Hair Transplant- Number Hair Grafts Extracted vs Graft Survival Rate?

If you are a patient and you want the best graft survival rates, how large should your sessions be in terms of grafts? 1000? This website offers megasessions but am worried about poor survival. Should I try to get the # grafts that results in each technician having to deal with the fewest number of grafts possible - in order to minimize error? What # grafts per hair transplant gives the survival rate?

Doctor Answers 6

There is a limit of how many hair grafts can be transplanted per square centimeter to ensure graft survival

Thank you for your question. You’re concerned about the survivability rate of megasessions, and you’d like to know the recommended number of grafts you can have in one session for maximum graft survival.

To first give you a little about my background — I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I have performed hair transplants for many years and developed an alternative non-surgical hair loss treatment called Hair Regeneration, under the company TrichoStem™ Hair Regeneration, which was originally developed to maximize the yield of hair transplants, and also reverses hair loss progression.

When it comes to hair transplants, there are a number of different variables to consider, such as thickness of hair, quality of hair, and quality of skin. It’s a procedure that requires a lot of finesse, and in many ways, asking a hair transplant doctor what’s the ideal number of grafts is synonymous to asking a facelift surgeon what’s the ideal way to perform a facelift, so a question like this will certainly garner a number of different opinions.

It’s important to understand that there are a limited and realistic number of hairs that can be placed inside a square centimeter. Instead of thinking in large quantities, think about the areas that you want to have covered. Most patients will want coverage in the front, the middle, and the back — which is basically everything. However, the number of hair grafts that can be harvested is limited, so if you spread the grafts out, you will not be getting the density and volume that you want. When I consult with patients who want that type of coverage, I will recommend that they put more towards the front and center, rather than the back.

What I’ll also do is draw squares on the scalp, which represents the number of square centimeters we want to cover. In my experience, no more than 20 hairs can be placed inside a single square centimeter. Some hair transplant doctors will claim that they can transplant 75 to 100 hair grafts in a square centimeter, which is methodically possible, but how many of those hair grafts actually survive after the procedure? As someone who is primarily an eye and cosmetic surgeon, I’m very good with my hands and I perform a lot of very delicate and meticulous surgery, so I can tell you that the survivability of hair grafts after transplantation is not so much about how it is placed, but about the health of the tissue it is placed in. Openings made in the skin does compromise circulation, so if too many grafts are placed they won’t survive.

A few years ago, we actually developed a system using Acellular matrix for the purpose of improving hair graft survivability, and improving the results of hair transplants overall. However, we also noted that the treatment improved healing of the donor area and thickened existing thinning hairs. As a result, we further developed the treatment to create Hair Regeneration, which is a non-surgical hair loss treatment that is performed separately from a hair transplant. The beauty about this treatment is that male and female patients who come to us with thinning hair and want a hair transplant can first opt for this injection in order to stop the progression of their hair loss, and thicken their existing hair. The treatment reactivates existing hair follicles that are not growing and basically kick starts the hair growth cycle, so upon seeing the results, most patients feel like they no longer need a hair transplant. In some cases, we are even able to achieve results that exceed 1-2 hair transplants in the right candidate.

Ultimately, if your hair loss is too advanced already, and you’ve lost a lot of hair, then a transplant may be able to get you the results you want. Keep in mind, however, that stabilization is very important. If you are able to stabilize and thicken the existing hair that you have, then every hair is a hair that does not need to be transplanted. I certainly share your concern, and I think a conservative approach would be more appropriate for you because you want to protect the hairs which are limited in supply. You don’t want to overfill and overharvest, and it’s important that you discuss this with a hair specialist to understand how many hair grafts they can transplant into a given area.

I hope that was helpful and I wish you the best of luck!

New York Oculoplastic Surgeon
4.3 out of 5 stars 70 reviews

Graft survival depends on the experience of the doctor and the clinical team.

Graft survival depends on the experience of the doctor and the clinical team.  If the team is not experienced, even 100 grafts will have poor growth.

Jae Pak, MD
Los Angeles Hair Restoration Surgeon
5.0 out of 5 stars 90 reviews

Hair Transplant- Number Hair Grafts Extracted vs Graft Survival Rate?

Thank you for posting your questions. The survival rate really depends on the experience of the entire staff, team, practitioner and holding solutions being used. The less "Time out of Body" better for the grafts. 

Matt Tahsini, MD
Pasadena Hair Restoration Surgeon
5.0 out of 5 stars 18 reviews

Graft survival

This depends not on the number of grafts you get, but on the experience of your surgeon and his/her team. Experienced teams get great results if they do 500 grafts of 5000 grafts. 

William Rassman, MD
Los Angeles Hair Restoration Surgeon
5.0 out of 5 stars 27 reviews

Small case size

In general this will result in more survival  but a lot still depends on the clinic. I have seen small cases do very poorly in clinics that outsource staff and fly in technicians who could care less about results.   So yes, smaller case can give more survival depending on the clinic.

Rashid M. Rashid, PhD, MD
Houston Dermatologist
4.5 out of 5 stars 8 reviews

Best survival rate hair transplant grafts

First of all, there is not a straight answer to your question. I too have seen photos boasting about megasessions but that doesn't necessarily translate into great results in future. There are many things that go into good graft survival: gentle handling of grafts both at harvest and placement, lower time out of the body before placement, proper temperature and solution grafts in which grafts are held, skillful trimming of the grafts, density of placement, etc. The more important questions are: how many grafts do you actually need? and what is the quality and experience of the physician you choose? To give you a comparison: in my office, our staff will do no more than 2000 grafts in one day (for the appropriate patient)  based on the time it takes us to plant the grafts through the "stick and place" method where one technician places all grafts on one patient. But there is more then one way to skin a cat and every surgeon has slightly different techniques. I suggest you find someone you trust that has an experienced staff and a good track record and NOT choose your surgeon based on number of grafts you can obtain in one session.

Jennifer Krejci, MD
San Antonio Dermatologist
5.0 out of 5 stars 5 reviews

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.