How Hair Transplant Surgeons Determine the Appropriate Number of Grafts for Each Patient

This following article from our Hair Loss Social Community and Discussion Forums was written by recommended hair restoration surgeon Dr. Ali Emre Karadeniz.

I see many discussions where the decision on graft numbers are discussed fiercely. Before we discuss the recommended number of follicular unit grafts for each case we should take a look at what goes through the minds of patients and hair transplant surgeons.

There are two main types of factors that are considered when deciding on a grafts number:

Scientific factors
Practical factors

Patients usually consider only practical factors as it is very difficult for them to know scientific factors which are usually related to concerns 10-20 years ahead.

Practical factors that patients consider can be:

The number of grafts to cover the largest possible balding area in one sitting
The number of grafts that will give them the lowest price per graft rate
The number of grafts that will delay a future session to the furthest possible date
The number of grafts that will give the highest density
The number of grafts that sounds the best
The number of grafts that gives the lowest and most youthful hairline

It is clear that all these factors lead to the highest possible graft number.

Hair restoration physicians may consider one or both types of factors depending on their personality, surgical background, ethical understanding and marketing strategy.

Scientific factors may be:

The number that gives the highest percentage of yield
The number that keeps more options for the future
The number that protects existing hair at the recipient area
The number that leads to the most balanced look 10-20 years ahead
The number that keeps the transection rate at the lowest
The number that protects the donor area

It is clear that all these factors lead to a number significantly lower than practical factors.

Practical factors that the surgeon may consider are:

All the factors that the patient considers as the primary goal is patient satisfaction.
The graft number that earns him the most money

It is clear that these are related to the highest possible graft number.

The graft number that gives the highest coverage and density not only satisfies the patient, but also gives the best before and after result. Transplanting a high number of grafts on existing hair gives the best possible density. The increase in hair per area is much more significant than the hairs that may be sacrificed during the procedure. A surgeon that puts 5000 grafts on a young patient with diffuse thinning is going to get a much better result than a conservative surgeon who would do only 2000.

Who is going to vote for the conservative surgeon when the 1 year postop photos show good density at the hairline and some thinning at the rest? The conservative surgeon is going to come on top 10 years later if he has the chance to do his 3rd or 4th transplant, but are we all going to be here to witness it?

Practical factors and scientific factors usually oppose each other. Patients want a significant result and they want it now. They usually don’t care about or at least are not aware of scientific factors. The surgeon risks confronting his patients if he cares about scientific factors. However this is very controversial, as arguing with a patient for the patient’s own benefit, while the patient is not understanding what is to his own benefit puts the surgeon in a difficult position. He can easily avoid these controversies by surrendering to practical factors.

The controversies remain unresolved.

Dr. Ali Emre Karadeniz
—
David (TakingThePlunge)

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.
To share ideas with other hair loss sufferers visit the hair loss forum and social community.

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