2nd Procedure - can someone explain 2s and 3s?

[a]

Hi,

I'm going in for my second procedure in a couple months. The first procedure consisted entirely of 1s. Honestly, I had no idea 2s, 3s and 4s were even a possibility. I've been told that the 1's will be in the front and the 2s, 3s and 4s will only be the back to add density.

 

My question is, do I want 2s, 3s and 4s anywhere on my head? This reminds me way too much of the old 'plug' treatment. If not, can someone show me what these look like?

[hsrp10]

Ones are critical for a natural hairline, but any density at all will require the higher hair count grafts behind the hairline. I would not request a transplant of all 1's for sure! LOL

If you already have hair or a transplanted area then the doctor will have to balance hair count vs blade size for deciding the best placement.

Because I already had hair my doctor said he chose 2's more than 3's for my latest procedure because he said this was the best approach in my case.

 

So the answer is yes and a skilled surgeon will know where to place them.

If you have a thin or bald area anywhere behind the hairline you could specifically ask your doc to place more 3's and 4's if possible.

[a]

Good Point. Can I get any pics for what they look like??

[hsrp10]

google "follicular unit image" and you should get an idea of what they look like

[Paulygon]

this may be a bit off topic.. but (my googling led me to) something called "ultra-refined follicular unit"

 

http://www.hairrestorationnetwork.com/eve/155037-question-answer-what-ultra-refined-follicular-unit-transplantation-fut-how-does-recipient-incision-size-relate.html

[Blake Bloxham]

A,

 

Scalp hair naturally grows in "bundles" of hair follicles called "follicular units." These units either consist of a single follicle, two follicles, three follicles, four follicles, and rarely five follicles. In modern hair transplant surgery, only follicular units are extracted and implanted into balding areas. This is why the term "FUT" actually stands for "Follicular Unit Hair Transplant Surgery." Follicular Unit Hair Transplant Surgery can be performed one of two ways: either via Follicular Unit Strip Surgery (FUSS) or via Follicular Unit Extraction (FUE).

 

When these follicular units are extracted during an FUSS or FUE procedure, they become "follicular unit grafts" (FUG). The FUGs are defined by the size of the follicular unit, i.e. single follicle, double follicle, triple follicle, or quadruple follicle. This is where the term "single graft," "double graft," et cetera, comes from.

 

Each of these grafts must be placed in a specific region of the scalp to create a natural appearance. The first few millimeters of the frontal hairline - also known as the microhairline - must be filled with single unit grafts. If anything larger is used, the feathered transition zone is ruined and the frontal hairline will have a "pluggy appearance." Next comes the macro hairline, which is created by naturally transitioning from single follicular unit grafts to double and triple unit grafts. From this point onward, a series of double, triple, and quadruple grafts may be used to recreate natural density in the posterior frontal scalp, midscalp, and vertex. In these areas, larger follicular units ("3's" and "4's") are often used to cover a larger area of scalp and offer the greatest amount of coverage with the fewest number of grafts - the biggest "bang for your buck," if you will.

 

I hope this helps!

[Dr. William Lindsey]

As usual, Blake is right on the money with his answer. I agree that first 4 or 5 rows has got to be singles, even in very fine haired guys..otherwise it looks pluggy. Although patients may not like fine hair at the front, as it may not appear quite thick enough for them (I can think of more than a few posted cases of mine with fine hairs that someone on the forum commented that the hair line was still pretty thin) I promise you that that is better than a bunch of 2s or heaven forbid 3s at the hairline. We see that once or twice a month in repair cases and it always is noticable, even in finer haired guys. For normal to thicker haired individuals, if you put a thick, occipital donor region, double hair unit at the hairline it is obvious when contrasted to thinner hairs that haven't yet succumbed to MPB or that don't match sideburn region hairs.

 

Now the converse is also true. When we do the crowns, or even a second case working toward the crown, particularly in finer haired guys, who needs singles???? I specifically ask the techs to not give me singles if they can help it. I'd rather have a slightly bigger 3 than a bunch of perfect 2s and a cup of perfect singles which won't accomplish anything back there in the head. The downside is that means we get few grafts (the same amount of hairs, just in 2 or 3 hair units) and thus I can charge less. But its the right way to approach the crown in my opinion. Its better to do the right thing than to worship at the alter of the almighty dollar.

 

Dr. Lindsey McLean VA

[Blake Bloxham]

Dr. Lindsey,

 

Thank you for both the helpful information and the kind words!