Most people on this site recognize the importance of factors beyond the number of grafts transplanted needed to achieve a nice result, yet it seems that many of us are still preoccupied with graft number and relegate the other factors to the proverbial backseat. Graft count, hair count, hair shaft diameter, color contrast, hair texture, and hairs per follicular unit are the things that spring to my mind as being most often discussed on this site. In anyone's opinion, which of those do you feel is most important to achieve a nice result, and which is least important? In my opinion, my list would be from most important to least important as follows:
1. hair count
2. graft count
3. hair shaft diameter
4. hair per FU
5. hair texture (ie wavy, curly, straight)
6. color contrast between hair and scalp

I'm curious to see what some of you guys think, and maybe for a doctor to jump in with his own opinion. (btw, I know some of the top docs use DFU's when appropriate, so I would place a DFU in the category of hair per FU)

I was told by doctors that because my hair is curly, it is better. Yet another doctor said that curly hair does not "travel" in aiding to cover less dense areas.

So 5 may be debatable, I guess.

3, I thought would be good too, but again, there are arguments against the coarseness of hair too...not sure though.

I will only discuss those two.

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take care...

TC17,

I just referenced this excellent topic on another thread. In my opinion, this topic can't be discussed enough. People have been obsessed with the number of grafts for years, and more recently, the number of hairs. And while how much hair is moved during hair transplant surgery is extremely important, there are many other factors that are just as if not more important to creating a cosmetically pleasing hair restoration result. Characteristics to be considered include:

1. Graft count
2. Hair count
3. Hair shaft diameter
4. Graft types - follicular units (FUs), double follicular units (DFUs), multi follicular units (MFUs) (See more on graft types)
5. Hair characteristics (wavy, curly, straight, color etc.)
6. Scalp to hair contrast ratio
7. Strategic placement and use of the grafts (present and future planning)
8. A patient's remaining natural hair
9. Patient expectations

In my opinion, it's really hard to gauge the importance of each category since it varies for each patient. In hair loss sufferers who have a healthy donor supply, great scalp elasticity, and thinner hair characteristics, I'd argue that graft and hair count and graft types are potentially higher in importance. On the other hand, take a patient with a thick curly head of hair and a lesser donor, hair characteristics are going to play a much larger role in creating a cosmetic improvement.

What is important to recognize is that all of the above are vital to ensuring a successful and natural looking hair transplant. For instance, strategic planning, placement, and patient expectations are vital in every procedure for not only the outcome of a single procedure, but in the long run as subsequent procedures may become necessary to account for hair loss yet to come.

Another important point is that even the best doctor has to make due with what they've got in front of them. Some patients are not blessed with the best characteristics (donor supply, hair shaft diameter, ec.). It's easy for members of oru hair loss forum community to make claims on a doctor's hair transplant photo album that they should have done a larger session. However, it's not always possible.

Rest assured that even clinics who regularly do ultra megasessions do hair transplants on less than optimal patients. These types of patients seldom turn out to be "wow" transformations. Over the years, I've seen many of them. Thus, when evaluating a hair transplant, it's important to know and understand all the details rather than simply looking at photos.

Coalition member Dr. Bill Reed who's become well known for producing "wow" results recently posted a case that illustrates the above important point. By looking at the photos alone, many might say it's a less than impressive result. But when you consider all the variables and limitations of the patient's characteristics, I'd say the transformation is pretty impressive based on the limitations. See 2070 Grafts by Dr. Reed.

Well known Coalition member Dr. Ron Shapiro commented on this particular album with the below statement that I think further illustrates what I'm saying:

"I would like to also congragulate Dr Reed for showing this type of case. I have often lectured that if we had unlimited donor meeting patients expectations of naturalness and density would be easy. The real skill is to be able make a patient with limited donor look the best they can. This means to be able to understand thier expectations and then be able to create patterns and distributions of hair that will look natural (maybe not full) withing the contraints of thier limited donor. Their are alot of tricks to doing this and part of it is to know the pattrens that will look natural when one has a thinning look. Obviously there are some people who when told they cannot get the fullness they had hoped for due to thier poor donor who will opt for just shaving if they cant get that. But thier are many who are very grateful for a procedure that will turn back the hands of time to a place when they had hair ....although slightly thinning...as long as it looks natural.

We can all show the wow results but it skews the what is the situation in a larger percentage of patietns with poor characteristics.

I know Dr Reed and he is one of the brightest minds I know. I commend him for showing this type of situation"

This is a great topic. I look forward to more people's input.

Best wishes,

Bill (Falc)

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So do most people think that blondish hair is maybe a little easier for HT purposes?

Stimpy