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No. of Grafts required and HT surgeon advice in India


BOLD

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HI Friends,


I am a 27 yrs old Indian Male whol is losing hair since last 17 yrs. NOw after living without hair for so many years now , I have decided to go for Hair Transplant surgery for myslef. But , I am very confused about many things regarding that and hoping that someone from Hairrestorationnetwork will be able to help me.


I am uploading few pics of my own and would request experienced members of the group to help me suggest that how many sitting and grafts will be required for me. My doctor says two sittings will be required 3500 grafts in first siting and 1500+ grafts(to cover crown) in second sitting. I would like a suggetion as to what shoul i expect after my first sitting of 3500 grafts in terms of appearance. How much further can I go given the donor area condition on my head, i mean can i get another 3500-5000 grafts surgery to have even more fuller look.


One more advice, if anyone can hel me. I hv shortlisted Dr Rajesh Rajput here in Mumbai after he was recommended to me by two other Hair restoration doctors. But I read one blog about one case where he placed very few grafts depite claiming it to be of highr no. I would request anyone who has any information on his past work or anyone who has get it done from him, any advice will be welcome.


I am also going to Dr Madhadevia and Dr vasa in ahmedabad before takinga final decision. I can go to Delhi for Dr AP also. Would anyone tell me that what will be the best option for me

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  • Regular Member

Dear Bold,

A hair transplant has a very large artistic element in it's application. It is very difficult to project an exact outcome even when knowing the surgical methodology of the physician you are consulting with. How is the doctor going to allocate the first 3500 grafts? I'm assuming that he is going to rebuild your hairline, corners and anterior third of your head in the first procedure.

The hairline and front is a very strategic in a HT procedure. The hairline frames your face and keeps the facial appearance symmetrical. OK. It appears you are heading towards an advanced Norwood class.

Did your doctor perform a miniaturization study? How dense is your donor hair per square mm? What is the laxity of your donor region (very important for size of procedure and safe donor incision closure)? How thick (fine, medium or thick) is your hair shaft diameter? Is your hair wavy, or straight when grown out? Another factor, Bold, is the contrast of color of your black hair on a lighter skin tone. All these factors play an important role in devising a surgical protocol for you.

The gold standard is to achieve approximately a 40% density of the transplanted area when compared to the donor density. This will give the appearance of very adequate density. Can that be achieved in your case? It is unknown without some of the general information requested above.

The surgery graft number recommended by this physician seems a very fair assessment given your presentation (pictures). The donor region appears good but donor density (hairs/sq mm), miniaturization and scalp laxity need to be determined. This will ultimately determine how far you can go. Remember, the donor scar must be as aesthetically pleasing as the newly transplanted hair! Ask the doctor if he can do a trichophytic closure after your last HT procedure.

Are you using finasteride?

As to receiving all the grafts you contracted for: we take the leap of faith to entrust a licensed health care professional to serve the patient in the the patients best interest. One would hope that the doctor wants the best outcome for you and will place all the grafts he can safely harvest.

Bold, try to look at patient pictures with a similiar presentation and a similiar number of grafts to get a ballpark estimate as to what you can expect. Remember that so many factors may be different like head shape and all the previous mentioned information or questions I asked above.

The surgery protocol, absent the above information, seems fair and appropriate.

Good Luck Bold. Please keep us updated on your information gathering and ultimate decision.

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Thanks rich91403 for your detailed reply. It cleared my doubts regarding grafts requirements and other points. I understand that the no. of grafts required depends upon several factors pointed out by you. My doctor told me that first surgery will be done to create an appearance which will hide baldness. So, after 1 year I will look like a person with broad forehead and receding hairline, but I wont appear as a bald person, A subsequent surgery 0f 2000 to 3500 grafts can be done for improving hairline and achieving a fuller look. However, my doctor told me that his experience is that most of the patients are satisfied with first surgery as a solution to baldness and don't consider second surgery necessary. However I think I would prefer going for second surgery in due course of time.

I am taking finasteride for quite some time now and I am not that happy with the results.Although my hair density seems to have improved, I still experience massive hair fall. I asked my doctor about it and he told me that it is normal and due to regular medication my fallen hair will get replaced properly. Still I wonder whether 20 to 25 hair everytime i wash my hair or apply oil is normal ? And as required I am continuing with the medicines.

 

I have finalized my surgery in the first week of July. I am a bit nervous and hope everything goes well. I hope I will keep getting support from the community. Thanks again.

 

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  • Regular Member

 

rich91403

Dear Bold,

 

You,re welcome and congradulations on selecting a surgical date. I've read your profile and our collective hearts go out to you with this hairloss situation and how it is impacting your life.

 

It appears you are practicing a very healthy lifestyle and please do not entertain the thought that you have done something wrong to negatively impact your hair. Mendelian genetics and being a male are probably the dominant causes of your hair expression.

 

The good news is that there is a solution for what ails you. You are taking a proactive step towards it's resolution so all is good. Now we have to be pragmatic and efficient in this moving forward process.

 

You are going to have a large surface area to cover. Placing 3500 grafts diffusely over the entire male pattern area "may" not satisfy the density you are seeking to offset the appearance of baldness. I agree with your foresightful thinking that a second procedure is probably going to be necessary. It is good that you have that in the back of your mind. If you are satisfied after the first 3500, then that is great. If you desire more density, then you have mentally prepared for that. The good news is two procedures may do it for you. I've had like seven! I lost count already!

 

Bold, I read on your profile that you are using two milligrams of finasteride per week. The doctors in the US and the clinical studies here have shown that 1mg per day is the effective dose (based on clinical trials). Maybe you can discuss this with your physician.

 

One other factor on your pictures. There appears to be a "crown edge" from the picture that shows the back of your head. This is a region of donor rim that still has characteristics of receding inferiorly. It appears to be solid and permanent hair but a miniaturization study should be performed to see how wide this "crown edge" is. Since you're making the big move, the boys here on HTN gotta look out for you. Just ask your doctor to assess and plan for the "crown edge".

 

Keep up the good diet and exercise program. I look forward to hearing about your progress and the positive impact it has on your life.

 

Rich (I'm a medical consultant for Dr Parsa Mohebi). I'm expressing my own opinion as a fellow hair loss sufferer.

 

 

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Dear rich91403,

 

Doctor has not performed any miniaturization study, he studied my donor area with the help of a hand held magnifying glass. He told me that on the day of surgery, the density of hair will be measure by a device(which he showed to me) and based on that grafts will be extracted from the donor area.

I am quite satisfied with the approach of my doctor , I know that in such matters we have to have faith on the doctor. I am very surprised that you have gone through HT 7 times. Its amazing. I can only say that it is very brave of you , and it shows the level of confidence you have on the procedure.

I am on finasteride, 2 mg per week, i am thinking f increasing it to 3 mg per week along with external application of same, Do you think its safe, my doctor told me that 1 mg of finasteride per day has no harm on body...

I am again thankful to you for such speedy response. I must admit that my confidence on this whole thing has increased and I am looking forward to my HT very eagerly

 

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  • Regular Member

Dear Bold,

 

I'm very glad to hear that you are confident and satisfied with your doctor's approach.

I am using finasteride daily without any negative effects. The recommended dose by the doctors here (FDA approved) is 1mg per day for hair loss as the effective dose. I believe that would be an appropriate dose for you per your doctor's approval. He seemed to recommend the 1mg per day and I believe that to be a responsible one.

The reason I had seven procedures is because the technology was so much different in the early eighties. Now, one or two procedures usually takes care of most patients. I was born too early!!!

Bold, you're very welcome for the response. I hope you get a great result and if I can be of any support along the way, I'd be honored to do so.

 

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