Conflicting advice about how many grafts I may need

[HLab]

Hi all, I'm a total newbie both here and in the world of hair restoration so sorry if I'm a bit slow to understand some things but please bear with me!

I recently decided to pursue the idea of a hair transplant, I've narrowed my options down to two doctors, both in different countries to me (I live in New Zealand). I'm not going to mention the names of these doctors for now because I don't want to risk bias in any potential replies and I also believe they are both recommended on this site and may read this thread.

I'm very confident that both doctors have excellent reputations but the thing is they've given me conflicting advice as to how many grafts I may need. One says 2000-2500 and the other says 4000. These estimates have been made only by looking at photos I emailed them so I totally understand that I can't get an exact number, but they're miles apart!

Anyway, my question is: If you look at the photos I've attached, would anybody be able to tell me which of the two estimates is more likely to be correct?

Thanks in advance and feel free to ask any questions if I've missed anything.

[hal]

Hmmmm.

2000 seems very low.

I can tell you that you and I have similar balding patterns-- except you have a stronger crown.

Anyway, my transplant was 3,700 grafts and that was to re-build the entire front third.

Based on my own experience and looking at your images, I'd say 4,000 was closer to the mark.

Hal

[HLab]

Based on my own experience and looking at your images, I'd say 4,000 was closer to the mark.

Hal

Useful advice, thanks very much

[JoeTillman]

Hi all, I'm a total newbie both here and in the world of hair restoration so sorry if I'm a bit slow to understand some things but please bear with me!

I recently decided to pursue the idea of a hair transplant, I've narrowed my options down to two doctors, both in different countries to me (I live in New Zealand). I'm not going to mention the names of these doctors for now because I don't want to risk bias in any potential replies and I also believe they are both recommended on this site and may read this thread.

I'm very confident that both doctors have excellent reputations but the thing is they've given me conflicting advice as to how many grafts I may need. One says 2000-2500 and the other says 4000. These estimates have been made only by looking at photos I emailed them so I totally understand that I can't get an exact number, but they're miles apart!

Anyway, my question is: If you look at the photos I've attached, would anybody be able to tell me which of the two estimates is more likely to be correct?

Thanks in advance and feel free to ask any questions if I've missed anything.[ATTACH=CONFIG]48878[/ATTACH][ATTACH=CONFIG]48879[/ATTACH][ATTACH=CONFIG]48880[/ATTACH][ATTACH=CONFIG]48881[/ATTACH][ATTACH=CONFIG]48882[/ATTACH]

When I was a consultant working for one clinic I would see photos like yours and salivate. If you are considering FUSS you are an IDEAL candidate. Why? Because I can see that your donor density is high, maybe even above average, and you have a low contrast between your hair color and your scalp color. Low contrast means stronger illusion of density.

So the question becomes, are you looking at FUE or FUSS? Both are great procedures but you have to understand the limitations of both and that is something that is not going to fit into one post. You need to do a lot of research so that you have fewer surprises once you have the procedure.

My preference, coming from a background of mega-sessions, is that when you get into the realm of 4000 or more grafts you're taking an unnecessary risk. This is because this is going to be 50% of your total donor reserves (depending on procedure) and if it doesn't work out then you will turn into one of those guys that we see every day looking for repair work.

I think going for around 3000 would be the safer option. You have less tension on the donor wound if you opt for FUSS and you aren't depleting your donor density if you opt for FUE. If you do decide on FUE then make sure the clinic you are considering takes from the widest extraction pattern possible in order to minimize the cosmetic impact from the 1/1/1 ratio of donor extraction. This ratio means that for every one follicular unit that is removed there is an equal reduction in density and an equal increase in scarring.

I could go on, as there is so much to understand, but you've started out right by using IAHRS doctors. It's a good starting point.

I'll leave you with this video to watch and consider...

[HLab]

The docs maybe great but its not always them seeing the photos and this may be why. I think in person consults would be the next step.

Thanks for your comment and I completely agree, although it's a long flight to the doctor so I really need to do as much research as possible before I have a consultation in person.

Would you have any idea from the photos how many grafts I may need?

[HLab]

So the question becomes, are you looking at FUE or FUSS? Both are great procedures but you have to understand the limitations of both and that is something that is not going to fit into one post. You need to do a lot of research so that you have fewer surprises once you have the procedure...

I think going for around 3000 would be the safer option...

Thanks for the advice, 3000 is another number into the mix!

With regard to FUT v FUE, I'm leaning toward FUT but am a bit worried that the scar will restrict me from keeping my hair short (which I prefer), but that's a decision I'll come around to eventually. I see that FUE scars can also be visible through very short hair anyway.

It's interesting that the graft numbers change with every person that sees the photos, it's clearly not an exact science but I'm getting multiple opinions which is great.

[JoeTillman]

Well, I should clarify my observations. Physically, your characteristics tell me that you could probably get 5500 grafts in one strip. The density looks that good and I can actually see that your donor scalp has high laxity. However, my point is that just because you can does not mean you should. 3000 grafts is a safer number because it will make a massive positive change for you without risking the majority of your donor hair. It will also reduce the chance of a wider donor scar.

Regardless, I should back up and ask your age and if you are taking preventative medications. Propecia? Rogaine? Both?

[Notgivingup2]

Joe is certainly the man to listen to on this subject, if he says 3000, you can bet that would be a solid number to go by.

[HLab]

Well, I should clarify my observations. Physically, your characteristics tell me that you could probably get 5500 grafts in one strip. The density looks that good and I can actually see that your donor scalp has high laxity. However, my point is that just because you can does not mean you should. 3000 grafts is a safer number because it will make a massive positive change for you without risking the majority of your donor hair. It will also reduce the chance of a wider donor scar.

Regardless, I should back up and ask your age and if you are taking preventative medications. Propecia? Rogaine? Both?

Ok that's worth considering, thanks.

I'm 35 and haven't ever taken any medication for hairloss.

[HLab]

Joe is certainly the man to listen to on this subject, if he says 3000, you can bet that would be a solid number to go by.

Noted, thanks very much

[janessa642]

When I was a consultant working for one clinic I would see photos like yours and salivate. If you are considering FUSS you are an IDEAL candidate. Why? Because I can see that your donor density is high, maybe even above average, and you have a low contrast between your hair color and your scalp color. Low contrast means stronger illusion of density.

So the question becomes, are you looking at FUE or FUSS? Both are great procedures but you have to understand the limitations of both and that is something that is not going to fit into one post. You need to do a lot of research so that you have fewer surprises once you have the procedure.

My preference, coming from a background of mega-sessions, is that when you get into the realm of 4000 or more grafts you're taking an unnecessary risk. This is because this is going to be 50% of your total donor reserves (depending on procedure) and if it doesn't work out then you will turn into one of those guys that we see every day looking for repair work.

I think going for around 3000 would be the safer option. You have less tension on the donor wound if you opt for FUSS and you aren't depleting your donor density if you opt for FUE. If you do decide on FUE then make sure the clinic you are considering takes from the widest extraction pattern possible in order to minimize the cosmetic impact from the 1/1/1 ratio of donor extraction. This ratio means that for every one follicular unit that is removed there is an equal reduction in density and an equal increase in scarring.

I could go on, as there is so much to understand, but you've started out right by using IAHRS doctors. It's a good starting point.

I'll leave you with this video to watch and consider...

nice video.. helpful

[JoeTillman]

Ok that's worth considering, thanks.

I'm 35 and haven't ever taken any medication for hairloss.

In that case, it is good that you're not a 22 year old kid but it's bad that you're not doing anything to prevent your existing loss. So, if you have a surgery, what will you do when, not if, you lose more hair? Are you financially stable enough to have a second or third hair transplant? Are you prepared to deal with the potential of having a bald crown should you not be financially able to afford more surgery? I see the evidence in your crown now, it's starting to miniaturize. It is only a matter of time until the crown is a wasteland of straggling, miniaturized hairs gasping for breath in the desert of your scalp. I know, dramatic, yes but necessary to get my point across.

Talk to your doctor about Propecia or Proscar and try that for a year. While you're trying it continue your research.

[HLab]

In that case, it is good that you're not a 22 year old kid but it's bad that you're not doing anything to prevent your existing loss. So, if you have a surgery, what will you do when, not if, you lose more hair? Are you financially stable enough to have a second or third hair transplant? Are you prepared to deal with the potential of having a bald crown should you not be financially able to afford more surgery? I see the evidence in your crown now, it's starting to miniaturize. It is only a matter of time until the crown is a wasteland of straggling, miniaturized hairs gasping for breath in the desert of your scalp. I know, dramatic, yes but necessary to get my point across.

Talk to your doctor about Propecia or Proscar and try that for a year. While you're trying it continue your research.

I have considered Finasteride and Minoxidil but I'm concerned about side effects and I also have extremely sensitive skin (eczema) which reacts badly to most chemicals. I don't even shower with soap, just hot water because of that. I guess I could speak to the doctor and see but I have my reservations.

I do have enough money for more procedures, although I don't want to be going under the knife every year. I'll speak to my doctor.

[JoeTillman]

I have considered Finasteride and Minoxidil but I'm concerned about side effects and I also have extremely sensitive skin (eczema) which reacts badly to most chemicals. I don't even shower with soap, just hot water because of that. I guess I could speak to the doctor and see but I have my reservations.

I do have enough money for more procedures, although I don't want to be going under the knife every year. I'll speak to my doctor.

You should at least consider every option and make decisions based on facts, not rumor and hearsay. I say this because even if you have enough money you can't assume the best for every contingency. If you don't take medication, you will lose more hair. Period. With that out of the way you might also lose your money and not be able to afford more surgery. You may also have a result that is unnatural or does not grow so that money would be needed to get repair surgery instead of additional coverage and then your rainy day funds for more work starts to dry up, as well does your donor hair. My point is, ultimately, this is an unpredictable situation you are in and too many times people assume the best and do not think about the worst. I think one should hope for the best but prepare for the worst and nothing could be more true than for surgical hair restoration.

[HLab]

You should at least consider every option and make decisions based on facts, not rumor and hearsay. I say this because even if you have enough money you can't assume the best for every contingency. If you don't take medication, you will lose more hair. Period. With that out of the way you might also lose your money and not be able to afford more surgery. You may also have a result that is unnatural or does not grow so that money would be needed to get repair surgery instead of additional coverage and then your rainy day funds for more work starts to dry up, as well does your donor hair. My point is, ultimately, this is an unpredictable situation you are in and too many times people assume the best and do not think about the worst. I think one should hope for the best but prepare for the worst and nothing could be more true than for surgical hair restoration.

Completely understand your points there. I'll speak to my doc but it's unlikely I'd go for anything topical and I really can't be bothered dealing with erectile dysfunction, etc (if it turns out that I'm one of the unfortunate few that reacts that way to propecia). It's all a bit too well documented for me to dismiss as rumours and hearsay but I do appreciate it doesn't affect most people that way. The fact is that for me, regaining my hair is very much a secondary issue compared to my actual health and well being and the idea of messing with my DHT levels worries me when I look at the potential problems it could cause.

Taking some excellent tips from your posts, thanks for the help. Feel free to keep it coming if you feel there's anything else I should be looking at, I'm open to all suggestions