding to undergo surgical hair restoration, or for that matter certainly any elective cosmetic surgical procedure; the decision should be yours alone

The Initial Signs Of Hair Loss And When To Consider Surgical Hair Restoration

The Initial Signs Of Hair Loss And When To Consider Surgical Hair Restoration

Hair transplantation can be an excellent method or hair restoration, but it is not a miracle cure and does have limitations; the largest being the donor resources are finite, if hair loss progresses it can be harder to reach total restoration unless your hair characteristics are good and a correct plan is made to deal with progressive hair loss

From the first procedure a long term plan should be taken, especially if the hair loss pattern is minor with the potential for it to advance; using a relatively high % of the donor in a small area will hamper future restoration and achieving a balanced natural coverage

The timing of a hair transplant will also play an important role, age, current hair loss pattern, potential for future loss have to be considered on an individual basis. A good start is to research a number of doctors and clinics, how they approach hair restoration

Your hair characteristics will play an important role in determining what long term result can be achieved. Hair line restoration can be easily achieved by anyone but if hair loss advances to a high Norwood stage are the hair characteristics able to maintain successful restoration?

Collate the information from as many sources as possible, it is very possible that much will contradict each other; if the case ensure you qualify your research as to why answers to your questions differ

 

 

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How Good Is My Donor Hair Supply?

Ultimately a good or bad hair transplant candidate can be determined by the quality of hair around the back and sides of the head, known as the donor area; the hair is genetically strong and does not suffer the same symptoms of male pattern baldness

The donor supply area will vary dependent on the eventual pattern of hair loss across the top of the scalp; the wider the pattern of hair loss will reduce the size of the safe donor zone as hair loss progresses down the sides and back of the head

A Good Donor Hair Supply Allows For Restoration From Hair Line To Crown In One Procedure

A Good Donor Hair Supply Allows For Restoration From Hair Line To Crown In One Procedure

Measuring the quality of the donor supply can be listed into aspects, size or surface area, skin laxity, hair characteristics, hair or follicular unit density and the percentage of miniaturisation within the donor area

Hair shaft diameter; miniaturisation is the progressive thinning of the hair shaft, becoming finer and weaker than the surrounding good quality hair. Miniaturised hair should not be transplanted because it will impair the result and potentially will not regrow due to the trauma of the procedure

If the % of miniaturised hair in the donor is high it will reduce the chances of being a hair transplant candidate

Follicular unit hair density; FU´s are naturally growing groups of hairs, normally 1 to 4 hairs with the highest density generally around the back of the scalp. Donor hair density will determine how much can be removed safely

An average density is around 75 FUcm², the density will later dependent on ethnicity and hair characteristics. Too low a density makes treating progressive hair loss impossible and over harvesting the donor will impair the look and possibly increase visible scarring

Hair characteristics covers aspects such as hair calibre, hair curl, variant in skin to hair colour; if the characteristics are poor even with a high FU density can produce poor hair transplant results

Skin laxity affects the FUT hair transplant technique generally more than the FUE technique; FUT relies on removing a hair bearing strip and the width of the strip is largely determined by the skin laxity. Safe donor management needs to be employed to not make the strip too wide and increase the potential of poor healing

Laxity can affect FUE also but in a different way; if the skin physiology is very lax it can impair the punching of the follicular units, the skin can break away and damage the grafts, making them useless to transplant

The size or surface area of the donor supply; this again varies between the technique of choice. FUT harvesting is localised to a thin strip generally well within the safe donor zone but still the position has to be safely calculated, especially with very advanced hair loss, or individuals with retrograde alopecia

The length and width of the strip will be calculated dependent on the number of grafts required, can range from around 10 to 30 cms in length and 1 to 2 cm in width; better laxity attributes allows for 6000 plus grafts to be harvested on a good candidate

Correctly Assessing The FUE Donor Safe Zone

Correctly Assessing The FUE Donor Safe Zone

FUE relies on removing follicular units individually and over a wide non-specific area, caution needs to be taken not to venture out of the safe zone when extracting. On lower hair loss stages it can be impossible to predict the size of the safe zone and a conservative approach is advised when measuring the safe area

To measure the safe zone is easier on higher hair loss stages as there is a clear demarcation line between the donor zone and the recipient area; an average size safe zone can be around 28cm wide by 6cm in height; not taking the area directly from the start of where the hair begins, such as directly above the ears or the nape of the neck, but keeping around 1-2cm in case of future hair loss or miniaturisation

Using all these aspects will help determine how much hair can be safely harvested, what density will be required when placed and the coverage that can be achieved over the surface area. Correct donor management of the supply of hair can restore even advanced hair loss; utilising the correct harvesting technique will maximise the graft numbers in one or over multiple sessions

 

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Hair Characteristics Plus Hair Transplant Density

A successful natural hair transplant relies on many criteria; two aspects that play an important role when planning are the hair characteristics of the individual and the density required to be placed across the recipient area

These two aspects are linked in how restoration will be made, what coverage and fullness can be achieved; each reflects on the other how the grafts will be redistributed

The art of a hair transplant is to use the minimum number of follicular units to cover a surface area whilst achieve a natural look and balanced coverage; employing an educated donor management protocol will minimise the changes in the donor area

Good hair characteristics allows for a lower density of follicular units to be placed; coarse hair, curly hair gives greater coverage and shadow over the scalp, the distribution of larger follicular units, 3, and 4 hair groups in strategic areas also increases coverage

The hair or follicular unit density placed is not the primary calculation but offset against the hair characteristics; calculating the number of grafts required to cover an area, at the same time taking into consideration how future hair loss could progress

4920 FUT Hair Transplant Using The Hair Characteristics To The Maximum And Placing The Required Density To Achieve The Look Of Fullness

4920 FUT Hair Transplant
Using The Hair Characteristics To The Maximum And Placing The Required Density To Achieve The Look Of Fullness

Placing too high or unnecessarily high density over the hair line and frontal third can impact in two negative ways; the density may not reflect the natural native surrounding hair density as well as using a high % of the finite donor hair resources

As a hair transplant relies partly on illusion, creating the look of fullness from less hair than was originally in the area allows a hair transplant to cover even high level patterns of hair loss successfully

If the majority of the resources are used to treat relatively low hair loss stages and hair loss progresses to an advanced stage it will become harder to maintain a balanced coverage and even density

It is common even with good hair characteristics that a NW6 or 7 hair loss stage total coverage can be achieved but not an even density from hair line to crown; the crown having a lower placed hair density

This is because even with good overall hair qualities the donor is restricted and the wider the recipient surface area the higher the demand for hair; a natural balanced coverage will still be achieved even though the crown density may be slightly reduced

With careful planning and donor hair management from the initial procedure; using the hair characteristics to maximise the graft distribution, placing a required density to achieve the look of fullness will result in a natural result being achieved, be able to treat progressive hair loss and sustain a natural balance of hair growth over the head

 

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Treating Advanced Hair Loss

Hair loss in the majority of men is progressive; an individual´s genetic disposition can be a reasonable guide to how advanced hair loss will progress. Advanced Norwood stages make defining the safe donor area easier

The size of the safe donor area is more important when using the FUE hair transplant technique as it relies on a wide surface area to extract the follicular units from; FUT extraction is more localised to a thin strip around the sides and back well within the donor area

NW5 Diffused Hair Loss Pattern Treated with 3994 FUT. Hattingen Hair Transplantation

NW5 Diffused Hair Loss Pattern Treated with 3994 FUT. Hattingen Hair Transplantation

Having the ability to measure the safe zone allows for an accurate assessment long term of how many grafts can be extracted, be it in one procedure or multiple surgical hair restoration procedures

Advanced hair loss sufferers also generally have lower expectations in terms of restoration; a natural result is priority but expectations of a low adolescent hair line is not the top significance for many

With planning it is possible to rebuild the surface area of hair loss, and on the right candidate achieve total coverage in a single procedure, even if this means a slightly lower hair density over the crown

Achieving total coverage with a natural hair density in one procedure is time efficient for the individual, only means entering the donor and recipient areas once, causing as little change to the skin and better healing

From the hair line position the area behind can be measured, frontal third, mid-section and crown; care has to be taken to measure the miniaturised hair around the demarcation zone when the sides and back meet the top of the scalp

The miniaturised areas of hair will increase the recipient surface area but must be taken into account when planning hair restoration otherwise the restored area will not meet the sides creating an unnatural island of hair

From calculating the donor hair density it is then possible to determine how many grafts/follicular units can be safely harvested and what hair transplant technique can be the most efficient to achieve as close to the required numbers

The hair characteristics will then determine what density of hair is required to be placed over the recipient area to achieve the look of thickness; the better the hair characteristics the lower density is required and greater coverage can be realised

NW6 Hair Loss Stage Treated with 7305 FUT. Hattingen Hair Transplantation

NW6 Hair Loss Stage Treated with 7305 FUT. Hattingen Hair Transplantation

If coverage cannot be achieved over the crown the hair density will be reduced as the placement reaches the vertex; this creates a natural looking pattern of hair loss and not stopping with a flat dense wall of hair

If total coverage can be achieved it is common the hair density over the crown will be reduced compared to the placement over the frontal and mid-section; few candidates can achieve total coverage and even density from hair line to crown in one procedure

Regardless of not being able to cover the crown or a lower density coverage the result can stand alone and look perfectly natural; if the individual does not wish for whatever reason to continue restoration the pattern of hair growth will be natural and balanced

If future restoration is desired then this can be performed at a later date; it is best to allow at least twelve months between hair transplant procedures; this allows for the hair growth to mature and the skin to fully heal

Correct donor management and on the right candidate can allow for upwards of 6000 grafts to be reached in a single procedure with the FUT technique; FUE procedures are generally much smaller and would require multiple sessions to get near such high numbers

Planning with any hair transplant is important as the first session the scalp is always in the best condition to maximise graft numbers; a mutually agreed plan between doctor and patient will ensure that both parties understand what can be achieved and the long term happiness of the individual

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