What is the difference between single, double and triple hair FU

[chrisis]

Could someone explain what the difference is between single, double and triple hair FU? Presumably they're grafts that compose single, double and triple hairs?

What determines how many you'll have in a transplant? Is it to do with the nature of the patient's donor hair area? Or is there a cosmetic intention to it?

Thanks

[Jotronic]

Chris,

You assume correctly in that these grafts you ask about have single, double and triple hairs. This is determined by how they grow naturally in your donor zone when dealing with follicular unit transplantation. What determines what you'll get and how many is usually how they grow in your donor zone. You are getting FUE if I recall correctly so this will be between you and your doctor. With strip it is anyone's guess but as a Caucasian male you have an average of 2.3 hairs per FU with about 20 to 25% of your grafts being singles alone. Maybe 50% are usually doubles then triples and even quads can make up the rest. This is a rough estimate but you get the idea.

[mattj]

You presume correctly. A hair follicle will normally contain more than one hair, with the average being somewhere in the region of 2.3 hairs per follicle.

The nature of the patient's donor area will determine the average, and where the difference is perhaps most notable is in the 4 hair units. Some patients have very few of these larger groupings when compared to others.

Basically single hair FUs are essential for the very front of the hairline, where they tend to make the result look softer and more natural. The larger FUs provide density and are used behind the hairline.

FUE makes it possible for the surgeon to be more selective in what size groupings are taken.

[mattj]

I see Joe beat me to it.

One thing worth adding is that a typical hair transplant will provide a total number of hairs well over double the number of grafts that were transplanted, due to that 2.3 hair average.

[gillenator]

While it is true that the majority of naturally occurring FUs are established primarily in one's, two's, and even three's, it is not unusual for individuals to have some four's and larger hair groupings.

One of the benefits of FUE is that these natutrally occuring FUs are extracted "intact" without microscopic dissection that is prevalent with strip. With strip, the FUs are seperated from one another and should be done under microscopic dissection. This is what some doctors/clinics refer to as ultra-refined microscopic dissection. Many proponents of FUE argue that all FUs should be harvested intact without disruption to their natural occurance and by doing so (disruption), can promote transection (damage). This is partly true although not altogethor true. Please allow me to explain further.

Every HT patient has his/her own unique attributes and hair characteristics including donor density. Each case is different and has its own goals and limitations. Let's take someone who still has a strong frontal zone with a good hairlline intact. The patient has lost hair in the crown and desires to fill in that zone. The number of single hair grafts needed is not as critical as the patient who has indeed lost their hairline altogethor. In the case of FUE, the surgeon can then "cherry-pick" the best multiple hair bearing FUs to fill in the crown area.

With FUHT, the strip specimen excised will bear a variety of FUs inclusive of single hair FUs which obviously are not going to be discarded even though they are not as ideal for filling in larger surface areas that are not high visual impact areas like the hairline or frontal zone.

In re-building a hairline, many single hair bearing FUs are needed to create the most natural appearing hairline especially the commencement of that hairline. Again with FUE, the surgeon can potentially "cherry pick" the best single hair grafts to start the hairline, can move to various donor zones including the parietal zone or even nape area to make single individual extractions.

Some doctors are of the opinion that the nape area can produce single hair grafts with a lower degree of hair shaft diameter to best match or duplicate the same hair caliber that a natural hairline produces. This enables the surgeon to not only match the single hair commencement of a natural occuring hairline, but also to add that thinner "softer" caliber aesthetic touch that only thinner caliber hair shafts produce. Every now and then we read about a patient readily recognizing the difference between terminal hair grafts mixed in with their natural hair in the hairline and noting the differences seen with the variables in hair shaft diameter and even color.

Terminal hair harvested from the occipital zone where almost every strip is taken can have a much higher degree of coarseness and many times is being intermingled with exisitng natural hair that is diffusing (losing caliber). Patients with a wider color contrast between hair color and scalp complexion can tend to notice the differences moreso. Clearly, losing caliber is one of the visual effects of hair shaft diffusion. Yet this is where the surgeon can again "cherry pick" hair that has "thinner" caliber that will visually blend better with the existing diffused hair within the recipient zone.

Back to strip. If the patient is in need of re-building the hairline, there may not be enough natural occuring single hair grafts withing the strip specimen. This is where the surgical team (techs) then will need to maipulate the strip by breaking up some of the two's, three's and latger natural occuring FUs into singles. There are many very talented techs who do a marvelous job of carefully dissecting these larger FUs into singles, with minimal transection. But the lower transection rates are only as good as the techs who dissect them. The lesser experienced techs and staff obviously are going to have higher rates of transection than the best techs cutting under a scope.

Some FUE surgeons will argue this point strongly and feel that anytime you disrupt a natural occuring FU, the more trauma that is placed on the individual hair follicles within the grafts. I agree with that point. And as a reminder, FUs and grafts are not necessarily the same thing. Grafts are simply that portion of scalp tissue that carries the hair follicles within them to implant in the recipient site. A three hair natural occurring FU for example can be one graft "if left intact". Or it can be dissected into three seperate single hair bearing grafts. This is sometimes referred to as graft manipulation. And even some less than honest clinics will deliberately break down multiple hair bearing FUs so that they can charge more money since most procedures are priced out by the graft, not by total hair moved in the procedure. Think about that for a minute. It goes on more than we realize!

In addition, those same patients re-building their hairlines with FUE may still need to have some multiple hair bearing FUs that are extracted broken down into single hair bearing grafts if their respective donor zones do not have enough natural occuring singles needed for the hairline re-construction. It is extremely rare that this graft manipulation would be needed with FUE because a very high degree of patients have enough single hair FUs within their own respective donor zones.

Hope this adds some additional insight.

[britissh]

I'm also wondering,
Do people with fine hair generally have higher donor density? I was said I have above average density but my brother's and father's less dense hair seems fuller than mine because their hair is thick.What kind of approach should be applied to patients like me? My fus are generally double hairs and I was said 2500 grafts required to restore frontal third between existing hairs and many of these hairs will be single haired grafts.
thanks

[chrisis]

Thank you Jotronic, MattJ and especially gillenator, for the very long and detailed reply!

I'm wondering if I should ask my doctor to focus the single FUs at the front, to achieve that natural harline? Is there anything else any of you guys know about that might achieve a better result, that it would be reasonable for me to ask about?

I feel lucky to have such knowledgeable people offering me advice. I promise to keep this forum updated, so that you know how everything turns out

[Spex]

All HT hairlines are only made up of 1's mate

[Spex]

I'll add - All HT hairline SHOULD only be made up of singles.

Angle and direction are key - Luckily you have so much native hair he will be able to follow its pattern /direction.

You are in god hands so try not worry too muck.

I look forward to following your progress.

Best
Spex

[sp8rky]

I'll add - All HT hairline SHOULD only be made up of singles.

Angle and direction are key - Luckily you have so much native hair he will be able to follow its pattern /direction.

You are in god hands so try not worry too muck.

I look forward to following your progress.

Best
Spex

Haha beat me to it!

[mattj]

Yep, your doctor will already know that the hairline requires singles. There's nothing we can teach him.

[chrisis]

I'll add - All HT hairline SHOULD only be made up of singles.

Angle and direction are key - Luckily you have so much native hair he will be able to follow its pattern /direction.

You are in god hands so try not worry too muck.

I look forward to following your progress.

Best
Spex

That's encouraging. I will ask to be sure! I will also try to give the show a call some time.

Yep, your doctor will already know that the hairline requires singles. There's nothing we can teach him.

Good stuff

Have any of you guys got thoughts on how densely packed my hairline should be? I was wondering if maybe the very front could be more dense, with less density required towards the back. Is that plausible?

[Jcm800]

Sorry to jump in chrisis - i've followed your post's regarding Fin sides, and your view's on the medication. But, after a HT, isn't it recommended you use Fin? Will you be going that road again? If not, won't your HT hair just fall out in due course?

Ps how's your hairline doing with Minox, last pics i saw it was looking really good?

[chrisis]

Sorry to jump in chrisis - i've followed your post's regarding Fin sides, and your view's on the medication. But, after a HT, isn't it recommended you use Fin? Will you be going that road again? If not, won't your HT hair just fall out in due course?

Ps how's your hairline doing with Minox, last pics i saw it was looking really good?

Finasteride is recommended but not absolutely necessary. Hair transplanted from the donor area is resistant to DHT, so that won't fall out. I may lose more hair around the recipient area, but that's a problem for further down the road. I'll continue treating with minoxidil to help prevent that. My hairline is about the same, so I don't expect any further improvement with minoxidil, thus surgery