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Hair follicles extracted from donor area through FUE or FUT method are also known as grafts or hair grafts. Each grafts when transplanted to recipient area provide 2-4 hairs which means after transplanting for eg. 2000 hair grafts patient will get 6000 to 8000 hairs.
The given below chart represents the Norwood Taxonomy system of hair loss, which provides standard guidelines for the number of follicular unit grafts required in the first hair restoration procedure.
Number of Hair Grafts in FIRST Hair Transplant Session*
|Norwood Class||Follicular Unit Grafts||With Crown**|
* The first session is generally developed as a stand-alone procedure. A second transplant session would be contemplated for an auxiliary density, or if your hair loss makes it headway. Hair graft numbers in the upper section of the range are reviewed when the donor supply is sufficient. For very massive sessions, it is more suitable to trim the existing hair in the transplanted area to very short.
** Coverage for Crown (or partial crown) coverage should be a primary target in the first follicular hair transplant technique only if the case sufferer has an above-average donor supply and if constrained hair loss is foreseen. If crown restoration is set out hastily or untimely, patient’s future alternatives will be more limited and the possibility for a cosmetically balanced hair transplant may be deteriorated.
There are key goals that need to be fulfilled in the first hair implant session. These include:
- Making, or strengthening, the frontal hairline with a view to construct a permanent face frame for an individual.
- Offering coverage to bald areas of the scalp, scanty hair region, hair thinning, with the hair transplant stretching at least to the point of vertex transition.
- Adding adequate volume and density in the first hair restoration session so that the final appearance looks natural and that this method will “stand by itself.”
The complete area of the scalp that needs coverage should be transplanted in the first hair restoration session, so that the cosmetic transplantation can be done as speedily as possible. Physician consultants must not perform the hair transplantation in portions or in capriciously small follicular hair transplant sessions. Extra sessions may be called for in the future, to add on more volume, fullness or to vindicate from future hair. Everything that can rationally be achieved in one hair restoration process should not be spread over various sessions.
Second Hair Transplant Session
Normally it takes somewhere around 10 to 12 months to observe the exact outcome of a follicular unit hair transplantation process. If a surgeon or the patient feels the need for a second hair transplant session, it should be taken into account only after the hair from the first surgical procedure has grown in. Over the period of the first year, the progressive boost-up in the hair’s length/breadth, volume, diameter and texture can notably modify the appearance of the hair transplantation and may persuade the way the patient wants primping their hair. Only once the hair has attained a sufficient styling length can the patient and the surgeon make the best exquisitely functional judgments subjecting to the installation of additional hair grafts.
Another noteworthy logic to hold over second hair transplant procedure is the scalp laxity that will continue to refine and revamp after the first hair restoration for a period of about 9-12 months making donor hair convenient to harvest. Since, most of the hair grows in a time period of 9-12 months. In most cases there is a mutual decision to wait until one year after the first procedure to avoid chances of transplanting hair on top of the first one. The hairs that are growing in are possibly the hairs from the first surgery.
Objectives for the second hair transplant are as follows:
- Increase thickness in the formerly transplanted areas
- Refine and revamp the hairline further
- Rationalize for additional hair loss
- Crown coverage when suitable
Subsequent Follicular Hair Transplant Sessions
The total number of grafts required for full surgical hair transplantation can largely differ because of huge changeability between patients with regards to their head shape/size, hair features, quality attributes, density, scalp laxity, facial cuts and usual aesthetic needs. The following table, hence, caters only as a mainstream guideline for the total number of hair grafts necessary for each Norwood class.
|Norwood Class||Follicular Unit Grafts||With Crown**|
* The chart is displaying total number of follicular unit hair grafts, transplanted over one or more sessions, that is usually required to accomplish a complete hair transplantation process.
Advantages of Large Hair Transplant Sessions
There are numerous surgical benefits of conducting a large, first hair transplant process. In a virgin scalp (one that has never been transplanted before) the resilience of the skin is intact, so that grafts can be located more conveniently and will stay more safely in place. Another distinctive character of a virgin scalp is an intact blood supply. This enables hair grafts to be placed adjacent to each other without having to make compromises for their survival after the surgical hair transplantation procedure.
In the donor area of a virgin scalp, both the scalp laxity and density are at an extremity, so that a proportionately good amount of hair can be harvested and permit the incision to heal with the robust possible scar. In an untouched (virgin scalp), there is no deformity of follicular units, or altered hair direction from preliminary hair restoration, so the follicular units are effortlessly withdrawn with their total complement of hair, giving maximum fullness to the hair transplant.
A fair amount of loss of potential donor hair is sure to be caused by each follicular hair transplant procedure due to spoliation of hair close to the distorted remaining hair follicles, wound edges, reduced scalp laxity and scarring in the donor area. However these elements can be declined in a well-planned hair transplantation that uses the most impeccable cosmetic surgical methods, they cannot be reduced to zero. Therefore, to increase the total production of hair, it is better to lessen the total number of hair implant sessions.
Apart from these technical troubles, there are several social reasons for performing the hair transplantation immediately. Multiple, small hair transplant surgical sessions, spread over a stretched period, keeps the patient completely concentrated on the very problem he wanted to repair. The more readily, the transplantation is completed, the earlier the hair restoration patient can emphasize on other, more valued aspects of their life.
Hair transplantation need not be a cookie cutter approach. In fact, one of the greatest advantages of FUE hair transplantation is just how convenient it is for surgeons to personalize the procedure to accommodate the patient’s particular desires. With FUE, it is literally possible to transfer one hair follicle at a time to thinning or balding areas. Since the FUE hair transplantation procedure is so customizable, often transplant patients will pick down the road to have extra sessions to add more follicles. In the first hair restoration procedure, many a times the complete area of the scalp needs coverage. Add-on sessions may generally be craved for once full results are acquired to add more aesthetics, fullness or to account for future hair loss.
Finally, in all hair restoration, there may be some corresponding shrugging off of hairs (deluge effluvium) in the recipient area. The hair that is at tremendous risk of being shed is the hair that has initiated to miniaturize (an alteration in hair shaft diameter that can ideally be acknowledged with a densitometer). The Miniaturized hair (scaled down) is at the end of its life expectancy, so the moment it sheds, it may not return back. In parts of scalp, where there is a higher degree of miniaturization, the shedding may be cosmetically important. Unless a significant amount of hair is restored in these conditions, there may be limited advantages from hair transplantation surgery.
Limits to Large Hair Transplant Sessions
Although the aim should be to accomplish the hair transplantation surgery as fastidiously as possible, but there is a certain limit to the number of grafts that can be harvest in a single session. It is essential to note that as the number of hair grafts placed per unit area increases, so does the danger of vascular compromise (deteriorated blood flow to the regions caused by damage to the scalp) and this may lead to sub-optimal graft growth. That is the basic reason to generally limit the hair transplantation to no more than 3000 grafts per session. As an outcome of this limitation, some patients may also seek to add additional grafts in future time.
Other problems, like popping, may lead the grafts to dry out and maximize the danger of mechanical anxiety at the time of placing grafts, become more probable as hair graft density is taken to enormous and these factors may also cause less than optimal growth of grafts.
The constant supply of oxygenated blood to the scalp is vital & supports a big chunk of transplanted grafts in one session. Although, exposure to sun damage and smoking are few of the elements that can literally compromise blood flow and these risk elements must be determined well in advance by a hair graft physician so that appropriate measures can be taken to confirm optimal results.
Problems linked with decreased blood flow and graft elevation are more intimately related to the number of hair grafts placed in a particular area (density) rather than the outright numbers of grafts placed. For this reason, the restoration process of a large number of follicular unit grafts over a large area does not invent the similar issues as creating very high densities in one particular area. Because these risk factors are critical to all hair restoration surgeries, it is crucial that the hair transplant surgeon concentrates more on maximizing hair graft sessions and keep patients well informed of their alternatives and after care regime.
However, harvesting mega number of grafts (in “large-sessions”) represents its own hurdles, like extending the time the grafts persist outside the body, needing more surgical workforce, causing lethargy both for staff and patients etc.. As with voluminous-packing, the use of mega hair restoration sessions should be reserved for only the highly experienced surgical teams.
Another significant element impacting blood flow is the size of the hair grafts and, hence, the size of the recipient sites. A bigger recipient site contributes towards more harm to the blood supply in comparison to smaller ones and will enormously limit the number of grafts that can be placed at a point of time. Luckily, a key advantage of hair restoration performed wholly with follicular units is that the large chunk of hair can be placed in the smallest possible recipient sites.
Massive follicular hair restoration procedure also needs huge amount of donor tissue. Since an individual possess 90 to 100 follicular units per square cm of donor tissue, in Follicular Unit Hair Transplant surgeries, the FUT specialist should be able to acquire from 90 to 100 follicular grafts for every square cm of tissue transplanted. Thus, a 2,400 graft surgery will demand an incision that is 1cm broad and marginally more than 24 cm in length. A 4,000 hair graft procedure will need a 1.5 cm wide incision which is more than 27 cm in length. However, 1 cm incision generally heals with a fine hairline scar, while the incisions of 1.5 cm or more critically maximize the risk of a broadened scar. A broad donor scar can literally become a cosmetic issue and can limit the number of hair that can be acquired in future hair restoration surgeries.
A highly experienced, skilled surgical hair restoration staff and suitable patient selection help avoid such issues, but the risk factors will increase if there is an increase in density and amount of grafts. Due to a reason that these factors are ingrained to all hair transplant surgical process, it is crucial that the surgeon concentrates largely on increasing graft growth, rather than merely looking for some expeditiously high target number of grafts. What is finally important for the patient is, not the amount of grafts that were harvested, but how many actually grown.
How large should hair transplant sessions be?
In Follicular Unit Hair Transplantation, the objective must be to obtain the best possible cosmetic result in terms of the patient’s total donor reserves, rather than making efforts to place as many grafts as possible in single hair transplant session. The total number of grafts required for an extra hair transplant session can vary based on the necessity of the patient and their individual hair characteristics
Splitting Up Follicular Units
You are advised to proceed in Follicular Unit Hair Transplantation with caution. In this process, a stereo-microscopic dissection is executed to dissect inherently growing 1-4 hair follicular units from the donor area. In case, these units are kept intact during the dissection, there will be significant growth and a hair restoration patient will reap the maximum possible density, volume and fullness. However, if the microscopic dissection is faulty and few hairs in the follicle are damaged, the ultimate outcome will be less than perfect.
If follicular units are split-up into tiny groups, or into individual hairs, the graft numbers will potentially rise up (and so will the Cost of the hair transplant surgery, if the patient is billed by the graft) without any multiplication in density (and perhaps less fullness because of sub-optimal growth.)
For instance, if a patient undergoes a 2,000 graft hair restoration surgical process where the 4-hair grafts divided into 1- and 2-hair grafts, either by the way of poor dissection or deliberately, the fresh process would then have 2,400 grafts with absolutely the same number of hairs. However, now each graft would comprise of only 1.96 hairs instead of 2.35 hairs. Additionally, 400 more sites would require to be superfluously placed into the patients head to cultivate these grafts. This, in turn, will held responsible for the hair to expand out over a wider area of the scalp, diminishing the prospective fullness in the more crucial parts of the scalp such as the front, and thus elevating the price of the surgical hair transplant procedure.
Splitting Follicular Unit Hair Grafts
|FU Graft Size||Intact FU Grafts||Split FU Grafts|