Why Does My Hair Transplant Surgeon Recommend I Have Two Procedures?

This hair restoration question was answered by hair loss forum member “ArochaHair”, online representative for Coalition physician Dr. Bernardino Arocha:

I have an strip hair transplant procedure coming up on Dec 9. During my consultation, it was recommended I concentrate more on the front, with a relatively small percentage on the crown, and that I could have a 2nd procedure later to cover the crown.

My wife, ever the skeptic, believes he simply wants to make more money, and that I should tell the doctor to put more on the crown. A quick perusal of the Hair Restoration Forum tells me that the crown requires more grafts than the front, for similar results.

Here are a couple of pictures from tonight. Can you tell me how I might reasonably request my grafts to be distributed? I think I have a large area to cover, and 2450 grafts or so would not be sufficient to include the crown. What do you think?

You need to make sure whomever you trust to give you the best hair restoration result possible has a lot of experience doing the same for others. The problem with any approach for you is that you are limited by the resources of your donor zone, which is where the hair is coming from to address the areas of hair loss. In your case, your supply does not meet the demand so that means you just do not have enough hair to address all of your balding areas with a very high density so you have to accept some compromises.

There are two schools of thought when it comes to transplanting hair on patients with a lot of loss (like you). You are a 5A on the Norwood Scale which means you still have some hair across the bridge of your scalp but your crown and the front are essentially bald. You have the option of either going for the biggest session possible to address all areas or to break your pattern of loss into two sections and address each accordingly.

If you go for option #1, you’re looking at 4000 to 6000 grafts in one procedure and this is using FUT (strip). You’ll have enough hair transplanted to give you a strong hairline but one that has natural looking recession and with moderate density. You’ll then have lighter coverage for the top and even lighter coverage for the back. Will the coverage or density be enough in any of these areas? it is difficult to say.

Option # 2 is to have two sessions. Session #1 is to address the front first as this is going to give you the biggest cosmetic improvement since it is what you see in the mirror and what people around you see when they look at you and talk to you. If that works out well and you’re happy you have the option of having a second procedure for the back or to not do anything at all and enjoy your results and improved appearance.

ArochaHair
Online Representative for Dr. Bernardino Arocha
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David
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.