How many grafts I will need to get a good hairline? (Photo)
Doctor Answers 6
Stabilization of progressive hair loss and maximizing graft harvesting and placement are important in advanced hair loss
A little background - I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I am also the founder of TrichoStem™ Hair Regeneration Centers that uses a method we developed in our practice for non-surgical restoration of thinning hair for both men and women with a 99% success rate. We developed the Hair Regeneration treatment from performing hair transplantation which we have been doing for over 20 years.
In counseling about hair transplants, I always start by asking about age of onset and learning about the rate of progression. You first noticed your hair loss at 21, which means you probably started earlier than that. It has been my observation, and generally well accepted, that when someone first notices hair loss, they’ve already lost about 50% of their hair. Now, you have very advanced hair loss at the age of 29, so you have to ask yourself where will you be in a year, 2 years, and beyond, which is why stabilization is the priority. You can transplant hair, but the problem and limitation of transplantation is the number of grafts available from the donor area. Regardless of whether you use the strip method, follicular unit extractions, robots, or any technology, the limitation is the same - the true permanent zone in the back of the scalp. If you think about the baldest person you’ve ever seen, they still have a very narrow band of hair at the back of the scalp. Hair loss just doesn’t from the front going backward, but in the back where it can go from the bottom upward. You have to think about what you have available for transplant.
That said, you also have to think about what makes up a natural hairline. A hairline where there’s continuity between the front and the sides looks a lot more natural than just a frontal hairline with the sides dropped down, so it’s very important that stabilization is established. So how do you establish stabilization? There are two medical therapies that are approved in this country: minoxidil and finasteride. Finasteride is a pill you take daily, and is in the category known as DHT blockers or dihydrotestosterone blockers. Essentially, finasteride systemically stops an enzyme called 5-alpha reductase to inhibit conversion of testosterone to dihydrotestosterone. However, only 60% of men will respond to finasteride because only 60% of men may have DHT-sensitive hair loss. In addition, it is well observed that finasteride doesn’t stop progression, but rather it slows it down. However, it has been our experience and it’s probably filtered by people who seek us out, that 95% of men who come to us don’t want to take finasteride. The reason is they’re concerned about long term sexual side-effects, also there’s an issue with compliance.
We actually help our patients before doing a transplant with Hair Regeneration. With Hair Regeneration, we are able to stop progression, reactivate hair that has not been growing, as well as induce thinning hair to shed so thicker hairs can grow in. The limitation of Hair Regeneration is salvageable hair follicles - when someone has male or female pattern hair loss, as long as there’s a hair follicle, Hair Regeneration can be of value. If the skin doesn’t have a hair follicle, there is nothing to save, so our goal is to stay in front of the progression so any hair transplant can be maximally beneficial.
When it comes to hair transplant, in a situation like yours which is more advanced hair loss, you have to be prepared for more than one transplant. There’s a limit in the number of grafts in one given session in harvesting and in transplant density. When we map out a transplant patient or surgery, I’m drawing square centimeters on the front of the scalp in areas for maximum coverage that will help frame the face, and I measure the density and number of hairs available to maximize any given transplant. Typically, the strip method generates a lot more grafts than follicular unit extraction, and usually you get the most grafts from your first transplant. There’s going to be some debate about this, but with 20 years of practice of experience, it’s a reasonable statement.
You need to first think about stabilization and about realistic expectations of hair transplants. When you’re younger, there’s a desire to have more volume in line with your contemporaries. There’s something called the Rule of Decades: in your 20s, only 20% of your contemporaries have hair loss, while 80% have lots of hair; when you get into your 40s and 50s and beyond, more than 50% of your contemporaries have hair loss. There are ways for you to look good in the long-term because you can’t keep up with the loss. You have to do something for stabilization, and be very strategic with the way the hair is transplanted.
Learn about finasteride or medical ways to stabilize like Hair Regeneration, and look at the context of a realistic outcome in transplantation. It’s not just about the number of grafts, but about the coverage and where those grafts are placed. Remember, there’s a mismatch - you can’t get enough hair from a limited area to cover the whole scalp, or even cover the front with a lot of volume, so you want to create a natural-looking framing of the face. I hope that was helpful, I wish you the best of luck and thank you for your question.
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Redesigning hairline appropriate for age
You should see a doctor for an estimate of grafts needed for accomplish your goals. 2000 or 3000 grafts are estimates but it ma
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How many grafts I will need to get a good hairline?
How many grafts I will need to get a good hairline? (Photo)
Discuss with your surgeon the medications and nutrients that you are to stay off of for at least 2 weeks before surgery and ask about the post-transplant hair growth, as it is not immediate.
Number of grafts
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.