Should surgeons report grafts count break downs?

[Nick153452]

I have been looking over results recently from the top surgeons on this site, and I have concluded that it would be in the patients best interest if the surgeons who report results also report the graft breakdown; how many 1, 2, 3, and 4-hair grafts were placed, along with a total hair count. The reason is, everybody have their own unique make up of these grafts. I often see people say such things as, "That is an incredible result for such a modest number of grafts." But what goes unnoticed is that often times, that person has an extraordinary amount of 3-4 hair grafts in their arsenal to add incredible density. Although physician skill is of course a factor in the overall result, this factor is worth noting independently. I do believe that without this number being reported, and expressed during a consultation, that expectations can be unreasonable set, leading to disappointing results.

 

For example, I have seen people who have 3000 implanted grafts who have just as much hair transplanted as someone who has nearly 4,000 grafts. I did some calculating and have seen people with average hair/graft under 2 whereas I've seen some as high as 2.51 (and I'm assuming that it goes higher)

 

This is, of course, more important for strip than FUE as FUE allows a surgeon to select grafts. Nevertheless, its importance should not be ignored.

[Cant decide]

I agree 100% that this is not highlighted enough. They say the average hair to graft ratio is 2.2 but I believe it is more like 2.0 from calculating many patients ratios on this site. So if you have someone who gets 3000 grafts and is a 2.0 guy, that same 3000 on a 2.3 guy would be like getting 3450 grafts.

[harryforreal]

Whoa, Cant Decide - I'm not a math person!!! The last math class I took was as a junior in high school!

 

Ok, so, let me make sure I understand:

 

Can't Decide: On average each implanted FUG (Follicular Unit Graft) has 2.2 hairs supposedly; but you believe the average number of hairs per FUG is closer to 2.0.

 

Nick: You believe that the lower average number of hairs per FUG results in an appearance of lower density and in contrast a higher number of hairs per FUG results in a higher appearance of density - if strategically placed.

 

I agree that surgeons need to post the graft breakdown AS WELL AS a diagram of where those grafts are placed. I love how Shapiro and Shapiro have on their website a diagram showing the dispersion of FUG's based on the number of hairs in each graft. I also love how some surgeons on here break it down even further into "fine hairs," so some say 156 fine 1-hair FUG's, 204 coarse 1-hair FUG'S, 233 fine 2-hair FUG's, 275 coarse 2-hair FUG's, and so on.

 

It's interesting Nick that you believe that FUG's with higher hair count increase the appearance of density. I feel if my surgeon had used only 1's in the front of my hair the appearance would seem more dense because the hairs would be spread out more evenly across my head and lay down more easily thereby covering more of my head,

 

In my case, all the 2-hair FUG's in the front of my hair line and in the front part of my hair I believe results significantly in a less dense appearance than 1-hair FUG's. They are too coarse, stand up rather than lay down, with no fine hairs in between - it looks like a sickly, old forest with thick tree trunks covered on top by growth but nothing in between the trees grows on the forest floor. Probably looks fine if you are a bird flying above looking for a nice target to bomb; but from the front it looks freaky. Micro-plugs essentially, but still very pluggy and not natural looking...

 

I can't brush my hair back and find it absurd that after my hair transplant I'm still doing the "comb over" in order to hide these sickly tree trunks. Also the 2-hair FUG's looks like a bunch of little analog TV antennas sticking out of my head. Makes me think of the Saturday Night Live skit series "The Coneheads"....only I'm envisioning a new series entitled "The Antenna Heads"....

[Spanker]

You also have to keep in mind that different procedures will require different numbers. Meaning if a doctor is working on a NW1 or NW2, he may have to cut grafts, especially if it is a strip procedure. So the pt might have 1500 grafts, and a 80 percent of them are ones and twos.

[Spanker]

Whoa, Cant Decide - I'm not a math person!!! The last math class I took was as a junior in high school!

 

Ok, so, let me make sure I understand:

 

Can't Decide: On average each implanted FUG (Follicular Unit Graft) has 2.2 hairs supposedly; but you believe the average number of hairs per FUG is closer to 2.0.

 

Nick: You believe that the lower average number of hairs per FUG results in an appearance of lower density and in contrast a higher number of hairs per FUG results in a higher appearance of density - if strategically placed.

 

I agree that surgeons need to post the graft breakdown AS WELL AS a diagram of where those grafts are placed. I love how Shapiro and Shapiro have on their website a diagram showing the dispersion of FUG's based on the number of hairs in each graft. I also love how some surgeons on here break it down even further into "fine hairs," so some say 156 fine 1-hair FUG's, 204 coarse 1-hair FUG'S, 233 fine 2-hair FUG's, 275 coarse 2-hair FUG's, and so on.

 

It's interesting Nick that you believe that FUG's with higher hair count increase the appearance of density. I feel if my surgeon had used only 1's in the front of my hair the appearance would seem more dense because the hairs would be spread out more evenly across my head and lay down more easily thereby covering more of my head,

 

In my case, all the 2-hair FUG's in the front of my hair line and in the front part of my hair I believe results significantly in a less dense appearance than 1-hair FUG's. They are too coarse, stand up rather than lay down, with no fine hairs in between - it looks like a sickly, old forest with thick tree trunks covered on top by growth but nothing in between the trees grows on the forest floor. Probably looks fine if you are a bird flying above looking for a nice target to bomb; but from the front it looks freaky. Micro-plugs essentially, but still very pluggy and not natural looking...

 

I can't brush my hair back and find it absurd that after my hair transplant I'm still doing the "comb over" in order to hide these sickly tree trunks. Also the 2-hair FUG's looks like a bunch of little analog TV antennas sticking out of my head. Makes me think of the Saturday Night Live skit series "The Coneheads"....only I'm envisioning a new series entitled "The Antenna Heads"....

 

 

I think 100 1 hair graft would look more dense that 50 2 hair grafts, but I don't think that is what he is trying to say.

[Nick153452]

 

In my case, all the 2-hair FUG's in the front of my hair line and in the front part of my hair I believe results significantly in a less dense appearance than 1-hair FUG's. They are too coarse, stand up rather than lay down, with no fine hairs in between - it looks like a sickly, old forest with thick tree trunks covered on top by growth but nothing in between the trees grows on the forest floor. Probably looks fine if you are a bird flying above looking for a nice target to bomb; but from the front it looks freaky. Micro-plugs essentially, but still very pluggy and not natural looking...

 

It's purely a numbers game. If you can fit 3 pieces of hair into an area slightly larger than you can 1 hair, then you are by definition increasing density. The reason for the decreased density in your own hairline probably has something to do with the surgeon, as it isn't recommended, nor practices to place 2-hair grafts in the hairline; it gives it an unnatural appearance.

 

In other words, if you wanted to fill your head up with 1-hair FUGs, my surgery would have been a 7,018 graft procedure. Additionally, that would have been a lot more work on behalf of the surgeon to stab my head that many times, and even more time for placing the grafts. Plus, I'm not even sure if that would give an added density because, as stated earlier, you can't densely pack as many hairs, IMO. Maybe a doctor could step in and correct me.

 

This can be demonstrated by the SMG photos. In my particular case, 45 grafts/cm were placed in my hairline, these were all single grafts. That will be a desnity of 45hairs/cm2. Behind my hairline 30-40 grafts/cm2 were placed of 2-3. That ends up being at the very least 60 hairs/cm2. Further back towards my crown, they placed the 3-4 ones with a density of 20-25 (at least 60 hairs/cm2).

 

This is why I believe that graft breakdowns are essential, just as essential as photos, in reporting results.

[Nick153452]

You also have to keep in mind that different procedures will require different numbers. Meaning if a doctor is working on a NW1 or NW2, he may have to cut grafts, especially if it is a strip procedure. So the pt might have 1500 grafts, and a 80 percent of them are ones and twos.

 

 

Yeah, of course, instances are circumstantial. However, when people are looking at results in the gallery, they most likely aren't going to be looking at people who don't have similar balding cases to them.

 

Plus, I still believe that it would allow us to more better understand the procedure that it being presented in the results section of the forum if these numbers were present.

[harryforreal]

I think 100 1 hair graft would look more dense that 50 2 hair grafts, but I don't think that is what he is trying to say.

 

Yes, that is what I am saying at least. And I only wanted to thicken up my hairline at the front really - I don't feel the doctor listened to what I wanted or just didn't care - was just interested in making his minimum cost procedure. It's interesting to me by contrast that Dr. Feller and Dr. Lindsey have a "200 FUE" option - I probably would have been fine with something like this, but then maybe Dr. Feller/Dr. Lindsey would have said differently....I had 1000 grafts done - don't know how many hairs that was, or how they were divided or if they were divided at all. Also don't know how they were placed or where. I find it interesting Nick that you know exactly where your 1-hair, 2 hair, 3-hair, and 4-hair FUG's were placed:

 

In my particular case, 45 grafts/cm were placed in my hairline, these were all single grafts. That will be a desnity of 45hairs/cm2. Behind my hairline 30-40 grafts/cm2 were placed of 2-3. That ends up being at the very least 60 hairs/cm2. Further back towards my crown, they placed the 3-4 ones with a density of 20-25 (at least 60 hairs/cm2).

 

How far back from the hairline did your doctor start using 2-3 grafts if I may ask?

 

If you can fit 3 pieces of hair into an area slightly larger than you can 1 hair, then you are by definition increasing density.

 

I don't quite agree - it may be more dense on top where the hairs spread out, but at the bottom of the FUG if all the hairs are coming out of the same follicular unit then there is no density at "ground level" - which is what I see in my hairline. That is also the reason I think so many docs do pictures from above so much - looks more dense from above. But who is looking at people from above like a bird???

 

But I agree with your original point that doctors should break down the FUG's by number of hairs AS WELL AS indicate where those graphs are placed/dispersed across the recipient area on the scalp.

[Nick153452]

I find it interesting Nick that you know exactly where your 1-hair, 2 hair, 3-hair, and 4-hair FUG's were placed:

 

 

 

How far back from the hairline did your doctor start using 2-3 grafts if I may ask?

 

 

 

I don't quite agree - it may be more dense on top where the hairs spread out, but at the bottom of the FUG if all the hairs are coming out of the same follicular unit then there is no density at "ground level" - which is what I see in my hairline. That is also the reason I think so many docs do pictures from above so much - looks more dense from above. But who is looking at people from above like a bird???

 

But I agree with your original point that doctors should break down the FUG's by number of hairs AS WELL AS indicate where those graphs are placed/dispersed across the recipient area on the scalp.

 

 

Shapiro medical group has an INCREDIBLE education section on their website. Since I went with Shapiro Medical for my hair transplant, I am only assuming that they are following their own guidelines. However, it is fairly standard practice. Here is the link, I hope it's not taken down Selective Distributions

 

 

We can argue whether or not mutli-hair grafts are better for desnity all day long, but that's not the point of the thread. The point of the thread was to bring up an issue that I find to be commonplace, and that there is no situation in which we wouldn't benefit from. Knowing more about the grafts can only help us make more informed decisions are our own expectations as far as what we can acheive. For example, if somebody is trying to fill density on the top of their head or in the frontal 1/3 behind hairline, and they have low donor and a low number of multi-graft FUGs, then they will be able to make more informaed decisions as to their plan of action and what they should be able to expect, based on their own graft composition, by looking at other similar cases in the gallery.

[harryforreal]

Hi, Nick - Yes, I have looked at their website, and I think it is great - wish I had looked at it BEFORE I had my surgery, but I was a bit naive about medical practices. I must say that my opinion of medical professionals has dropped to just about whale sh!t on the bottom of the ocean, even though it's not fair to regard all medical professionals in this manner, but it's my initial reaction now.

 

I still am interested in knowing how far back from your hairline your doctor started using 2-3 hair FUG's?

[greatjob]

I completely agree that this should be reported with every clinic posting. It is great for strip procedures so potential patients can compare apples to apples. I have been wondering lately about graft breakdown with fue, because I rarely see it posted, although I must admit I haven't looked too hard, but I would really like to see this posted with fue results as it could display a potential benefit of the procedure.

 

I agree 100% that this is not highlighted enough. They say the average hair to graft ratio is 2.2 but I believe it is more like 2.0 from calculating many patients ratios on this site. So if you have someone who gets 3000 grafts and is a 2.0 guy, that same 3000 on a 2.3 guy would be like getting 3450 grafts.

 

I have been doing a lot of statistical analysis lately with my work, population and quantitative genetics which I can't stand btw, but this post almost made me want to compile data from this site and clinics to develop confidence intervals for the average hairs per graft and numerous other stats. I say almost because I hate stats, am too busy, and even if I wasn't I'm too lazy . But it would be interesting to compile all the data from the top clinics and accurately quantify hair to graft ratio, average donor available, procedure size, ect..

Edited June 29, 2013 by greatjob

[Cant decide]

I completely agree that this should be reported with every clinic posting. It is great for strip procedures so potential patients can compare apples to apples. I have been wondering lately about graft breakdown with fue, because I rarely see it posted, although I must admit I haven't looked too hard, but I would really like to see this posted with fue results as it could display a potential benefit of the procedure.

 

 

 

I have been doing a lot of statistical analysis lately with my work, population and quantitative genetics which I can't stand btw, but this post almost made me want to compile data from this site and clinics to develop confidence intervals for the average hairs per graft and numerous other stats. I say almost because I hate stats, am too busy, and even if I wasn't I'm too lazy . But it would be interesting to compile all the data from the top clinics and accurately quantify hair to graft ratio, average donor available, procedure size, ect..

 

My Fellow Science/Math Nerd

 

I thought about doing something like this myself. I can tell you that after my surgery, I must have calculated at least 50 other patents hair/graft ratios on here and the average seemed to be 2.0. The highest I calculated was about 2.51 and the lowest about 1.64 if memory serves. Most fell between 1.90-2.10.

[RCKHair]

I had 2650 grafts for 3800 hairs, an average of 1.4

[greatjob]

mine was 2.08 hairs/graft on my last procedure

[Cant decide]

Mine was 2.29

[Cant decide]

It is said that those with medium or fine hair tend to have more 2,, 3 and 4 hair grafts while those with coarse hair have less. Their coarseness makes up for the lower hair count. I think I would rather be a guy with coarse hair at 1.95 then medium to fine hair at say 2.10. Interesting what that cutoff would actually be...

[Nick153452]

I would say about 1 cm - 1.5 cm behind the hairline? I'm just randomly throwing out numbers, but it sounds like a good number to me

[Nick153452]

I have been doing a lot of statistical analysis lately with my work, population and quantitative genetics which I can't stand btw, but this post almost made me want to compile data from this site and clinics to develop confidence intervals for the average hairs per graft and numerous other stats. I say almost because I hate stats, am too busy, and even if I wasn't I'm too lazy . But it would be interesting to compile all the data from the top clinics and accurately quantify hair to graft ratio, average donor available, procedure size, ect..

 

 

:eek: I had the same thought!! But then I realized that I'm too lazy to do that! :cool:

[evil]

I don't know how you calculate your ratios but here's my graft/hair breakdown, maybe you guys can calculate it for me.

 

1s-254

2s-1043

3s-1611

4s-128

 

Thanx guys!

 

 

 

 

[Cant decide]

2.49 wow.....One of the best I have seen. Is your hair fine?

 

Good for you!!

[evil]

2.49 wow.....One of the best I have seen. Is your hair fine?

 

Good for you!!

 

Wow that was a fast response!, thank you ..

 

I would classify my hair as medium, but definitely not fine at all, the other stat that my doc gave me was that I have 88 grafts per sq centimeter, does that make sense? BTW Thanx for bringing this subject up.

[Cant decide]

88 per sq cm is about average donor density but again, 2.49 is a way above average ratio. This is great especially for crown work which I know you just had done.

[JohnnyDrama]

Hey CD, I reckon average donor density is closer to 78 than 88. Would be interested to hear different doctors opinions.

[Cant decide]

I have heard average is 70-90 for a Caucasian male.

[JohnnyDrama]

Ah then you were speaking in terms of range, I was being a bit more precise! In that case we may both technically be correct, but I'd wager that 78 wouldn't be far off if were to pull a figure out of the sky for it.

 

Something that I also found odd was the difference in readings from one clinic to the next for a particular individual.