Advice on number of grafts

[Jaz159]

Hi everyone. This is my first post so forgive me if I waffle on a bit. First of all just wanted to say that this has been a great help to me in learning about different surgeons and options when it comes to hair restoration.

 

I am 27 years old and have been suffering with hair loss for about 9 years now. I caught it early with finasteride and minoxidil and they have slowed the progress but I think a surgery will really stop me worrying about this daily. I had a small surgery (probably premature) in 2011 with Dr Raghu Reddy at the private clinic in London. It was for approx 900 grafts in the frontal corners. This has given me a solid base to use hair fibres on and this is how I've been masking the hair loss for a while now.

 

So I have been looking for a surgeon for around 6 months now. I am aware of some recommended ones who are in my price range. However my issue is knowing if they are quoting me for an appropriate number of grafts. I have had the following quotes

 

Dr Koray Erdogan (online quote) - 5000 grafts

Dr Nader Ebrahmimi ( face to face) - 5000 grafts

Dr Tejinder Bhatti ( online quote) - 3000 grafts

 

I am trying to strengthen my hairline and mid scalp. I would like to have good density in the frontal portion of my head. I am also looking for a touch up in the crown by as I don't see it in the mirror I don't mind so much.

 

I feel like 5000 grafts is too much but I'd like some opinions if you'd be so kind.

 

Thanks alot guys. I have attached some pictures but please have a look at my album 'Hair 2017' for more. ( I can only upload 4 here)

[mattj]

5000 seems like a lot, but as you're quite thin throughout the top of your head, that number isn't excessive. I would expect a very solid result with that number.

 

Is this going to be FUT or FUE?

[Jaz159]

Mattj thanks for the reply.

 

Yea my hair loss is quite diffuse. It's fairly stable too due to the finasteride and minox. I think I'd get a good result with that number of grafts but my only issue is if I lose more hair in the future not having enough left in the donor to cover the loss.

 

FUE as I like my hair quite short.

 

I'm in 2 minds. One that I could get it done and enjoy a full head of hair for a while. Two that I get a more conservative transplant but never really be happy with it. What's your opinion?

[mattj]

A more conservative approach might be in your best long-term interests, but I would say that if you're concentrating on the front and midscalp (and aren't desperate to pack grafts into the crown) then that is a very reasonable approach. 5000 grafts for FUE in one sitting is a very high number.

[Jaz159]

Yea the crown is thin but as I don't see it daily it doesn't bother me. I'd rather have a strong hairline and dense midscalp then just use a concealer if the crown does start to bother me.

 

Both doctors who recommended 5000 grafts would do the procedure over 2 days.

 

In that case perhaps 3000 graft FUE in the hairline and midscalp would get me a good result?

[mattj]

I wouldn't want to question the advice of the doctors, especially if one has met you face to face. You could certainly benefit from the full 5000 grafts and 3000 is probably too few if covering the midscalp too.

 

Basically, if you think about this as a procedure working from the front and going back, the higher the number of grafts, the further back you can go, or the greater the density can be.

[Jaz159]

Ok thanks a lot for the advice. Does Dr Rahal do online consultations or would I need to see him face to face?

 

Also I agree that to get a full look I'd need to have 5000 grafts. My only issue is that to get that is sacrifice future surgeries which I may need to rely on.

[Swooping]

4000-5000 grafts in two sittings.2x FUE if your donor has a good density. FUT or FUT + FUE is also a possibility.

[Bill - Seemiller]

Sometimes it's difficult to evaluate the amount of hair loss you are experiencing via pictures however I would agree that 5000 does seem like a lot based on the photos. But perhaps the idea is to replace some of the vellus hairs on their way out with terminal hairs transplanted. After all, many of the hairs on top of your scalp or likely in the process of miniaturizing and may be permanently shocked during surgery. Transplanting more hair, your hair will be thicker after surgery even if you end up losing some of the hair already on its way out.

 

For instance, it's evident that you are feeling pretty rapidly in your crown and the frontal area but I'm venturing to say that there is a lot of miniaturization in and around existing terminal hair that is making it appear thicker but after surgery, you will likely lose a lot of that because it would have been gone within a year anyway.

 

That said, you don't typically want to purposely illuminate any hair that you have on your head so you might want to ask why such a high number of grafts was quoted.

 

Best wishes,

 

William

[JayLDD]

3000 is a small amount of grafts for a NW5-NW6 pattern like yourself if your goal is good density in the hairline and a touch up on the crown area.

 

http://www.hairrestorationnetwork.com/eve/185300-dr-hasson-3965-grafts-fut-8.html

 

This for example is a very common procedure I am seeing lately with norwood 3s. 3000-4000 grafts in the hairline frontal band from doctors that the majority here would consider ethical, and even this is not PERFECT and could benefit from a small touch up. Most acceptable dense frontal third procedures require 3000 grafts for full coverage, and many tend to go back for touch ups raising the number up to 4000 regularly. Erdogan and Hasson are regularly doing 5000 graft sessions with fantastic results, and have done so for years. I cannot understand the surprise at the 5000 graft number, it is very, very common particularly for those in similar situations to yourself.

 

In your case you are probably more suited to FUT if you want to absolutely maximise your donor, but without a doubt I would opt for Koray if you are set on an FUE megassession. His track record of hundreds and hundreds of 5000 graft procedures and his coverage value system is bordering on flawless.

 

It easy to criticise the high numbers for virtue signalling purposes, but I'm yet to see anyone achieve good coverage on norwood 5s like that of H+W or Erdogan 5000 graft megassessions. Their track record also proves long term viability and consistency too with high graft numbers, without sacrificing yield. Good coverage and hairline density in your situation is a pipe dream with 3000 grafts.

 

There is nothing "conservative" about doing 3000 grafts over 5000, your donor capacity is the same whether or not you do a small or a large procedure first. The number one concern should be finding a doctor who has a large array of patient posted results including those that are recent that reflect consistency, results you find aesthetically pleasing, and success with long term donor management.

[mattj]

Ok thanks a lot for the advice. Does Dr Rahal do online consultations or would I need to see him face to face?

 

Also I agree that to get a full look I'd need to have 5000 grafts. My only issue is that to get that is sacrifice future surgeries which I may need to rely on.

 

You can contact me or go through Dr Rahal's website if you wish to have a consultation. Not a problem at all.

[ars34]

You need minimum 4700-5500 grafts for good density

[Jaz159]

Thanks everyone for your replies.

 

JeanLucBergman I agree with your point that most of the hairs on my head are probably miniaturising already. If Dr Erdogan's intention is to overcompensate now for the hairs that will fall out later then a 5000 graft procedure seems reasonable. I would like a thick head of hair and perhaps 3000 grafts just wont cut it.

 

I'm not keen on FUT solely based on the fact that I like to keep my hair at grade 1 on the sides. My intention would be to get SMP in the donor area to mask the removed hairs from a mega session of FUE. Has anyone heard of this being done and being effective?

 

Mattj - I have sent you an email for Dr Rahal's opinion