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So after speaking with an extremely reputable surgeon in the US, i was told a patient with advanced hair loss, (assuming has good donor) has anywhere between 6500-8500 grafts in their donor bank. This is the case if the patient starts with strip, (and does multiple strips) And then finished off with fue. According to this doctor, this will give an advanced pattern full coverage. (With less density in the crown obviously). I’m guessing average donor can yield 6500ish grafts with above average donors reaching the 8500 mark. Does anyone agree or disagree with this philosophy of graft availability & coverage potential?

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I agree that strip and FUE combined will produce more grafts, but will the majority get full coverage? No. There are too many factors to consider, hair thickness, head size, hairline placement, etc. In some cases, full coverage is possible, but no one, and I mean no one that is a Norwood 6/7 should be expecting to achieve full coverage. That is a recipe for disappointment. 

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5 minutes ago, Melvin-Moderator said:

I agree that strip and FUE combined will produce more grafts, but will the majority get full coverage? No. There are too many factors to consider, hair thickness, head size, hairline placement, etc. In some cases, full coverage is possible, but no one, and I mean no one that is a Norwood 6/7 should be expecting to achieve full coverage. That is a recipe for disappointment. 

With a conservative hairline why can’t you expect full coverage? I feel like 65-8500 grafts can cover a lot of area front to back. Maybe not a complete nw 7 but a nw 5/6.

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8 minutes ago, James C said:

With a conservative hairline why can’t you expect full coverage? I feel like 65-8500 grafts can cover a lot of area front to back. Maybe not a complete nw 7 but a nw 5/6.

Look, i'm just being honest with you, I have nothing to gain in telling you the truth. No one should expect full coverage if they are a Norwood 6. Technically can you cover the entire scalp with that many grafts? Yes, but will you be satisfied with the density? No. The balding area of a Norwood 6 is 250-300 cm2 (depending on head size). Now, for adequate density you would need at least 45 grafts per cm2. That's 11,250 grafts for 250 cm2 and 13,500 for 300 cm2. It is impossible to cover the area with adequate density using 6500-8,000 grafts.  

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Melvin is absolutely on the money. Even if you are able to access up to 13,500 grafts, how will the donor region look? What caliber is the hair? The best hair transplant results are the ones that appear unremarkable. By that they look so natural that it appears that nothing was done in the first place. Covering an entire scalp (if possible) does not guarantee in qualifying for an unremarkable result. All the best.

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25 minutes ago, Melvin-Moderator said:

Look, i'm just being honest with you, I have nothing to gain in telling you the truth. No one should expect full coverage if they are a Norwood 6. Technically can you cover the entire scalp with that many grafts? Yes, but will you be satisfied with the density? No. The balding area of a Norwood 6 is 250-300 cm2 (depending on head size). Now, for adequate density you would need at least 45 grafts per cm2. That's 11,250 grafts for 250 cm2 and 13,500 for 300 cm2. It is impossible to cover the area with adequate density using 6500-8,000 grafts.  

I agree with this Melvin, but i don’t think anybody should expect 45 grafts per sq cm throughout the entire head.. Using the same 250sq cm of demand, The math works If you go 40 grafts per sq cm in the front, 30 per cm2 for the mid scalp and 20 in the back. I’m going to include a photo of the math on paper for 200,250,300 sq cm of balding area. 

9F3C4A47-DEE9-4CE0-AA90-B3E084D4B97E.png

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22 minutes ago, Gatsby said:

Melvin is absolutely on the money. Even if you are able to access up to 13,500 grafts, how will the donor region look? What caliber is the hair? The best hair transplant results are the ones that appear unremarkable. By that they look so natural that it appears that nothing was done in the first place. Covering an entire scalp (if possible) does not guarantee in qualifying for an unremarkable result. All the best.

Good point Gatsby, recently I spoke to Dr. Konior, and he said past a certain point, the donor is just as important as the recipient. There is a delicate balance that needs to be adhered too. Overall, if you cannot accept the limitations associated with surgery, you probably shouldn't get surgery. I'm all about education. We don't sell hair transplants here, we share and exchange knowledge. 

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4 minutes ago, James C said:

I agree with this Melvin, but i don’t think anybody should expect 45 grafts per sq cm throughout the entire head.. Using the same 250sq cm of demand, The math works If you go 40 grafts per sq cm in the front, 30 per cm2 for the mid scalp and 20 in the back. I’m going to include a photo of the math on paper for 200,250,300 sq cm of balding area. 

9F3C4A47-DEE9-4CE0-AA90-B3E084D4B97E.png

With 40 grafts per cm2 in the hairline, it will not be dense, and will show weakness in the light, 30 grafts per cm2 in the midscalp will mean that your hair will be see through. If that is something you're willing to live with then okay, you're accepting a limitation. The average crown vertex of a norwood 6 is 100-130 cm2, which means you would need at least 2,000 to 2,600 for the crown alone. Remember the hair in the crown is angled flat against the skin, so by default you will see a lot more scalp, then the front or midscalp. Very FEW individuals have the donor available to get that many grafts in the crown. Start a poll and ask every Norwood 6 patient here how many grafts they have had in their crown, don't take my word for it.

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6 minutes ago, Melvin-Moderator said:

With 40 grafts per cm2 in the hairline, it will not be dense, and will show weakness in the light, 30 grafts per cm2 in the midscalp will mean that your hair will be see through. If that is something you're willing to live with then okay, you're accepting a limitation. The average crown vertex of a norwood 6 is 100-130 cm2, which means you would need at least 2,000 to 2,600 for the crown alone. Remember the hair in the crown is angled flat against the skin, so by default you will see a lot more scalp, then the front or midscalp. Very FEW individuals have the donor available to get that many grafts in the crown. Start a poll and ask every Norwood 6 patient here how many grafts they have had in their crown, don't take my word for it.

Yea these are all acceptions of limitations. But to get max coverage on a 250 sq cm scalp that’s how it must be done unfortunately. The numbers don’t lie. Still better then being slick bald in my opinion. And if that lighting at 40 grafts per sq cm is a big enough problem, you can squeeze in some smp, toppik, dermatch to top it off. Or maybe beard grafts for added density, idk. How many grafts per sq cm do you have in your crown Melvin?

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3 minutes ago, James C said:

Yea these are all acceptions of limitations. But to get max coverage on a 250 sq cm scalp that’s how it must be done unfortunately. The numbers don’t lie. Still better then being slick bald in my opinion. And if that lighting at 40 grafts per sq cm is a big enough problem, you can squeeze in some smp, toppik, dermatch to top it off. Or maybe beard grafts for added density, idk. How many grafts per sq cm do you have in your crown Melvin?

600 grafts give or take. There is absolutely no way I could get another 2,000 grafts, especially with FUE. Before going through with surgery, you need to fully accept the reality, otherwise you will be disappointed, and that disappointment could be avoided.

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I don't think someone who let their hair get to NW7 can ever get full coverage. 

But consider this- when people start losing their hair, they often have a vision of themselves as a NW7 while in reality most balding men end up in the NW4-6 range.  I think the average balding man, with an average donor, should be able to achieve full coverage.  Yeah a NW6 may still need some concealer in the back but still.

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On 9/22/2020 at 12:28 AM, James C said:

I agree with this Melvin, but i don’t think anybody should expect 45 grafts per sq cm throughout the entire head.. Using the same 250sq cm of demand, The math works If you go 40 grafts per sq cm in the front, 30 per cm2 for the mid scalp and 20 in the back. I’m going to include a photo of the math on paper for 200,250,300 sq cm of balding area.

 

OK. There is a difference between full coverage and full density. Can you get full coverage? Sure if you are willing to go with a low density because anyone can get a lower density in order to cover a larger area. Is this the right way to go? That depends. Most people will go with higher grafts density in the front half and low density in the crown. That's usually possible, but again, depending on how much area you have to cover you still may be getting a rather low graft density in the frontal half. This can usually be satisfactory on older men who just want to get some coverage and look good for 60 something years old, but that amount of coverage would rarely be acceptable to someone at 30 years old. It all depends on where you are in life, how much hair you have, and what your goals are.

 

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I was thinking about this and here seemed like a good place to post this.

I think a lot of men don't really understand the amount of grafts needed to fill in an expanding area or how one NW6 can differ from another NW6. I'm not even going to get into the hair shaft thickness or how much donor each one has. Let's assume two people both have the same hair type and donor quality and both are NW 6. Measuring my own head all around the side and back starting at one temple and going around the head to the other temple measures 35 centimeters. Let's assume these two men I mentioned are the same as that. However the first NW 6 has hair one centimeter higher up on the sides and back then the 2nd NW6. If they both go with 40 grafts per square centimeter the 2nd NW6 will need 1400 more grafts to get the same coverage that the first NW6 has because he has that additional 35 centimeters all around his head to cover. In addition to that, 40 grafts per cm2 is not very thick, so the 2nd NW6 will also probably look thinner even though he had 1400 more grafts placed because the first NW6 had maybe 80 grafts per cm2 in that same area, so he has more hair higher up on the sides and back to help with coverage even though the 2nd NW6 had grafts placed there.

Now lets move on a few years later. The first NW6 was able to keep his balding area the same while the 2nd NW6 lost another centimeter all around. This means the first NW6 still looks great while the 2nd NW 6 needs another 1400 grafts just to get 40 grafts per cm2 in the area that the first NW6 still has 80 grafts per cm2. This also means the 2nd NW6 has a much more depleted donor area due to now using 2800 more grafts.

Now remember both of these men were NW6 and had very similar hair loss patterns in pictures, but the number of grafts needed is much different EVEN WITH THE SAME DONOR HAIR QUALITY.

 

Edited by BeHappy
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