How to Ensure Patients Receive the Correct Number of Grafts During Hair Transplant Surgery

This common question, asked by a member of our hair loss social community and discussion forums, was answered by recommended hair transplant surgeon Dr. Ricardo Mejia:

I recently underwent hair transplant surgery and I’m worried the physician didn’t implant the correct number of grafts for my hair restoration goals. Is it possible to ensure I received an adequate number of follicular unit grafts during my hair transplant procedure?

It is the doctor’s responsibility to properly educate you on the number of grafts that are needed to achieve the expectations of your hair transplantation surgery. The most important aspect of the education process is to properly understand what a follicular unit is and what a graft is and to understand the proper terminology that the physician is speaking. Typically in modern day hair transplantation, a follicular unit is a group of hairs that are held together by a piece of skin. This follicular unit may contain one hair, two hairs, three hairs, or even four hairs.

A follicular unit that is dissected is also called a graft. A graft is nothing more than a piece of tissue holding hairs similar to a follicular unit. In modern day hair transplantation most physicians refer to a follicular unit as equivalent to a graft. However, there are some physicians that may use the terminology called graft hairs, which is confusing because they are referring to the total number of hairs and not grafts. So if you have four grafts and they have three hairs per graft, they may say 12 graft hairs as opposed to 4 grafts. Consequently it is important to understand the proper terminology.

The next issue in understanding how much is needed for your surgery is the area that is being transplanted. The area will determine the approximate number of grafts. Are you transplanting in an area of 50 sq cm, 100 sq cm or 200 sq cm. If an individual is completely bald with 100 sq. cm. and there is absolutely no hair then one can transplant anywhere from 20-50 follicular units per cm sq and consequently can achieve a total of 2,000 to 5,000 follicular units. Obviously the more follicular units per cm sq you are transplanting, you are also transplanting finer two hair or single hair grafts.

The next issue to determine the proper number of grafts that is obtainable is to understand your donor density. Donor density can range anywhere from 50-100 follicular units per cm sq depending upon your age and donor density. The average distance on the scalp from ear to ear is approximately 30 cm and an average width of strip taken from ear to ear is 1 cm. Consequently the total width of a strip can be 30 cm sq. If your average follicular unit density is only 70 grafts per cm sq then the total number of grafts obtainable is 2100 grafts or 70 x 30. However if a surgeon extends the surgical line more anteriorly in front of the ear and is able to obtain a larger length and width and can remove twice as much area then it is possible that 4200 grafts can be obtained. However, to uniformly remove a 2 cm strip in many patients can produce significant tension and is generally not advised.

Consequently, it is up to each individual physician to properly evaluate each patient carefully, understanding their donor density and area that is to be transplanted. They also need to understand patient expectations to arrive at a proper estimate of the total number of follicular units to achieve your expectations as well as what can be physically obtained from the back of your scalp. Keep in mind that there are differences in how physicians dissect follicular units and some may keep chubby follicular unit grafts with more hairs per grafts and others may subdivide or keep very fine follicular units with smaller numbers per graft. To illustrate this, assume that two strips of equal sq cm area are taken out by two individual hair surgeons.

Assume that you count the exact number of hairs from each strip and assume that they both contain 8,000 hairs. What is the difference between the physician that states that he will give you 2,000 grafts and the physician that states that he will give you 4,000 grafts? Who gave you more hair? The answer is, neither. Both gave you a total of 8,000 hairs. Surgeon A gave you an average of four hairs per graft or 2,000 grafts and surgeon B gave you smaller grafts of two hairs per graft or 4,000 grafts but in total the number of hairs is the same. This may account for some of the differences in numbers that you may be receiving or it may be based on the estimations of your donor density and the amount that they can take out and the amount of sq cm areas that they are transplanting into. Hope this helps, but each case and consult is different.

Dr. Mejia

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Blake  – aka Future_HT_Doc

Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum

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