How Many Grafts Do I Need For A Hair Transplant?
- Written by Hair Transplant Surgeon Ali Emre Karadeniz
'How many hairs or grafts do I need?' is a very sophisticated question and the reality beneath that question may be much more complicated than you think.
This is a very sophisticated question and the reality beneath that question may be much more complicated than you think. There are four main reasons why.
The amount of hairs lost in an advanced hair loss patient is generally more than 50% of all that hair. That means the amount of hairs needed to give a full head of hair for this patient doesn't exist in the donor area. It may be that even 50% doesn't exist.
So it becomes a useless question to ask "How many grafts do I need?" or "How many donor hairs do I need?". I can make an analogy like "How much money do I need?". The answers is obvious: all the money that's available. Since what we can buy with money is unlimited, that question becomes impossible to ask. When the hair loss is much beyond what the donor supply can give, it becomes a similar question. Because it's absolutely unachievable, so the answer to that question in those cases actually: "we need everything". Most often the answer to questions "How many grafts do I need?" or "How many donor hairs do I need?" is "We need everything!" and for that reason the question becomes irrelevant.
It's about the donor area. The back of the head is the donor area, this is where we take donor hairs and we may use FUE (the individual harvest of grafts) or we can use a strip method (FUT). The donor capacity here is limited, the capacity is theoretically the amount we can take from this area without making it significantly thin so we can use it in another region. This is very limited. The more aggressive you approach - the more you try to take you can take more- but then you do more damage to the donor area. In case you do FUE, if you do more punch holes than a certain amount you're making holes that are very close to each other, which not only cause more scars but also they cause significant thinning throughout the donor area.
So if we don't care about the donor area we could take much more, we could simply scrape the whole scalp off and we would get tens of thousands of hairs. But we can't do that because we need to preserve the donor area aesthetics. So if we don't consider the donor area preservation then this question is again unaskable. If we set standard, saying "alright we want minimum scarring, we don't want a see-through donor area, we don't want a moth-eaten appearance, we want enough coverage", then perhaps we can calculate. But oftentimes patients don't think about this and clinics may neglect that fact just to give everything the patient wants and then you get a destroyed donor area.
So that's the second reason why this question is actually a dangerous question.
Third reason why this question is problematic, it is about the technical limitations of the surgical team. If a surgical team is not experienced and let's say we're doing an FUE procedure and their experience means that they can only do around 500 grafts without causing significant damage, it doesn't matter if you need 2,000 grafts. Because this surgical team cannot provide that number without risking your health. So again, if we don't consider the technical limits of the surgical team, the answer to the question becomes problematic whereas if there's a clinic that's capable of doing very high numbers then it may be within their range to do what you need, so that's the third reason.
The fourth reason is the progression of hair loss. Let's assume the patient is receding at the front and he's expected to lose much more hair behind it. If we are going to do a plan that assumes the hair loss not going to progress, the answer to the question may be one thing, but if we want to be more clever and make a long term plan and consider the patient's future hair loss we may be more conservative and decide to use a different number of grafts or donor hairs to preserve some for future hair loss. The only consideration is not how many hairs or grafts we need at that moment, due to a multi-staged plan we may choose another number that perhaps is not the maximum but we may choose an optimal number to fulfill our multi-staged goals.
As you can see there are multiple reasons why the question alone "how many grafts do I need?" or "how many donor hairs do I need?" actually cannot be simply answered without looking at all these parameters, or even if we try to answer it we're going to make a mistake and mislead the patient.
I could even add a fifth reason which is not a medical reason - but you can even add that - and that's finance. This applies mostly for instance in cases where there are a lot of donor hairs available, especially in Body Hair Transplants (BHT).
Let's say the patient is quite bald and he has insufficient donor resources at the back but he has excellent beard and chest hairs. He may have tens of thousands of hairs available. When the patient asks "how many hairs or how many grafts do I need?" the answer could be 20,000. Prices vary amongst clinics but we may be talking about hundred thousand euros or dollars of labor, perhaps ten surgical sessions to do all that. So it's not a medical reason but when you ask that question of "how many hairs do I need?" or "how many grafts do I need?" you should even consider this fact that finance affects the answer. The answer is only valid if you have a hundred thousand dollars, then it makes sense to understand that you need ten or twenty thousand.
If it's practically not possible to charge for a treatment like that then it becomes unnecessary to figure that out. So, it's a very complicated topic and I believe we can't approach hair transplant planning by questions like "how many grafts do I need?".
Oftentimes, clinics answer this question depending on their technical limitations, so they're actually answering the number of grafts they can do, not what you need. Or the number of grafts they believe you would pay, not the number of grafts you need. So they would answer with the number grafts you simply want to hear not even the number you need or they can do, they may just make up a number feeling that this number is going to get the patient in, make the sales.
So there are some questions in the hair transplant surgery and the "number of grafts" is one of them. When you ask this question, it may not help you if you don't understand all of these details I just mentioned.
Written By Dr. Ali Emre Karadeniz, MD, PhD
Ali Emre Karadeniz, MD (Dr. K) is the only American Board of Hair Restoration Surgery Certified Turkish plastic surgeon. He has performed over 2000 hair operations. He is an active member of the International Society of Hair Restoration Surgery (ISHRS).