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How many grafts? Parsing the numbers game.

When someone considering a hair transplant comes in for a consultation, one of the first questions they often have is, ‘How many hair grafts do I need?’ 

The answer is more complicated and nuanced than you might think. As always, our goal here is to cut through myths and misinformation, so let’s take a look at what goes into assigning that all important hair graft number.

Is my surgeon conjuring the number of grafts I need out of thin air? 

When people ask a surgeon how many grafts they’re going to need, what they’re looking for is a concrete number, but that number depends on a lot of factors. If you’re someone obsessing about the number of grafts you need, I’m here to tell you you’re focussing on the wrong thing


As a hair transplant surgeon, one of the first things I need to figure out when I’m considering a new patient is how many hairs they have for me to work with, and that can depend on several factors. Sometimes a patient comes in with a compromised donor site from previous surgeries. I have to factor in how many grafts I can realistically (and safely) attempt without causing more damage. I also need to determine what the patient’s expectations are and how many grafts are needed to give them the density they want. Two patients with similar areas they want to cover may need drastically different numbers of grafts depending on the thickness and density of the hair they have all over as well as at the recipient and donor sites. There’s a real artistry that goes into these preliminary patient assessments. What can be done and what will look good are sometimes two very different things. Balancing expectations factors in heavily as well – the density a patient wants might be technically achievable but leave them with a substandard result. Getting the balance of expectations and what’s possible right is really something I strive to achieve when I’m consulting with a patient.

More isn’t necessarily better, especially when it comes to hair transplant grafts. 

When it comes to hair transplant grafts, more isn’t always better.

When you’re given a number of grafts by a prospective surgeon, you owe it to yourself to figure out what the number you’ve been given actually means. Is the surgeon talking about grafts or the number of hairs they plan to transplant? Some hair transplant clinics and doctors will give you the number of hairs. This is a bigger deal than you’d think, as there are on average two hairs per graft. That means that a number of 2000 might only translate to 1000 grafts. As the patient, it’s your job to look past that number and make sure you understand what’s being calculated and what it really means. 

We also need to talk about the old adage ‘more is better’. Contrary to what you might think, too many hair grafts can land you in pretty hot water, and there’s a real psychological element at play. Imagine that a clinic promises you 4000 grafts. Every other clinic you consult with recommends only 1500 to 2000 grafts, but the prices of the transplant surgeries are comparable. There’s a real temptation to think that the clinic offering 4000 grafts must be the better deal. More hair graft bang for your buck, right?

A good hair transplant surgeon is conservative, careful, and cautious. 

That’s just not the case when it comes to hair transplants. Getting greedy and being over aggressive can lead to things going wrong, such as:

  • Your new hair won’t take.
  • If a surgeon is too aggressive and too many grafts are transplanted into a small area, it can really compromise the tissue and blood flow. The newly transplanted hairs won’t grow well and, worst case, can be lost. 

  • Existing hair can be compromised.
  • The same goes if the target area still has native hairs. Too many slits to the transplant site can traumatize the existing hair follicles leading those native hairs to fall out sooner, setting you back or making the problem worse. 

  • You can over deplete the donor site.
  • The third risk of going overboard with aggressive grafts is that you can deplete your donor area. Transplanting grafts you don’t need now (and might lose due to the reasons mentioned above) can be costly later on, leaving you unable to have future hair transplants and with a thin (or even bald) look in the back. 

  • The surgeon had better be good.
  • Another big consideration when considering the number of grafts is how experienced the surgeon is. Say for example a surgeon plans on harvesting a modest 1500 FUE grafts for transplantation. They still need to be very good at the procedure, as each harvested graft requires its own excision hole (an absolute minimum of 1500). The risk with going to a less experienced FUE surgeon is that they might need to make 3000 holes to obtain those 1500 grafts, extracting only half the hairs that they attempt. It will leave you with a worse appearance in your donor area and increase the risk of trauma. You also might needlessly deplete your donor reserve. As a rule of thumb, I always aim for the least number of grafts I think I need to make a nice improvement, leaving donor hair in reserve just in case I ever need to go back and harvest more at a later date. 

    And as to the results? A great surgeon who utilizes fewer grafts efficiently can deliver better results than a surgeon who uses more grafts carelessly. Once you have the grafts out, placement in the target area is really important as well.

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    Final thoughts

    Deciding how many grafts a patient needs really is a fine balance between transplanting enough now so the patient will be happy and not seek future surgeries, while still leaving a reserve for future transplants if they need it. Whether it’s the scalp, beard, or eyebrows – safe and effective is the bar I try to meet. 

    When picking a surgeon and discussing the number of grafts, the question shouldn’t be ‘how many?’ but how best to use them. Be careful of places that over promise density – it’s never a wise plan. Focus on what is going to give you the best-looking result possible and leave stressing over the graft numbers to the wayside.

     

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    Written by
    Kristi Charish
    Edited by
    Dr. Gary Linkov
    The content of this newsletter is for entertainment and educational purposes only. This content is not meant to provide any medical advice or treat any medical conditions. Patients must be evaluated by an appropriate healthcare provider on an individual basis and treatment must be tailored to meet that patient’s needs. Results and particular outcomes are not guaranteed.

     

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