If you were me.. 2,800 or 3,500 grafts?

[hairz]

Your going to need more than 3500 grafts to create a new hairline and add density to it, ive had 2700 in total and believe me its not megga effective.

 

Now I see what you mean. I will start taking it soon for my crown and middle zones. I think the front of my hair is to fair gone to recover it as it is bald with no hairs at all in the temples and just a little hair in the center.

[gillenator]

Hairz,

 

I got your PM and took a peek at your pics again. I also read your post that has the diagram and your proposed graft allocations.

 

Without seeing your hair shafts in person, it appears that you have average hair caliber, narrow color contrast, and some wave characterisitcs which may be more apparent in your donor zone.

 

Because the grafts will be harvested from the occipital zone if you have FUHT, then some wave will be apparent with the regrowth in the frontal zone especially if there is any length grown to it. This will add to the illusion of coverage and volume as compared to no wave characteristics.

 

IMHO, I really do not think there are many people that need to try and achieve as high as 70 plus FU per cm2. About 5 years ago or so, when dense packing was the buzz in the forums, I received some post-op photos of men who insisted on getting to the 70 FUcm2 level and tried to get as much density as their surgeon could possibly attain.

 

The honest truth is that I began to see the yield factor decrease across the board along with the visual observation that there is not much difference in the "illusuion of coverage" when you get beyond 50 FUcm2. Again these are men with either average or above average hair characterisitcs.

 

In other words, I felt that the patients who went beyond the 50 FU mark did not look better or more restored that the ones at the mid-point ranges. The hair shaft diameter of terminal hair in the donor is far superior than the diffusing hair that was once in the recipient areas. This is why patients with average hair caliber can appear restored even if they attain 50% of original density!

 

The other yield factor can be compromised because whenever the level of trauma is raised because of the hundreds of additional recipient incisions and their closer proximity to each other can have a negative effect on the overall yield. So I am more of the opinion that 50-55 FUs cm2 will produce a higher overall yield than 70 FUs plus with a higher trauma level and corresponding lower yield factor.

 

You can always have another pass for density in the future while preserving your available donor for the future.

[hairz]

Hairz,

 

I got your PM and took a peek at your pics again. I also read your post that has the diagram and your proposed graft allocations.

 

Without seeing your hair shafts in person, it appears that you have average hair caliber, narrow color contrast, and some wave characterisitcs which may be more apparent in your donor zone.

 

Because the grafts will be harvested from the occipital zone if you have FUHT, then some wave will be apparent with the regrowth in the frontal zone especially if there is any length grown to it. This will add to the illusion of coverage and volume as compared to no wave characteristics.

 

IMHO, I really do not think there are many people that need to try and achieve as high as 70 plus FU per cm2. About 5 years ago or so, when dense packing was the buzz in the forums, I received some post-op photos of men who insisted on getting to the 70 FUcm2 level and tried to get as much density as their surgeon could possibly attain.

 

The honest truth is that I began to see the yield factor decrease across the board along with the visual observation that there is not much difference in the "illusuion of coverage" when you get beyond 50 FUcm2. Again these are men with either average or above average hair characterisitcs.

 

In other words, I felt that the patients who went beyond the 50 FU mark did not look better or more restored that the ones at the mid-point ranges. The hair shaft diameter of terminal hair in the donor is far superior than the diffusing hair that was once in the recipient areas. This is why patients with average hair caliber can appear restored even if they attain 50% of original density!

 

The other yield factor can be compromised because whenever the level of trauma is raised because of the hundreds of additional recipient incisions and their closer proximity to each other can have a negative effect on the overall yield. So I am more of the opinion that 50-55 FUs cm2 will produce a higher overall yield than 70 FUs plus with a higher trauma level and corresponding lower yield factor.

 

You can always have another pass for density in the future while preserving your available donor for the future.

 

Thanks for your reply! Dr. Rahal will be putting 65-70 FUs cm2 on the hair line mostly using one hair follicles. Would using one hair follicles at 70 FUs cm2 make a difference in the problems you've stated? Dr. Rahal feels confident in putting 65-70 FUs cm2 without yield loss. Behind the hair line will be as you've stated 50-55 FUs cm2.

[Cant decide]

Gillenator- I respect your opinion quite a bit but I am surprised at the idea that 70 grafts per sq cm does not make a visual difference vs 50. I know what you are saying about yield but assuming all grew, I have to believe that 70 would look a good amount denser than 50. Do you have any pics that may prove the point?

[hairz]

Just so I have an idea of What X graft per sq/cm looks like. Could you please tell me about how much you think this person has. It says 40-50 grafts cm2 and looks like good density to me. The second says 30-35 grafts cm2 which I think should look nice on the crown. Thank you

Edited March 5, 2013 by hairz

[gillenator]

hairz,

 

Thanks for your follow-up question. No, I do not think that 60 -70 FUs cm2 is too many for the "commencement of one's hairline" unless that individual has the upper end degree of coarseness to their hair shafts. This is because as you have pointed out the distinction of using "single hair grafts", is the appropriate graft size for starting/building the new hairline.

 

Nature establishes each individuals' hairline in single hair FUs if we study and observe a natural hairline without the effects of diffusion or miniturization. And yes it would be appropriate to use doubles behind the commencement of the hairline and then building density as the coverage ascends toward the midscalp. Many HT surgeons use this approach to create the most natural aesthectically appealing hairline and frontal zone as possible.

 

The top docs make the most least invasive recipient sites as possible with many using micro-sized blades that match the peripheal size of the ultra-refined prepared grafts. This is boosting yield by minimizing the level of overall trauma within the recipient area.

 

If the patient has a very high grade of caliber (coaerseness), 60-70 may appear unnatural and especially if the color contrast is wide, meaning very dark coarse hair against a fairer complexion. Again this is where nature or our Creator, establishes the single hair with a finer grade of caliber. Because most FUHT procedures take the strip from the occipital zone, that donor hair is typically of a fatter caliber than what nature establishes to commence the hairline.

 

This is also where FUE can allow the surgeon to "cherry pick" finer grade hair in single FUs to start/commence the hairline. It is possible to combine both techniques to achieve the level of naturalness without compromising the yield overall.

 

You are in good hands with Dr. Rahal and he may be bringing the graft count higher because your hair does not appear to be in the upper end scale of caliber. You also have a more narrow color contrast so that the differences in hair shaft diameter is not as readily noticed as those with wide color contrasts. You may want to ask him what instruments he intends to use to create the single hair recipient incisions and I'll bet you anything that he plans to use micro-sized blades to start your hairline.

 

Don't get me wrong, I am not speaking for this doctor nor representing him in any way, and possibly Matt can expound on this but IMHO, this approach is a trade mark of ultra-refined surgical hair restoration of the finest level.

[gillenator]

Gillenator- I respect your opinion quite a bit but I am surprised at the idea that 70 grafts per sq cm does not make a visual difference vs 50. I know what you are saying about yield but assuming all grew, I have to believe that 70 would look a good amount denser than 50. Do you have any pics that may prove the point?

 

Thank you Cant decide. Sure, if all of them grew in the upper limits, that can potentially produce more visual "volume" because of the added hair shafts. The problem again is that overall trauma and transection are the two biggest enemies of corresponding yields. Generally speaking, the further the distance these grafts (recipient incisions) are situated from each other, the higher the overall yield not accounting for transection. Some of the best yileds that I have seen are in the 40-55 FU cm2 range believe it or not.

 

The fundamental problem that nearly no one questions is "tracking or documenting" yields post-op for 12 months at various levels of dense-packing. Very few and I do mean very few surgeons do this post-op. Why? The reason should be obvious.

 

The foremost goal of any surgical restoration must have a sense of "working within the patients' limitations" which include donor supply. This is a large part in supporting an opinion that building density in those defined upper ranges are a waste of donor hair. And again I am speaking of behind the commencement of the hairline and into the frontal third. The most appropriate goal IMHO is to "attain the goal of visual coverage", and nothing more. This approach will leave most HT patients with future donor as an extremely high percent of patients will return for more surgery as their hairloss progresses over the years to come.

 

Sorry cant decide, because I am not "employed" by any doctor/clinic, I do not "own" the pics that patients email me. I still am bound by HIPPA and the patients who send pics to me clearly do not want any part of their photos publicly displayed. Many of them do not participate in the forums by posting but they do surf these communities for information.

 

Yet even the pics that are displayed in these many forums give enough post-op examples of what I am referring to.

 

Best wishes to you my friend...

[gillenator]

Just so I have an idea of What X graft per sq/cm looks like. Could you please tell me about how much you think this person has. It says 40-50 grafts cm2 and looks like good density to me. The second says 30-35 grafts cm2 which I think should look nice on the crown. Thank you

 

Good point hairz, and his ultimate density with the transplants look superior because he had more exisitng hair to start with. And yet he has a wider color contrast too!

 

I think both look really good and yet it appears that both men worked within their own limitations. Why improve what most people would see as a great head of hair? IMHO, both men have achieved the illusion of coverage.

 

Neither one of them has reached full maturation either so there's more to come.

[hairz]

Here are my updated pics. On the crown, I am not sure if it is a combover as my hair is really long in the back. If I comb my hair a different way ( in the crown) it has a part in it which makes it look like loss. I will have to wait until I shave down for a better look at any loss. Thanks again

[hairz]

When I was doing the research two or so years ago, I was told to Max out FUT and then FUE if needed. Is this still the case for me today? I see a lot of bigger FUE procedures than before when I first signed up here.

 

So the question is should I still max out FUT then go for FUE OR FUE all the way?

 

Thanks again guys

 

Ps. Only 4 more days to go!

[HARIRI]

I never like risking grafts at all. I find mega sessions pretty gambling. Get 2800 grafts and wait for the one year yield and then go for another. Follow the Jotronic approach, its the best.

[hairz]

I never like risking grafts at all. I find mega sessions pretty gambling. Get 2800 grafts and wait for the one year yield and then go for another. Follow the Jotronic approach, its the best.

 

 

But would you.. FUT 2800, go back for another FUT and then another.. until there is no more laxity/donor. Then FUE the rest of the scalp to max out full potential of donor?

 

Because if I remember correctly, With FUE only, you'll have less donor than doing the above.

[Eman]

From your pics, I would definitely max out FUT. I don't feel 2800 would be enough to get you where you would be happy.

 

I got as many as safely possible since I wanted a "one and done" procedure. The healing process is long and I wanted to get the most out of the session to keep me out of the chair again for as long as possible if not forever. Your loss looks similar to mine with a little more crown loss...so I would go with the max plan the doc recommends.

 

Finally, I still feel for the larger norwood levels, FUT is the way to go. That is my opinion, unless you have plans on shaving down. But if you where your hair longer, like you seem to do in your pics...the scar will be a non-issue