What is actually possible in the HT industry at this time?

[Spanker]

I hear a lot about expectations and what a hair transplant can and can not do.

 

I think the problem with this is that it varies so, so much for each individual.

 

In my opinion, there are some patients, base on their NW level and type of hair that look great and acually look like that never lost hair.

 

Then there are some, again, depending on the type of hair and the NW level that get transplants that just look like transplants. Even on this site.

 

 

So I guess my question is, when you hear a doctor saying things like "There are limitations to transplants." What does that mean?

 

Is the limitation that it is going to look like a transplant? That one may only be able to sprinkly the crown? I hear things like limitations and illusions, and other words like that just don't mean much since I have not seen many in person. (No good ones in person.)

 

 

There is my rant. Fire away.

[mahhong]

I hear a lot about expectations and what a hair transplant can and can not do.

 

I think the problem with this is that it varies so, so much for each individual.

 

In my opinion, there are some patients, base on their NW level and type of hair that look great and acually look like that never lost hair.

 

Then there are some, again, depending on the type of hair and the NW level that get transplants that just look like transplants. Even on this site.

 

 

So I guess my question is, when you hear a doctor saying things like "There are limitations to transplants." What does that mean?

 

Is the limitation that it is going to look like a transplant? That one may only be able to sprinkly the crown? I hear things like limitations and illusions, and other words like that just don't mean much since I have not seen many in person. (No good ones in person.)

 

 

There is my rant. Fire away.

 

Well, the problem is donor supply vs. demand ultimately. I would estimate across the area affected by MPB (top, back and sides) there is probably, in a non-balding person, somewhere between around 18-25,000 follicular units. In the average man the donor supply available is probably around 6-8,000 follicular units.

 

As you can see, even if you're lucky enough to have 10 or even 15,000 follicular units in your donor area, you still can't get all your hair back. So, in men with more severe balding (let's say NW5+), you probably only have on average maybe 1/3 of the original density to play with if you're lucky. In really severe cases maybe even much less.

 

So the limitation is simple supply and demand ultimately (though hair/skin characteristics are also important). If you have let's say 250cm2 of baldness to deal with and 6,000 grafts in your donor area you can achieve a maximum average of 24 grafts per cm2. That's not going to give brilliant coverage, so a doctor will prioritise the most important areas cosmetically; the hairline and mid-scalp. The crown is the least important area because, generally speaking, it doesn't frame your face or have any bearing on your general appearance from the front or sides (this is of course not entirely true, but generally). So a doctor might want to put say 40g/cm2 in your hairline and just a light covering of 10 or 15/gcm2 in the crown to not make too much of a contrast.

 

Another reason why a transplant might not look entirely natural that I've noticed is that sometimes people transplant a relatively even number of grafts right across the balding area. In men with more severe balding, this can give a kind of "fake" look, because nature did not intend for you to have light coverage right across the top of your head and normal density along the back and sides. It's ultimately more natural to have a denser hairline and mid-scalp and lighter crown than a sparse but even layer right across the top of your head.

 

All HTs are therefore something of an illusion. People see lots of hair on your head and essentially their eye assumes you have a full head of hair. If they were to look very closely they'd notice you don't actually have as much hair as you appear you do - but the average person not concerned with balding will rarely if ever tell the difference. I can vouch for this; when I started thinning I analysed every guy's head I came across and I was surprised how many men were technically balding that I'd once assumed just had a good head of hair. I realised that a lot of men who look to have a "full" head of hair really just carry of a strong illusion of having so, but closer up it's clear they've lost density in MPB susceptible areas.

 

So a HT still remains the art of replacing hair in such a way that creates the visual look of a full head of hair without requiring a full head of hair! In most men these days, even up to some NW6s, the results can be truly dramatic. You really can gain a very decent head of hair again that 99% of people would just look at and say "yeah. he's not bald".

 

So the limitations are how much you want to cover and how much hair you have to do it with. If you have a lot of real estate and not a gigantic amount of donor hair, the results will be something along the lines of moderate to decent with a good doctor. You'll get a head of hair back and in most circumstances it will look good, but under strong light or when wet it'll be clear you still have some thinness. If you have less dramatic hairloss and/or more donor or better characteristics, the results will improve proportionately.

[Mountinvan]

OK--lets say you have realistically maxed out on your donor for FUT, would you not have more follicles available for FUE? If yes, what is realistically available?

[Spanker]

Well, the problem is donor supply vs. demand ultimately. I would estimate across the area affected by MPB (top, back and sides) there is probably, in a non-balding person, somewhere between around 18-25,000 follicular units. In the average man the donor supply available is probably around 6-8,000 follicular units.

 

As you can see, even if you're lucky enough to have 10 or even 15,000 follicular units in your donor area, you still can't get all your hair back. So, in men with more severe balding (let's say NW5+), you probably only have on average maybe 1/3 of the original density to play with if you're lucky. In really severe cases maybe even much less.

 

So the limitation is simple supply and demand ultimately (though hair/skin characteristics are also important). If you have let's say 250cm2 of baldness to deal with and 6,000 grafts in your donor area you can achieve a maximum average of 24 grafts per cm2. That's not going to give brilliant coverage, so a doctor will prioritise the most important areas cosmetically; the hairline and mid-scalp. The crown is the least important area because, generally speaking, it doesn't frame your face or have any bearing on your general appearance from the front or sides (this is of course not entirely true, but generally). So a doctor might want to put say 40g/cm2 in your hairline and just a light covering of 10 or 15/gcm2 in the crown to not make too much of a contrast.

 

Another reason why a transplant might not look entirely natural that I've noticed is that sometimes people transplant a relatively even number of grafts right across the balding area. In men with more severe balding, this can give a kind of "fake" look, because nature did not intend for you to have light coverage right across the top of your head and normal density along the back and sides. It's ultimately more natural to have a denser hairline and mid-scalp and lighter crown than a sparse but even layer right across the top of your head.

 

All HTs are therefore something of an illusion. People see lots of hair on your head and essentially their eye assumes you have a full head of hair. If they were to look very closely they'd notice you don't actually have as much hair as you appear you do - but the average person not concerned with balding will rarely if ever tell the difference. I can vouch for this; when I started thinning I analysed every guy's head I came across and I was surprised how many men were technically balding that I'd once assumed just had a good head of hair. I realised that a lot of men who look to have a "full" head of hair really just carry of a strong illusion of having so, but closer up it's clear they've lost density in MPB susceptible areas.

 

So a HT still remains the art of replacing hair in such a way that creates the visual look of a full head of hair without requiring a full head of hair! In most men these days, even up to some NW6s, the results can be truly dramatic. You really can gain a very decent head of hair again that 99% of people would just look at and say "yeah. he's not bald".

 

So the limitations are how much you want to cover and how much hair you have to do it with. If you have a lot of real estate and not a gigantic amount of donor hair, the results will be something along the lines of moderate to decent with a good doctor. You'll get a head of hair back and in most circumstances it will look good, but under strong light or when wet it'll be clear you still have some thinness. If you have less dramatic hairloss and/or more donor or better characteristics, the results will improve proportionately.

 

 

Thanks for the reply. Very well thought out post.

[Al - Moderator]

OK--lets say you have realistically maxed out on your donor for FUT, would you not have more follicles available for FUE? If yes, what is realistically available?

 

No. Don't believe anyone who tells you that you can get FUE once the donor is maxed out. If the donor is maxed out then you're already looking at not having enough hair above and below the scar to cover the scar. Taking out more grafts by FUE will only make the scar show even more.

[mahhong]

No. Don't believe anyone who tells you that you can get FUE once the donor is maxed out. If the donor is maxed out then you're already looking at not having enough hair above and below the scar to cover the scar. Taking out more grafts by FUE will only make the scar show even more.

 

I don't think that's entirely true since the donor area is a bit larger in FUE. You don't have to take immediately around the strip; you can spread it over the whole donor area and use sections that will not compromise hiding the FUT scar.

 

That having been said I don't think the FUE donor levels after maxing FUT are all that stellar; maybe another 10-20% of your FUT donor yield if lucky. It's not like you're going to get 8,000 from FUT and then another 6,000 from FUE - maybe another 1,000 if you're fortunate. But there's a lot of tweaking and finalising you could do with a final FUE procedure so for some men it's probably still worth considering.

[67mph]

Important thread Spanker and informative answers mahhong.

 

Tough calculation isn't it hairloss and hairgain, just got to do the revision and find a good (and the right) calculator to help us out before the big exam!

[El Nino]

mahhong makes some good points.

 

I think a lot depends on your NW level and where you will finish on it. If you are a NW 3 or less and a good chance you won't go any further then you can dense pack a lot of grafts in a small area and virtually get back a full head of hair. If you are NW 4 or above or are destined to be in the future then all you can hope for is the "illusion of density".