How Many Can You Have Over A Liftime?

[Melvin- Admin]

This question comes up time and time again. It's almost as prevalent as FUTvsFUE, and the argument sort of goes hand in hand. What do you guys think? I would love to hear the communities thoughts.

How Many Hair Transplants Can You Have Over A Lifetime

[RecedingTide]

Thanks for starting this topic. However I think your assumptions and calculations are a little off. It is very much case by case but the donor area of a norwood 6 is usually roughly similar to the area of bald scalp.

A norwood 6 donor could be 8cm x 32cm or 256cm2. Untouched average density of approx. 85FU/cm2 in donor. This gives a 21760FU. 50% would equal 10880 grafts. I think that's probably a little much but taking 40% would be 8704.

I have a large head and I have a norwood 6 pattern. I have had 6572 FU transplanted by FUE. I have at least 2500 more that can be transplanted and I can cut my hair to a bare blade and I can hardly make out the extractions. I have been very fortunate however. Numbers wise, I have probably only depleted my donor by a third. Skill of the team and good healing physiology are important of course.

In short I think you're under selling FUE slightly. I understand that some people will make the argument that the best hair from 5-7cm from the napeline and FUT can get it all. This of course is a consideration for weaker donors.

[Melvin- Admin]

Yes, this is all case by case basis, but I think on average most people don't have 8,500 grafts available via FUE. In fact, I have seen maybe a hand full of guys ever reach those numbers with FUE alone.

[Dr Blake Bloxham]

2 minutes ago, Melvin-Moderator said:

Yes, this is all case by case basis, but I think on average most people don't have 8,500 grafts available via FUE. In fact, I have seen maybe a hand full of guys ever reach those numbers with FUE alone.

Great topic in general, and I completely agree with the above. 

I think we often see exaggerated numbers of lifetime grafts online. Particularly when it comes to doing FUE alone. I am astonished when I see patients in the clinic, evaluate their donor areas, and then hear the number of grafts some clinics tell them they can utilize via FUE only. 

The best way to maximize total number of lifetime grafts is to start with FUT, do FUT until the doctor believes you are "stripped out," and then switch to FUE to utilize the remaining donor area. In doing this, I find patients are typically able to get around 8,000 grafts or so -- though some may go a little more aggressive with the remaining FUE procedure and steal out a little more. This usually breaks down to 3 or so strip procedure of around 1,500 to 3,000 a piece (let's say the first is around 3,000; the next 2,000 or so; and the final maybe around 1,500, for a total of 6,500) and then a conservative pass of FUE at around 1,500 grafts (this is where I like keeping it). This gets you to your 8,000 and this should be "enough" -- though we all know a little more is always better! 

Remember that there are exceptions to every rule; some people have incredible donors and may blow these numbers out of the water; others have below average donors and need to tread very carefully. I think the most I have seen on a patient at our clinic is 10,000 or so over a combination of FUT then switching to FUE in the end. He actually had more than that in the donor but came in needing repair from a prior procedure -- which obviously stole some of his grafts from the get-go. We ended up putting FUE into his scar too when all was said and done. 

[LaserCap]

A lot more goes into this.  How about elasticity?  How about hair quality?  Blond with very fine hair will result in amazing naturalness but a great number of grafts is needed to accomplish the same result with someone with very coarse hair.  Typically this type of patient will have very poor donor.

With the introduction of FUE, and you can correct me if I am wrong, I've noticed that most clinics, (and I say this because seldom do I see a doctor doing the harvesting), will harvest the entire donor area including the nape, above the ears, and way up in the donor.  The problem, in my view, is that if the patient ends up experiencing retrogade or starts thinning down on the donor, all the grafts harvested from these areas can potentially thin down the road.  Eventually this is all a waste of time and money.  Short term? Perhaps a benefit until the loss occurs.  

Another point to consider is that of money.  If the patient can only move forward with min numbers at a time because of monetary considerations, elasticity eventually, will become an issue.

Lastly technique.  Over-harvesting, (too wide a strip - causing unnecessary pressure, or by taking FUE grafts using a very large punch,), can also affect lifetime numbers.

I am certain, if you really put your mind to it and over-think the procedure, you can come up with all kinds of scenarios.  This is why it is important to be judicious with your grafts.  

[Melvin- Admin]

19 hours ago, Dr Blake Bloxham said:

Great topic in general, and I completely agree with the above. 

I think we often see exaggerated numbers of lifetime grafts online. Particularly when it comes to doing FUE alone. I am astonished when I see patients in the clinic, evaluate their donor areas, and then hear the number of grafts some clinics tell them they can utilize via FUE only. 

The best way to maximize total number of lifetime grafts is to start with FUT, do FUT until the doctor believes you are "stripped out," and then switch to FUE to utilize the remaining donor area. In doing this, I find patients are typically able to get around 8,000 grafts or so -- though some may go a little more aggressive with the remaining FUE procedure and steal out a little more. This usually breaks down to 3 or so strip procedure of around 1,500 to 3,000 a piece (let's say the first is around 3,000; the next 2,000 or so; and the final maybe around 1,500, for a total of 6,500) and then a conservative pass of FUE at around 1,500 grafts (this is where I like keeping it). This gets you to your 8,000 and this should be "enough" -- though we all know a little more is always better! 

Remember that there are exceptions to every rule; some people have incredible donors and may blow these numbers out of the water; others have below average donors and need to tread very carefully. I think the most I have seen on a patient at our clinic is 10,000 or so over a combination of FUT then switching to FUE in the end. He actually had more than that in the donor but came in needing repair from a prior procedure -- which obviously stole some of his grafts from the get-go. We ended up putting FUE into his scar too when all was said and done. 

Excellent points and yes there are exceptions. Bill has almost 10’000 grafts via FUT alone. I imagine another 2,000 grafts via FUE. That said, no one should ever think that is the norm because it’s not. 

[Dr Blake Bloxham]

Just now, Melvin-Moderator said:

Excellent points and yes there are exceptions. Bill has almost 10’000 grafts via FUT alone. I imagine another 2,000 grafts via FUE. That said, no one should ever think that is the norm because it’s not. 

Bill got all the way up to 10,000?!? Wow. That's spectacular. Did not realize he was that high. And yes, you are right, he still has a good FUE pass left in him. 

But I agree completely: patients should not assume that they have this type of donor. Most people will be average and should remember that the donor is limited and needs to be utilized as wisely as possible. 

Very good topic. I am sure this will help out a lot of members. 

[Bill - Seemiller]

Great topics. And I happen to agree that most people don’t have 8500 grafts available via FUE. I mean technically they do but if you want to minimize the appearance of scarring, there’s no way you can harvest 8500 follicular unit grafts from the donor area in most patients.  

But regarding how many hair transplants one and having a lifetime, clearly that does vary. For me I’ve already had four strict procedures and 9600 grafts. Ironically, I probably still have some available donor for strip but I think I would opt for FUE at this point now for several reasons.  

But in general, it’s difficult to put a number on how many procedures one can have because there are so many variables. The number of grafts available is easier to put an average on. 

Best wishes,

Bill

[RecedingTide]

I happen to believe that under certain circumstances you can get almost as many from FUE as FUT lifetime. These caveats are that the candidate must not have any retrograde alopecia and must have good physiology in terms of wound healing.

No one seems to mention that 10-15% of your hairs are in the resting or telogen phase at any given time. What happens to these with FUT?

[mephesto]

5 hours ago, Dr Blake Bloxham said:

Bill got all the way up to 10,000?!? Wow. That's spectacular. Did not realize he was that high. And yes, you are right, he still has a good FUE pass left in him. 

But I agree completely: patients should not assume that they have this type of donor. Most people will be average and should remember that the donor is limited and needs to be utilized as wisely as possible. 

Very good topic. I am sure this will help out a lot of members. 

In general, how many more hairs can FUT + FUE yield versus just FUE?

[Melvin- Admin]

19 hours ago, RecedingTide said:

I happen to believe that under certain circumstances you can get almost as many from FUE as FUT lifetime. These caveats are that the candidate must not have any retrograde alopecia and must have good physiology in terms of wound healing.

No one seems to mention that 10-15% of your hairs are in the resting or telogen phase at any given time. What happens to these with FUT?

This is true, but the fact is you can get more hair combing both.