How to budget hair in hair transplantation – Hair Economy

Patient question to Dr Parsa Mohebi:

When you implant grafts into the patient’s scalp, do you implant them uniform distances from each other (like in the agriculture photo above)?

People have different hair styles that look optimal with their faces (or they’ve just become accustomed to some hairstyle that was popular when they were young and want to stick to that). Considering people have different hair design goals, shouldn’t the distance between grafts be customized to that individual’s goals? How do you determine the distance between grafts you implant into a patient’s scalp?

In the photo below, let’s assume both subjects came from a Norwood 5A baseline (since that’s where I came from before you did my procedure).

The man with the Mohawk (left) clearly needs more density in the middle and probably does not care much about the appearance of fullness outside the Mohawk region. In contrast, the man with the traditional hair cut (right) may be less adamant about requiring very high density in the middle, and may be a better candidate for “equi-distribution” (if that is a term) of grafts throughout the entire receptor region of the scalp.

This can get complicated because Actual density is a function of: (a) distance between grafts; (b) # of hairs per graft. And then Perceived density, extends Actual density to include factors of: © strategic placements of multi-hair grafts (ie. each graft can contain anywhere from 1-5 hairs), (d) subject hair color and skin tone; and (e) thickness and waviness of hair.

So, Doc, what are your thoughts?

The reason I am asking is because i LOVE the result of your work on me. But, when I got a full head of hair again, my lifestyle was changing for the better, and I purchase a BMW convertible, which I need for my reviving social life. One problem is that when I drive with the top down in that sports car, an area in the middle of my scalp appears to be thinnish because of the overhead wind. (I know I don’t HAVE to have a nice convertible.. but I am going to take advantage of my newfound confidence, and I’m going to drive the car I want to drive. Check out Spencer Kobren’s great show about “Life After a Good Hair Transplant” http://blip.tv/file/6702253 )

Anyway, Dr. Mohebi, thanks for taking the time to read my question.

I also have a favor to ask of you:

I have a profile on Hair Transplant Network that I use to educate and interact with other hairloss sufferers. HTN voted me “Hair Transplant Patient of the Week” based on the impressive work you did on me. I’d like to share my URL with your readers so they can learn more about my hairloss story: http://www.hairtransplantnetwork.com/blog/home-page.asp?WebID=2597

Thanks & Respectfully,

Paulygon

Dr Mohebi's Answer:

Great question. In fact, this is one of the first questions every hair transplant surgeon should ask before a hair transplant procedure. The answer to this is rather economic, because it has to do with supply and demand.

Hair economy

When I examine every new patient hair microscopically, I try to determine two main facts:

<!--[if !supportLists]-->1. <!--[endif]-->The final stage of hair loss or the total surface area that needs to be covered

<!--[if !supportLists]-->2. <!--[endif]-->The total value of their permanent hair

Recipient factors

It is important to know what the final stage of hair loss will be for a particular patient. Microscopic evaluation of hair can determine where you are heading in most cases even in early stages of hair loss. Family history of male patterned baldness can also help me make a better determination. For example, if you are heading for a class VI of hair loss (losing the entire hair from front and top), that means you will need adequate volume of hair to cover this large area.

Donor factors

Total value of permanent hair has to do with the qualities of donor hair described as follows:

<!--[if !supportLists]-->1. <!--[endif]-->Density: The more hair per square millimeter you have in the permanent zone, the more reserve of permanent hair you have for transplantation.

<!--[if !supportLists]-->2. <!--[endif]-->Thickness of donor hair: Thicker hair produces more volume after a hair transplant procedure. The important index to consider is the cross section of hair. If your hair diameter is twice as much as someone with fine hair, your final volume for the same number of hair will be four times more. So you can see that hair thickness is a crucial factor in the final result of a hair transplant.

<!--[if !supportLists]-->3. <!--[endif]-->Waviness: Wavy or curly hair produces the appearance of more fullness.

<!--[if !supportLists]-->4. <!--[endif]-->Color: The contrast of Hair color with skin tone is also important. Considering everything else is the same, transplanted hair in someone with only 20% hair density with blond hair on white skin will look a lot fuller than someone with black hair with white skin.

Other factors to consider

Besides donor and recipient factors, we have to take into consideration other factors that play an important role in the process of planning for hair restoration such as:

<!--[if !supportLists]-->· <!--[endif]-->Patient styling preferences: People who always comb from front to back require a denser front that can help the back areas too. People who comb from left to right require more coverage and maximum number of hair on the left side as opposed to the right

<!--[if !supportLists]-->· <!--[endif]-->Patient height: top coverage becomes more important for shorter patients while frontal hairline and back of the crown become more crucial for very tall people

<!--[if !supportLists]-->· <!--[endif]-->Patient job: Sedentary jobs makes top coverage more important

<!--[if !supportLists]-->· <!--[endif]-->Aging and other individual factors

A good hair transplant surgeon plans the hair transplantation with consideration of the future pattern of hair loss. Focusing on restoring a juvenile hairline in a very young patient could result in a fake hairline when the person’s hair loss is matured in the future.

So as you can see, planning for hair restoration is not always simple and should be done after a thorough examination of all the factors that play a role for each patient. Since the distribution of hair in transplanted areas is almost never even, the hair transplant surgeon should implant the hair grafts strategically to create the appearance of maximum fullness.

To answer your question about whether you need more transplantation to fill the very front of the scalp; it depends on whether you have adequate donor hair that can address your future hair loss in the top and crown areas. Obviously, our priorities might change due to factors such as height, job, and personal styling preferences.