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More Hair Isn't Always Better

More hair isn’t always better

If you decide to have hair transplant surgery, you should consult with your surgeon about the number of grafts that will need to be harvested for the surgery. The surgeon wants to harvest only the necessary number of hairs so that they don't thin out the donor area, especially with a single surgery. They also need to take into consideration the thickness of the hair, the patient's age, and whether they’ve had surgery before.

Below, we will discuss information that will help you better understand how your surgeon has decided on a certain number of grafts. 

Is a graft the same as a hair?

You might be told the number of hairs that will be transplanted instead of the number of grafts. A graft is usually not equivalent to a single hair. On average, a graft has about two hairs. This means that, if you plan to get a 1000 graft hair transplant, you will actually be getting around 2000 hairs. 

Should I get as many grafts harvested as possible?

More grafts does not always equate to better results. This is a common misconception. Harvesting and implanting too many grafts can lead to issues for the donor (overharvesting, shock loss, poor scarring, etc) and the recipient area (necrosis, unnatural results, shock loss, etc). 

Too many grafts at the recipient area

If too many grafts are implanted into a small area, blood supply may be limited. As a result, those new grafts may not grow. Implanting too many grafts can traumatize the pre-existing hairs in the vicinity. Also, creating too many recipient sites, very close together, can reduce the vascularity to the skin in that area, causing potential skin death and poor graft survival. 

Too many grafts harvested from the donor area

Extracting too many grafts excessively thins out the donor area and gives it the appearance of balding. Excessive graft extraction can also lead to poor scarring and affect hair growth in the donor area after it is healed. Also, if a mega session is performed, with 3500+ FUE grafts harvested in a single session, this will limit future sessions if necessary.

Do the surgeon’s skills affect the number of harvested grafts?

Ideally, the number of grafts that need to be implanted will match the number of grafts that are extracted, particularly with FUE harvesting. For example, if a patient needs 1500 grafts, the surgical team should aim to make as close to 1500 punches as possible, to reduce donor site scarring. 

The problem is that an inexperienced surgical team might need to punch significantly more holes to harvest the same number of grafts safely. This can drastically worsen the appearance of the donor area, and limit the potential of future procedures if needed. 

Which factors determine the recommended number of grafts?

The overall goal is to use the least number of grafts possible to create a pleasing aesthetic result.

The number of grafts partially depends on the state of the donor area. If someone is younger, or has a larger recipient area, they might need another hair transplant later on in life. For this to be possible, the surgeon must keep damage to the donor area minimal, while still sufficiently addressing the recipient area.

Should I ask my surgeon to extract fewer grafts?

There is such a thing as too many grafts, but poor results can also come from not using enough grafts. You should ask your surgeon to clarify why they have decided on the specific number of grafts. The decision is nuanced and is case-dependent.

During your pre-surgery consultation, be specific and ask for clarifications when they are needed. You can always seek a second opinion to get a different set of eyes on your particular situation. 

Do results only depend on the graft number?

To conclude, it is important to ask your surgeon about the number of grafts that will be transplanted and why that number was chosen. There is a safe and effective number of grafts which will be different for each area and each person. Results depend on many factors, including the patient’s hair loss pattern, the thickness of the hairs, and whether medical therapy is involved. 
Results also depend on the surgeon’s skills and the techniques that they are using. Some specialists can deliver great results with fewer grafts that are used more effectively. Others might place too many grafts into a smaller area, causing some of the problems we mentioned above. Try not to focus solely on the number of grafts transplanted.

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.

Written by Aleksandra Božović | Edited by Dr. Gary Linkov
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