What Every Young Patient Should Know When Considering Surgical Hair Restoration

[Billena]

A Publication co-authored by Carlos K. Wesley, M.D. in the peer-reviewed Dermatologic Surgery Journal.

 

All of the improvements in our field over the past two decades have allowed for a younger patient population to benefit from surgical hair restoration. The great determiner in treating young patients, however, is not what we can do, but what we should do with the limited number of follicular units (FUs) containing "permanent" hair that every patient has. This publication serves as a cautionary tail in order to help clarify the limits of the finite supply of "permanent" donor area hair used in treating young patients. Together with hair transplant pioneer Dr. Walter Unger and his daughter, Dr. Robin Unger, Dr. Carlos K. Wesley conducted a survey of the world's most experienced HT surgeons with nearly 1000 years of combined experience in which they were asked the following:

 

"Keeping in mind that over the years the hairs closest to the upper, lower, and anterior borders of the fringe will be lost, how many FUs containing very likely permanent hairs can be harvested from a 30-year-old patient who you believe is destined to develop Type V or VI male pattern baldness (MPB) and has either higher than average, average, or below average donor hair density?"

The survey determined that patients with an average hair density and destined to develop Type V MPB were estimated to yield and average of 6,404 FUs, 4,963 FUs with below-average density, and 7,904 FUs with above-average density. When Type VI MPB is anticipated, estimated mean harvest yields are 5,393 FUs with an average density, 4,204 FUs with below-average density, and 6,661 FUs with above-average density.

 

While not serving as absolute dogma, these findings can serve as useful guideline numbers for patients and physicians alike to help choose appropriate surgical goals.

[Spanker]

It would be interesting to know how the findings were made. Just a few years ago 5K strips were unheard of and FUE was not near the level as it is today.

 

Does that number include fue or just strip?

 

Dr. Mwamba just today presented a case where the pt had a 3k graft botch job, then Dr. M put a little over 3k grafts in, ans then he said the patient had up to 6900 grafts left according to his measurements. That puts the pt at having about 13K grafts available, which would have him totally exhausted. Admittedly, that number is best case scenario.

 

I wish we had more detailed as to how the information was derived.

[Dr. Carlos Wesley]

Good points, Spanker. This number represents only the number of 'safe' grafts harvested via strip harvest. Inclusion of FUE grafts from the periphery within the safe donor area would increase these estimates slightly.

 

The survey gathered the opinions of 39 of the most seasoned HT surgeons worldwide. They each provided a range for each of the six scenarios (below average, average, above average density for a future Type V and Type VI MPB 30-year-old patient). From these estimates, we calculated both the average and the standard deviation of the responses. Again, while these figures should not be treated absolute scientific dogma, they certainly establish the best available guidelines for treating this type of patient seeking HT.

 

In the attached figure, you can view the chart within the publication. The absolute best case scenario reported is about 12,000 'permanent' FU for a Type V MPB-destined patient at age 30. Not knowing any details behind the case you described, I can think of a couple of possibilities:

 

 

• The botched 3000k-graft session didn't really consist of 3000 naturally-occurring FU, but rather a number of "cut down" FU to artificially increase the number of grafts reported.
  
• The patient was destined to have less severe hair loss than a Type V MBP
  
• If everything was performed with FUE harvesting, the patient may very well have had a number of FU harvested and subsequently transplanted that were not permanent follicles. These will last only temporarily and the resultant punctate scarring from where these follicles were harvested will become exposed over time.
  

 

The final bullet point is the impetus for establishing these very important surgical planning guidelines.

[Spanker]

Good points, Spanker. This number represents only the number of 'safe' grafts harvested via strip harvest. Inclusion of FUE grafts from the periphery within the safe donor area would increase these estimates slightly.

 

The survey gathered the opinions of 39 of the most seasoned HT surgeons worldwide. They each provided a range for each of the six scenarios (below average, average, above average density for a future Type V and Type VI MPB 30-year-old patient). From these estimates, we calculated both the average and the standard deviation of the responses. Again, while these figures should not be treated absolute scientific dogma, they certainly establish the best available guidelines for treating this type of patient seeking HT.

 

In the attached figure, you can view the chart within the publication. The absolute best case scenario reported is about 12,000 'permanent' FU for a Type V MPB-destined patient at age 30. Not knowing any details behind the case you described, I can think of a couple of possibilities:

 

 

• The botched 3000k-graft session didn't really consist of 3000 naturally-occurring FU, but rather a number of "cut down" FU to artificially increase the number of grafts reported.

• The patient was destined to have less severe hair loss than a Type V MBP

• If everything was performed with FUE harvesting, the patient may very well have had a number of FU harvested and subsequently transplanted that were not permanent follicles. These will last only temporarily and the resultant punctate scarring from where these follicles were harvested will become exposed over time.

 

The final bullet point is the impetus for establishing these very important surgical planning guidelines.

 

Great research doctor. It is great to see that. That is very interesting and gives people a good idea of what they can expect. I would guess that the average person could eek out another 1k grafts through FUE conservatively.

 

Then you have people like me who have average density, but above average elasticity, so I don't really know what my final available count is. Hope I don't need to find out.

[Dr. Carlos Wesley]

At long last, this article just came out in print in the May 2013 edition of the peer-reviewed journal Dermatologic Surgery.

 

I think another 1000 grafts via FUE is a reasonable estimate, Spanker. In addition, if you begin to include grafts harvested from the beard via FUE, you can increase that number considerably...