How many grafts?

[Chris bam]

Heading over to Turkey soon, how many grafts will be enough for good coverage throughout after first HT? I use minoxidil but I know i will eventually lose most of my native hairs and need a second transplant. 

[kirkland]

If you are looking to add density 'throughout', I would say 4000 grafts. You have a NW7 pattern with much thinning throughout the crown area. That would suck up a lot of grafts. I would focus on re-building the hairline and adding density through the mid-scalp. That would require less grafts. Also, if you went on fin or dut, you could save your crown or grow some back.

[Portugal25]

@Chris bam most doctors will tell you to get on finasteride to regain density in the crown. 
You need to rebuild the hairline which is something that not every doctor can make look natural and then cover your midscalp and crown. 
I would say you will need at least 4000 grafts and your native hairs might suffer from shock loss due to transplanted hairs being implanted in the same area so a good surgeon will be crucial for you to achieve a good result. 

I strongly urge you to chose a Doctor that performs the whole surgery and has several patients posting great natural hairlines achieved by said Doctor.

[Chris bam]

Thanks for the feedback guys, right now fin is not an option as the wife and I will be trying for a baby soon. 

I hope around 4000 is enough for hairline up to midscalp. It all seems overwhelming and to be honest i can’t picture myself with a good head of hair again for some reason.  But I’m booked for Turkey in 3 weeks so I’m hoping for the best. 

[Raphael84]

@Chris bam Be careful in Turkey!

You have a very delicate case. I wish you all the best. Did you consult with any other clinics?

How old are you?

You have an NW 6 - 7 pattern with retrograde alopecia. As stated, you may lose some of your current native hair due to shock loss. You have a limited donor safe zone.

What are your long term expectations?

Please do not lower your hairline. I dont know your clinic, but Turkish clinics have are known for telling you whatever you want to hear, and offering a low and straight hairline. 

With a mature hairline, 4000 grafts should touch your mid scalp, somewhere around above the centre of your ears. You will lose your remaining native hair on top, and you explain that you will need a second transplant. But if you have 4000 grafts in your first procedure, depending on your density, you may already be maxed out and be very restricted in regards to further scalp grafts. Please be careful! Do your due diligence!

[ITA]

@Chris bam Can we know in which clinic in Turkey you will perform your procedure?  There are clinics and pseudo-clinics there, pay close attention to where you decided to go.

[Portugal25]

3 hours ago, Egy said:

@Chris bam Can we know in which clinic in Turkey you will perform your procedure?  There are clinics and pseudo-clinics there, pay close attention to where you decided to go.

@Chris bam is currently booked with Dr. Cinik and has paid him a 500€ deposit.

@Egy you had a HT with Cinik what would you advise to Chris Bam?

[ITA]

1 hour ago, Portugal25 said:

@Egy you had a HT with Cinik what would you advise to Chris Bam?

@Chris bam If you read my report, there is my story.  He must be aware that Cinik's clinic is a low-cost clinic, perhaps one of the best, but if I had the financial opportunity I would have chosen a high-level surgeon, I would have gone to Pekiner, Demirsoy or HLC.  By going to Cinik, I was aware of the risks, for example, you must know that they do not use the microscope, so you risk finding yourself on the front line and being operated on by nurses or even by young trainees, in my case, For my procedure I had a team  of experts (guaranteed by the same doctor).  I saw surprising results of transplants performed in the Cinik clinic, the same consultant of Dr. Cinik (who was with me on the day of my procedure) had two procedures and they were fantastic, but I also saw some bad ones, I understood however that in the transplant,  the "luck" and predisposition factors of the patient are fundamental for the success of the transplant.  The important thing is, however, not to rely on Turkish clinics that make you believe that you are, but they are not, like the “Estetistanbul”  of Hamid Aydin and Ziya Yavuz (now alone in business, I do not know what he called the  his company, not a clinic) and there are hundreds of them in Turkey. Until now, everything is going according to my expectations, at the end of the course, I reserve the right to recommend it or not.

Edited February 23, 2020 by Egy

[ITA]

58 minutes ago, Portugal25 said:

@Chris bam is currently booked with Dr. Cinik and has paid him a 500€ deposit

This is strange.  No booking deposit has been requested from me.

[Chris bam]

I really appreciate the feedback from you guys. I do not plan on lowering my hairline, I’m hoping that with 2 transplants and the use of beard/body hair i would be able to get close to 8000’grafts which I assume is what I’ll need for decent coverage throughout?

[Chris bam]

Do you recommend I ask them to only place grafts on hairline and up to midscalp?

So I wouldn’t touch the crown for the first transplant and continue using fibers to blend it in?

[Portugal25]

@Chris bam if you need beard grafts to add density it’s all the more reason to waive the 500€ you paid and book with either Dr. Pekiner or Esma&Serkan (even with the 500€ these two nurses will be cheaper than Cinik and will give you a better result using DHI to implant beard and scalp grafts)

Edited February 23, 2020 by Portugal25

[ITA]

12 minutes ago, Chris bam said:

Do you recommend I ask them to only place grafts on hairline and up to midscalp?

So I wouldn’t touch the crown for the first transplant and continue using fibers to blend it in?

In reality this is a good strategy for those who have a very large area to cover, take care to make a good front line first because this is the part that is most noticeable when talking with people, that is, the first thing that stands out  , and then, in a second transplant, if you still have follicular units available or take them from your beard or chest, you treat the rest, i.e. mid and vertex.

[Chris bam]

I was told at a dr Rahal consultation that i have about 6000 grafts in my donor area which can safely be used without damaging the area. Also told I’m on my way to Norwood 7 and have diffuse thinning. They don’t use body hair so i wouldn’t get desired results long term. 

i think I have pretty realistic expectations for first hair transplant I want about 4000-4500 using around 1000 beard and chest grafts and get good coverage for hairline and midscalp (around ear). I plan on going for a second a year later for another 3000+ to get coverage on crown. Based on conversations I’ve had with clinics in Canada and Turkey, if i use body hair, I’ll have enough for these 2 HT possibly a third small one years down the line.  

Edited February 23, 2020 by Chris bam

[Raphael84]

Thanks for the clarification @Chris bam

Dr Rahal evaluated 6000 grafts available through FUE? That is significant considering your restricted safe donor zone. Do you remember/know your density that was calculated at your consultation?

6 minutes ago, Chris bam said:

I was told at a dr Rahal consultation that i have about 6000 grafts in my donor area which can safely be used without damaging the area. Also told I’m on my way to Norwood 7 and have diffuse thinning. They don’t use body hair so i wouldn’t get desired results long term. 

i think I have pretty realistic expectations for first hair transplant I want about 4000-4500 using around 1000 beard and chest grafts and get good coverage for hairline and midscalp (around ear). I plan on going for a second a year later for another 3000+ to get coverage on crown. Based on conversations I’ve had with clinics in Canada and Turkey, if i use body hair, I’ll have enough for these 2 HT possibly a third small one years down the line.  

This sounds reasonable in regards to your expectations and understanding that body hair will be necessary to reach such numbers and further surgeries. 

4 hours ago, Egy said:

@Chris bam If you read my report, there is my story.  He must be aware that Cinik's clinic is a low-cost clinic, perhaps one of the best, but if I had the financial opportunity I would have chosen a high-level surgeon, I would have gone to Pekiner, Demirsoy or HLC.  By going to Cinik, I was aware of the risks, for example, you must know that they do not use the microscope, so you risk finding yourself on the front line and being operated on by nurses or even by young trainees, in my case, For my procedure I had a team  of experts (guaranteed by the same doctor).  I saw surprising results of transplants performed in the Cinik clinic, the same consultant of Dr. Cinik (who was with me on the day of my procedure) had two procedures and they were fantastic, but I also saw some bad ones, I understood however that in the transplant,  the "luck" and predisposition factors of the patient are fundamental for the success of the transplant.  The important thing is, however, not to rely on Turkish clinics that make you believe that you are, but they are not, like the “Estetistanbul”  of Hamid Aydin and Ziya Yavuz (now alone in business, I do not know what he called the  his company, not a clinic) and there are hundreds of them in Turkey. Until now, everything is going according to my expectations, at the end of the course, I reserve the right to recommend it or not.

Be careful! There are a few concerning details reported by @Egy. No microscopes? How?

[kirkland]

Those numbers seem about right. You would need to tap body hair to get close to achieving illusion of full density throughout all of the thinning areas.

[Chris bam]

 

Based on the assessment of your donor area being as follows:

14cm x 4 cm =56
10cm x 5cm x 2cm =100 
Total area of donor = 156 cm2

Total donor area 156 x 70 grafts (average of grafts in donor area in your case) = 17,920 grafts

17,920 divided by 1/3 = 5,973 follicles for your lifetime. 

 

i requested the measurements and that’s what they sent me by email. 

Not sure if this is a stupid question but what if you Take more than the safe number of grafts from your donor area and later either cover with smp or fue using body hair? I know it seems like a lot of work/desperation, but I’d rather have hair on the top of my head...

Edited February 23, 2020 by Chris bam

[ITA]

4 hours ago, Raphael84 said:

No microscopes? How?

Most low cost clinics do not use microscopes, do not divide follicular units into single, double or multiple, so you will never know the number of singles, the number of doubles or the number of multiples that have been extracted from your donor area and  grafted into the receiving area, but they will only tell you the total number of grafts and for that you will have to trust what they tell you. 

[Portugal25]

5 hours ago, Chris bam said:

 

Based on the assessment of your donor area being as follows:

14cm x 4 cm =56
10cm x 5cm x 2cm =100 
Total area of donor = 156 cm2

Total donor area 156 x 70 grafts (average of grafts in donor area in your case) = 17,920 grafts

17,920 divided by 1/3 = 5,973 follicles for your lifetime. 

 

i requested the measurements and that’s what they sent me by email. 

Not sure if this is a stupid question but what if you Take more than the safe number of grafts from your donor area and later either cover with smp or fue using body hair? I know it seems like a lot of work/desperation, but I’d rather have hair on the top of my head...

@Chris bam for 156cm2 you will indeed require at least 6000 grafts to get a decent result.
You can probably do 4000 scalp grafts plus 2000 beard grafts in one surgery if go to the best for mega session surgeries using beard grafts and they are; HLC (2.7€/graft), Dr. Pekiner (2.15€/graft) and Dr. Arika at Eugenix (1.8€/graft with tax).

You might reach a decent density in one surgery so you can hold off on the second surgery (thus saving money and 12 months of hair transplant recovery).

Again, it’s a hairline to be rebuilt plus beard grafts for added density meaning that you are a difficult case and not someone I would ever advise going to a Turkish low cost like Cinik.

Remember that you have a limited amount of grafts in your donor area so every graft is precious and you will be wasting them on the technicians at Cinik.

My advice, cancel Cinik, save more money and go to HLC, Pekiner or Arika.

Edited February 23, 2020 by Portugal25

[Pyrat]

On 2/22/2020 at 1:55 PM, Portugal25 said:

@Chris bam I would say you will need at least 4000 grafts and your native hairs might suffer from shock loss due to transplanted hairs being implanted in the same area so a good surgeon will be crucial for you to achieve a good result. 

Isn’t shock loss temporary. He should get back the hair that he loses through shock loss right ??

[Pyrat]

19 hours ago, Egy said:

@Chris bam If you read my report, there is my story.  He must be aware that Cinik's clinic is a low-cost clinic, perhaps one of the best, but if I had the financial opportunity I would have chosen a high-level surgeon, I would have gone to Pekiner, Demirsoy or HLC.  By going to Cinik, I was aware of the risks, for example, you must know that they do not use the microscope, so you risk finding yourself on the front line and being operated on by nurses or even by young trainees, in my case, For my procedure I had a team  of experts (guaranteed by the same doctor).  I saw surprising results of transplants performed in the Cinik clinic, the same consultant of Dr. Cinik (who was with me on the day of my procedure) had two procedures and they were fantastic, but I also saw some bad ones, I understood however that in the transplant,  the "luck" and predisposition factors of the patient are fundamental for the success of the transplant.  The important thing is, however, not to rely on Turkish clinics that make you believe that you are, but they are not, like the “Estetistanbul”  of Hamid Aydin and Ziya Yavuz (now alone in business, I do not know what he called the  his company, not a clinic) and there are hundreds of them in Turkey. Until now, everything is going according to my expectations, at the end of the course, I reserve the right to recommend it or not.

What is “luck” and predisposition factors here. I am asking because I am pretty close to making an appointment and want to understand if “luck” is on my side and verify if I have some of the predisposition factors required for a good transplant.

[Portugal25]

3 hours ago, Pyrat said:

Isn’t shock loss temporary. He should get back the hair that he loses through shock loss right ??

There is a shedding phase after 3 weeks and during the first 3-4 months the grafts will be in a resting phase (ugly duckling phase).

Shock loss to native hairs can happen and the risk increases if a unskilled surgeon is implanting grafts near native hairs. For this and many other reasons, it`s crucial to chose a skilled surgeon with several real patients posting great results.

Edited February 24, 2020 by Portugal25

[ITA]

7 hours ago, Pyrat said:

What is “luck” and predisposition factors here. I am asking because I am pretty close to making an appointment and want to understand if “luck” is on my side and verify if I have some of the predisposition factors required for a good transplant.

@Pyrat Luck, for example, could be the fact of having a donor area full of multiple double, triple or quadruple follicular units, if you are looking for reports from Cinik's patients, there is one in particular (whose name I don't remember  ) which started from a 6/7 norwood situation, so serious, but got a surprising result, because if you go to look at the photos, its grafts are mostly multiple and those offer a great coverage, and they also have a  great caliber of hair.  Not everyone who undergoes a transplant has this luck.  As for the predisposition, I wrote it in some threads, the success of the transplant depends a lot on our vascularization in the reception area, but nobody gives it due importance, and unfortunately it is a genetic thing.  We cannot know if where the hair is transplanted, below, we have more or less blood vessels willing to feed the new grafts.

[Raphael84]

Regarding "luck", I would suggest that we are all out of luck to be in the position we are in, as the unlucky ones to have experienced hair loss. Whilst a good percentage of the population never have to experience the cruel reality of hair loss and the emotional effect that this can have on us. Some accept it easier than others, but the negativity surrounding hair loss is significant.

Of course some guys are better candidates than others with more promising hair characteristics that will contribute toward a better result, and generally with few grafts. As @Egyexplained, a patients follicular grouping a hugely influential factor along with donor density (how many follicles per cm2) on what can safely be extracted from the donor area and therefore what can be achieved in regards to results. A patient with wiry, thick, coarse hair is generally seen as having better characteristics than a patient with thinner, fine and straight hair.

A patients physiology can effect your result. What is a physiology? The way in which a living organism or bodily part functions (thanks for the neat description google). Such things are undoubtedly effected by an individuals health, as is every function within the body. How your genes are expressed. This is a consequence of so many factors. Your weight, diet, sunlight, sleep, stress etc.

The motivation for this post was in reference to luck. Of course some patients can do all of the right things, and choose the best and most appropriate Doctor for their case, and they still do not achieve the result that they realistically expect or deserve. This is unfortunate. I would write unlucky but that sounds far too blasé. There is no guarantee, but this is the minority.

When considering to proceed with surgery, I believe you have to minimise risk and therefore control as much as you can. Once you arrive at the clinic and complete your consultation and have agreed on your hairline design and approach, from that point, everything is out of your control. But if you have chosen the best Doctor for you, through research and due diligence, speaking with previous patients, asking questions, meeting the Doctor, getting a feel for the clinic, learning about their reputation and how they have dealt with potential challenges previously etc. and are confident that you have chosen the very best  Doctor for you, then you have negated a huge percentage of potential risks in your hair restoration surgery. This gives you confidence when you sit in the chair. This is worth every penny. 

The recovery/growth process is long. Whether that be 5 months or 12 months. Nobody wants to wake every day with doubt  in their mind regarding their decision.