guslarkin

I just read about another graph placement issue. I saw it claimed that the crown requires more hair per squared CM, relative to the apex, to give the the same appearance of density. So if both the apex and crown are bald, it might be better to graft more hair per square CM to the crown than to the apex. This is just what I read. Anyone have any comments?

Dr. Beehner, Thanks very much for your comment. I suspected that MFU's is probably a good idea if used in the right way. As I understand, the best HT surgeons are good with angles these days. I shudder at the thought of grafts to the crowns without compatibility with the natural angles. Do MFU's permit grafting more densely in a given area due to limitations on how close grafts can be placed to each other, possibly due to limits in the blood supply to the area? One thought. If putting grafts of straight hair in the apex, and the patient, say, combs his hair left-to-right across the apex, would it pay to put more density on the left side to improve the appearance of density via a comb-over effect? It seems to me that it makes sense to take into consideration the hair style. I'm not sure I understand the normal patterns around the crown. But it appears to me to be a spiral. So I would think it makes the most sense possibly to give priority to density at, say, 2:00 or 10:00 (on a clock view of the spiral) of the crown, and let gravity and styling to provide the maximum illusion of density in the crown area? I see very little written anyway about approaches to placing grafts. I see priority-to-the hair line with single fU, followed behind with 2-3 hair FUs, and I see priority to the hairline versus the crown. But I see little written by these things. It makes me wonder how many HT surgeons are good at figuring out good strategies for graft placements. I realize that many factors come into play, but it seems that there must be some basic considerations that have general application. I suspect that there are several basic strategies that get modified based on the the patient's situation and goals. If so, then one could enumerate each strategy and then consider how the strategy might be affected by various facts (e.g., hair color, thickness, ages, donor supply, and so on.) One example. Let's assume, using my example above, that you decide to give priority to the left side of the apex. Then one might ask how this placement might be impacted by the age and pattern of hair loss of the patient. If the patient is young with NW 4, with a familial history indicating a pattern of NW 5 by middle age, then you might want to graft additional density farther to the left than if the person is, say, 60 years old. I see little written about any of these issues. I'm sure that doctors learn to deal with them with experience, but is experience the only way that doctors gain knowledge in them? Kind regards, Gus

I hear that some doctors combine multiple folicular units into single grafts. I realize that with a limited donor-area supply the surgeon can't increase the total density in a session by doing this, but I'm wondering if strategically placing some grafts of this type, especially some distance behind the hair line can give a better illusion of density given the typical angles from which a person is viewed by others. I'm also wondering if this approach actually permits grafting more density when the donor strip is large relative to the recipient area. It seems that transplant surgeons work with single-follicle units, mulitple-follicle FU's, and FU's that are a combination of individual FU's. In reading various web postings I see that it's clear that surgeons put single FU's on the hair line, and multiple-follicale FU's behind that. But I find little beyond this written about the placement of different types of FU's and even less written about single grafts composed of multiple FU's (MFU's). It seems that when there isn't enough donor hair in a session to create sufficient density in the recipient area, then one has to adopt some strategy regarding how to place the limited supply of hair in a single session. Combining FUs into single grafts may be a part of one strategy. If I understand correctly, there is a limit on how close to each other grafts can be placed, due to limits on the blood supply. So I'm wondering if using MFUs permits a surgeon to pack more hair in a given area. Any comments would be appreciated. I'm not taking a position on this; I'm just asking for opinions. I realize that MFU's can't increase the total hair removed from the donor area and available for placing in grafts. But perhaps they can contribute to a different and useful strategy for placing grafts in some cases? A related issue is the bigger question regarding strategies for placing grafts. Of course, it appears to be common knowledge that single-hair units get placed at the hair line. But what other strategies exist? Some possible examples: 1. Place more hair on one side of the top of the head when the person combs hair sideways across the top of the head. For example, a person who combs the hair from left to right might be better able to comb over a thin area if more hair is transplanted toward the left side of the apex. 2. Just spread the hair around evenly to the recipient are, even though the the result will leave the person with fairly thin hair. Then just leave the rest for a second surgery. 3. Give priority to the the front of the head and ignore the crown. This seems to be a common practice. But what if there's enough donor hear to provide 50% density and 25% density on the crown? Of course, the doctor could/should discuss these things with patients, but I suspect that many doctors don't, and if they do, their patients probably just ask the doctor for advice on what to do. I believe in patients being informed as possible and able to make good choices without having to rely only on the advice of a doctor. After all, different doctors have different approaches and opinions, so if noting else just understanding different strategies can help in selecting the right doctor. I'm mainly interested here in the strategies that doctors use/can use for placing a limited supply of hair. I know that the the choice of strategy depends on many factors such as the patient's age, familial patterns of hair loss, the color of the hair relative to skin color, the thickness of the hair, its straightness, the available supply, the possiblity of future surgeries, the hair style, personal preferences, and so on. But I am not concerned here about how to select the best strategy. I'm merely interested in simply what strategies exist for placing grafts when the goal is for a single surgery and the supply is good enough to provide, say, only 30% coverage in the recipient areas if the donor hair is spread around evenly. Using MFS's is just one such strategy. What do you think of this strategy, and what other strategies are used? Gus