Why do some smaller sessions appear to achieve adequate coverage/density?

[Hamilton]

Hey guys, I've been looking around at a lot of the transplant photos on this site, both very large and very small sessions, and I have a question about some of the smaller sessions I've seen. I was looking at the "1000-1999 graft" session category and I mainly saw pictures in which the patient had the majority of the grafts concentrated in a very small area; however, I saw some patients in which they appear to have achieved adequate coverage over a fairly large area with a relatively small number of grafts. Examples: 1205 grafts, 1628 grafts, and 1420 grafts. My question is this: how are these patients achieving the look of density and coverage with such small sessions? Or is it some kind of an illusion?

[Reptile]

You are right, I actually really like what was done with the first one with 1205 grafts, he was almost bare in the front (especially on the sides in the front) and thinning in the crown but with just 1205 grafts they covered it up well. Perhaps someone more knowledgeable can comment on this.

[Bill - Seemiller]

Hamilton,

 

"Illusion" is a term commnonly used when referring to hair transplants since it's impossible for people with extensive hair loss to restore a full head of hair. Though the number of grafts significantly contributes to overall coverage and density, there are a number of other factors to consider. Below are listed a few for your consideration.

 

1. Amount of existing natural hair: As you can see in most of the hair transplant photo examples you presented, most of the patients had a good amount of natural hair before surgery. When hair is transplanted in between and around the existing natural hair and grown out, it looks a lot denser.

 

2. Hair Length: Most of the before pictures in the examples above show very short hair whereas the results show the hair fully grown. Though there is no attempt to deceive here, it's important that prospective patients look sharply and consider how hair length contributes to the illusion of hair density.

 

3. Hair Characteristics: Thicker hair has the ability of creating a greater illusion of density than thinner hair.

 

4. Hair Style: Certain hair styles will make your hair appear thicker, especially due to the layering effect (hair covering hair)

 

5. Hair Placement: Strategic placement of the transplanted hair can significantly aid the illusion of density, such as the shingling effect (hair placed like shingles on a roof to minimize the appearance of empty spaces when light shines on the hair/scalp).

 

6. Hair Density: Though numbers of 50, 60, and even 70 follicular units per square cm (FU/cm2) sound impressive, in many cases this many grafts are not needed to create an adequate illusion of density. Patients are often satisfied with much less and can reserve plenty of donor hair for subsequent procedures if desired/needed.

 

I hope this helps you in your research.

 

Best wishes,

 

Bill

[Dr. William Lindsey]

Bill is right. Plus, donor hair caliber is a big issue. Think of hair like trees that you want to cover an open field with. If you have thin asian hair, like thin arbor vitae trees, it will take lots to give any significant coverage. If you have leyland cypress trees, like a wavy fairly thick european decent person's hair, it takes less, particularly with good color matches. And if you have mature Oaks or willows, like a middle eastern person's thick curly hair, or a black person's hair, it takes even less to give really nice coverage.

 

Dr. Lindsey McLean VA

[latinlotus]

Hamilton:

Efficient use of grafts is everything in HT. Doctors who are achieving great results WITH a minimal use of grafts should be congratulated, not the ones who are achieving high density like 50, 60 or 70 grafts/cm2. I don't see anything impressive with doctors using 3000+ grafts on a NW 3 patient.

[Dr. William Lindsey]

Right Latinlotus, who cares what the number is, as long as the patient is happy.

 

I would guess about 40% of my consults have been to a competitor who suggested a bigger case, just to transplant into currently existing good hair--and raise the price.

 

Do what needs to be done efficiently and spend your money or donor hair at a later date.

 

Dr. Lindsey McLean VA

[orangehair]

Hamilton.....thanks for posting this thread

 

the 1205 case of Dr. True's that you pointed out was the right number for that particular patient, in considering his persistent forlock, age (late 20's), how he wanted the hairline designed, saving some in the hair bank for future progression, wanting the ability to where hair shorter thus the scar result just as important to him, etc. It easy to find high numbers of grafts alluring but there are so many variables for each patient. And if you get a high yield out of a procedure, this always helps. This patient is also using Propecia.

[latinlotus]

dr. Lindsey:

 

my first consultation was with a famous FUE doctor who told me that i need 3500 grafts minimum! I guess he needed that number because he expects maybe half of the grafts to die...He also told me that he will try to achieve 75 grafts/cm2 density to give an illusion of density. The funny thing is that my natural donor density is a little less than 75 grafts/cm2...Needless to say i did not fall for this bs. I did more research and I am so happy finding this site.

 

All other doctors that i consulted recommended about 1800-2500 grafts.

[supernovrax]

I am having hairloss with the age of 25

Can anyone help me on what medicine should i go for? the most effective one.

[Sir Fivehead]

Also, rember what Pat says: Count HAIRS not graphs (more slices doesn't make the pizza bigger)! Unfortunately, there are some doctors that don't give both numbers to us on this forum.

 

For example, lets take Dr. A and Dr.B:

 

Dr. A harvests 3000 graphs with an average hair count per graph of 1.9, which equals 5700 hairs.

Dr. B harvests 3000 graphs with an average hair count per graph of 2.4, which equals 7200 hairs.

That is a 26% difference in the total amount of hairs. So, to just look at graph counts to compare results, can be quite misleading.

[TheEmperor]

Originally posted by Sir Fivehead:

Also, rember what Pat says: Count HAIRS not graphs (more slices doesn't make the pizza bigger)! Unfortunately, there are some doctors that don't give both numbers to us on this forum.

 

For example, lets take Dr. A and Dr.B:

 

Dr. A harvests 3000 graphs with an average hair count per graph of 1.9, which equals 5700 hairs.

Dr. B harvests 3000 graphs with an average hair count per graph of 2.4, which equals 7200 hairs.

That is a 26% difference in the total amount of hairs. So, to just look at graph counts to compare results, can be quite misleading.

 

If you add in the supposed poorer yield from larger sessions (or excess dissection), then the gains of higher graft counts may be even less.

 

I am starting to form the opinion that the largest sessions may not always get greatest yield. (This from my own results.) I had 3x as many grafts as those patients and my results look no better. There was a bit more native hair in those patients, but not much more.

 

I think what it really comes down to is that not everyone gets 100% yield. Those impressive results with 1500 grafts, had they gone to H&W, would have been "home runs" and turned out like Bobman or Shuffle. With differnt physiology their results could have turned out pathetic. I think the "X factor" is more prevalent than docs admit. Those pics are outliers and represent good hair quality and 100% yield.

[Dr. William Lindsey]

Hey, remember: patients are not math where 2 and 2 is always 4; but rather they are like cooking. If you cook with your mom's stuff in her kitchen things turn out one way, if you do it at your girlfriend's house it will taste a bit different and may take longer.

 

That's why you need to get the feeling the doctor is treating you, not a number that a consultant came up with.

 

Dr. Lindsey McLean VA

[Hamilton]

Thanks for the answers, guys! It all makes sense. Dr. Lindsey, I especially liked your tree metaphor. That really put it in perspective for me.

[Fallenstar]

personally, i am not in favour of anyone younger than 30yrs old and NW5/6 before going for HT. i certainly waited patiently till mid-30's and reaching a steady NW5/6 before going for it. this makes great impact in appearance.

 

with what i have seen on this forum and my research i would go with a mega session that gives a good coverage on front/mid scalp. i don't think the FUT/cm2 is a real decider, it all depends on hair characteristics & skin color. then maybe go with crown HT if there is still fuel in donor area.

 

i hope i can prove this once i have completed my crown work next week with Dr B Farjo, UK.

 

good luck with anyone considering HT...

 

my 0.02 cts worth

FS

[Abid]

after looking at those pics and reading this thread it makes me kinda feel like maybe even I could get away with 1200 grafts if done right......too bad other docs always reccomend a much higher number.....im a nw4 and one of the docs i visited said i needed 4500 grafts.....i was like wo in my head yeah whatever.....i knew he just wanted more money.....i wouldn't mind it either but at the end it all comes down to costs as to whether or not i can afford it.....i wish i could show you guys my head and maybe you guys can tell me how many grafts i really need.

[Hairtechnician]

I totally agree with Sir Fivehead. The numbers of hairs placed is more important in creating density than the number of incisions per sq cm, which connotes with the number of grafts per sq cm. For example, 25 3-haired grafts is equal to 75 1-haired grafts, so saying that 50 grafts per sq cm is more dense then 25 grafts per sq cm would not be accurate in that example. It really makes sense to look at the numbers of hairs transplanted rather than the numbers of grafts transplanted in a procedure.

[Dr. William Lindsey]

Hamilton,

 

I am a tree guy, not a tree-hugger, but I like trees and I like to farm and garden. Most of my patients have some idea of what trees they or their neighbors have, and so I use that as my analogy.

 

Plus, our office park has lots of trees, if the patient doesn't know trees, then we can just look out the window and continue our discussion.

 

Dr. Lindsey McLean VA

[FacelessMan]

Dr. Lindsey,

 

Good analogies...you illustrate the point well!

 

Benjamin