I am Very Bald – How Many Grafts Do I Need for a Hair Transplant?

I emailed one inquiry about hair transplant costs.   I was told by a hair loss doctor in India that I require approximately 6000-8000 follicular unit grafts, which I think is too much.   They said if I want enough hair density, that I require 2000 grafts for the hairline and temples and another 2000 for the crown.   I don’t think I am that bald.   Please tell me what I need to do to lower and add density to my existing hairline, refine my temples, and the expenses involved in a full hair restoration plan.

This hair loss question was posted directly to Dr. Raymond Konior  of Chicago, IL,  who is a member of the Coalition of Independent Hair Restoration Physicians.   See his professional answer below.

Interpreting graft numbers can be confusing for patients.   It is understandable why you would think such large numbers are unnecessary.   You need to understand that density is one of the main factors that will influence your satisfaction or dissatisfaction with the end result.  

The final density will depend on how many grafts are placed per square centimeter in the thinning hair zones.   Baseline density in a non-thinning zone has been reported to vary between 60-100 follicular units.   Variations in baseline density are influenced by age, area of scalp, race and other factors.   Your scalp would need to be examined under magnification to determine your exact baseline density in the donor site.   That inspection would also determine if you have any density fluctuations between the occipital donor site (back of your scalp) and the temporal donor site (side of your scalp).

Achieving a recipient site density comparable to the donor site, i.e. a 100% density hair restoration, is rarely achievable for most men with typical male pattern baldness since there simply is not enough donor material available for such heroic density restorations.   Fortunately most men do not need anything more than a 50% restoration to provide the appearance of satisfactory density within the hair transplant zone.   However, significant numbers of grafts are still needed to achieve a 50% restoration when the surface area of the transplant zone is large.  

In order to calculate an appropriate graft number you will need to perform some simple math.   First, you need to measure the surface area of the zone you want restored.   That zone should be measured in square centimeters.   The surface area is then multiplied by the number of grafts which will be transplanted into each square centimeter.   That will yield your final graft number.

Let’s assume your hair thinning zone had an average of 80 follicular units per square centimeter when your scalp was at its peak of density during your youth.   Let’s also assume that your donor site currently has the same density of 80 follicular units per square centimeter.   In order to produce a 50% density restoration you would need to have 40 grafts per square centimeter implanted into any severely balding or bald zone.   The significance of attempting to produce 50% density can be realized by using an example of a man with an average frontal hairline length of 18 cm (7 inches) and a balding zone 5 cm deep (2 inches).   A frontal bald zone with these dimensions has a surface area of 90 square centimeters.   A 50% restoration using 40 grafts per square centimeter would require 3600 grafts!   Men with class 4, 5 and 6 patterns typically have much larger surface areas that require attention than the relatively small zone depicted here.   You can now appreciate how such large numbers of grafts are needed if dense looking hair is the objective.  

The main problem in of the majority of men with advanced patterns is whether or not the donor site can yield the graft numbers needed for the production of high density hair.   Variations in baseline donor site density, donor site scalp elasticity and overall donor site size will influence just what can be harvested in a single session.   The reality of the situation is that many men have inadequate donor site  characteristics to yield the many thousands of grafts which are needed to produce high density over relatively large bald areas.   Ultimately you will have to decide your priorities for areas of coverage and density expectations.   Fortunately, many men are very satisfied the results achieved when using lower density restorations.   It is important to realize that the final result is also influenced by other factors such as the contrast between hair color and skin color, hair shaft caliber, hair texture and average number of hairs per follicular unit.   Favorable hair  characteristics with respect to color contrast and hair texture can enhance the final result despite using fewer follicular-units per square centimeter.    

Raymond Konior, MD

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Bill
Associate Publisher
 

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