Determining Graft Volume - Do legitimate Doctors just “eyeball it”? Or is it common practice to measure the coverage area and calculate a grafts requirement?

[Bobby212]

I had a procedure last week with a doctor recommended on this site, and came away thinking I was taken advantage of.

 My question though is, is it common practice for a doctor to take any type of  measurement of the area receiving the grafts to make a determination of how many grafts for the procedure?  Multiplying the area to be filled by a density factor sounds reasonable.

 My experience not only didn’t include any sort of formal way to determine the graft count, but it was the clinic manager (not the doctor) who first said I would need 3,000 grafts (recessed lateral parts of hairline). The doctor went along with that number, and I wasn’t given any reason for the 3k, when I pushed back that I thought it was too high, was told (again by the clinic manager) that anything less would not look right. 
 

So I reluctantly went along with it. Am I way off here thinking there should have been some formal way to determine a graft count?

[sunsurfhair]

I feel like the US docs eyeball it while the elite docs in Europe seem to be much more specific when it comes to graft counts and measuring the scalp at a microscopic level, etc., at least in person. Ferreira comes to mind as a good example. The tech itself seems to be more advanced over seas - not saying this is going to guarantee a better result, but I do like the newer tech they use vs what the elite US docs do and I wish they would utilize it here. That’s been my experience and some people I know who also got procedures in the US. 

Edited March 12, 2023 by sunsurfhair

[HappyMan2021]

Unless you have a limited donor i dont see what the worry is. 

[Melvin- Admin]

Can you share pictures? To be honest, most doctors can see you in person and determine the number of grafts eyeballing it.

[Rafael Manelli]

7 minutes ago, HappyMan2021 said:

Unless you have a limited donor i dont see what the worry is. 

Everyone has a limited donor. 

[Bobby212]

1 hour ago, Melvin- Moderator said:

Can you share pictures? To be honest, most doctors can see you in person and determine the number of grafts eyeballing it.

A secondary concern of mine in the last few days has been to question if 3,000 grafts were actually implanted. I see some results that appear to have a similar density, with larger coverage areas.

I realize this all could just be misguided stress after the procedure, and ideally that’s the case.

Here are some pictures

Before:

 

Immediately following procedure:

 

Day 4:

[bear56]

can't see it on the pics but it looks like you had temple work done also. the density is very good. judging just from the pics you have at least 2500 grafts without temple work.

[Gatsby]

I personally believe that an elite surgeon can eye ball for sure after an in person consultation.

[BackFromTheBrink]

6 hours ago, HappyMan2021 said:

Unless you have a limited donor i dont see what the worry is. 

Doesn't everyone have a limited donor? Given that fact, you would hope an assessment of total capacity would be made to guide the long term plan for each patient over their life.

[Bobby212]

5 hours ago, bear56 said:

can't see it on the pics but it looks like you had temple work done also. the density is very good. judging just from the pics you have at least 2500 grafts without temple work.

Yep good catch, I had a small amount of temple work. My chart from the doctor says there were 220 grafts at the temples (I assume 120 on each side).
 

It’s been near impossible to estimate a graft count in the temples. The implant sites were not real visible at all once I took bandages off after 2 days. I asked them a few days ago to send me the side view post-op photos but they haven’t responded yet. The photo below is 2 days after surgery, both sides look the same.

[asterix0]

In the short term, eyeballing can work if you are a low Norwood.

However, if you assume every patient will eventually be a high Norwood, and every graft should be used as judiciously as possible, eyeballing is not a reliable method to evaluate the donor.

The donor may show different regions that are stronger and weaker, it may be denser in some areas and so if you want to homogenize it as best as possible to allow for the greatest number of grafts to extract, you must precisely plan which areas of the donor have which capacity.

Different parts of the donor are better suited for the front, midscalp, and crown.

It is no coincidence that the best doctors in the world are meticulous about planning out their surgeries, that involves more than a 2 minute glance at a person's head. See @HugoX as an example. 

[Melvin- Admin]

Definitely looks high density and around 3,000 grafts. But you should be able to get a graft break down.

[Al - Moderator]

If someone has been doing hair transplants every day for 20 years and they are good at it then they should be able to have a pretty good idea of what's required just by looking at you. This sort of applies to just about anything really. If you do something long enough you know what is needed to do the job.

 

[stephcurry30]

This work looks like H&W and this looks somewhere in the range between 2.5k and 3k

[John1991]

13 hours ago, Gatsby said:

I personally believe that an elite surgeon can eye ball for sure after an in person consultation.

Within probably 300-500 grafts I agree.

[Hairy Henderson]

Looks like 3k grafts and pretty good work.  Who was it?

[Hairy Henderson]

9 hours ago, stephcurry30 said:

This work looks like H&W and this looks somewhere in the range between 2.5k and 3k

I don’t think it’s Hasson.  His hairlines are more “V” shaped and his temples look more rounded.

I like this design and would like to know who the surgeon was.

[sunsurfhair]

20 hours ago, asterix0 said:

In the short term, eyeballing can work if you are a low Norwood.

However, if you assume every patient will eventually be a high Norwood, and every graft should be used as judiciously as possible, eyeballing is not a reliable method to evaluate the donor.

The donor may show different regions that are stronger and weaker, it may be denser in some areas and so if you want to homogenize it as best as possible to allow for the greatest number of grafts to extract, you must precisely plan which areas of the donor have which capacity.

Different parts of the donor are better suited for the front, midscalp, and crown.

It is no coincidence that the best doctors in the world are meticulous about planning out their surgeries, that involves more than a 2 minute glance at a person's head. See @HugoX as an example. 

I agree with this. This is why I like the utilization of elite skill / knowledge / experience plus the newest tech to help pinpoint and identify further what you’re referencing. 

[Bobby212]

On 3/11/2023 at 10:11 PM, Calihome1 said:

Looks like 3k grafts and pretty good work.  Who was it?

Procedure was done by Dr Camacho