How Many Grafts Will I Need? (photo)

After a private consultation, any hair surgeon will advice you to keep on with some medicine for a year and then it would be good to consider a hair transplant surgery. As far as I can see 3500-4000 grafts is enough for your head. 

If you assume you will never lose any more hair (highly unlikely), you would need over 2000 grafts.  FUE is only a method of harvesting hairs.FUE is just a method of harvesting grafts. FUE is a great surgery but most people who want the FUE is mislead into thinking it is the best surgery.   FUE still leaves scarsMany doctors push FUE or Neograft or ARTAS claiming "no scar" or "minimally invasive". Many doctors dissuade patients from strip surgery asking "why would you want a big scar".I was an engineer working with Dr. Rassman in 1998 (before I became a doctor) . My work involved a concept of a robot which would use a special optical sighting system to align the hairs for an automated FUE. This work became U.S. Patent 6572625 that we licensed to the ARTAS robot. Similar technology from our U.S. Patents are used in the NeoGraft. I perform FUE in my practice with my hybrid FUE instruments, ARTAS, or even NeoGraft. My point is that I am very familiar with the FUE, ARTAS, NeoGraft, and all forms of harvesting hair follicles.Your focus of surgery should be on RESULTS. Not how a doctor takes out the grafts. From a donor scarring perspective, you keep your hair LONG (in the photos) so scarring from both surgery should not be an issue. Choose FUE if you ever want to shave your head one day. 

Thank you for posting your question and photos. From the looks of the pictures, you can use anywhere from 3000 to 3500. Of course, it would be best to be seen in person for a more closer look. Also, it is best if you had all the reinforcement all at once, versus splitting them between sessions. Hope this helps.

FUE does not have to be an all or none, nor does it benefit you to do one large procedure as compared to FUT. With FUT you get a big cut and dont want to do that twice, with FUE its very common for people to do 500-1000 g at a time. New FUE devices like Neograft and ARTAS also allow procedures to be more efficient.  In your case it all depends on how far you want your hair line to come down but the range could be 1000-2000g. Its best to get an in person consult to better establish your goals and expectations.

You will need at least 2500 grafts to fill in the area shown. Spitting it is not a good option as the frontal hairs must be singles and if you just do the frontal single hairs, then you will not look normal. IF you want to get a thin look, you might get away with 1500 grafts, but I would not recommend a smaller number of grafts to keep you looking normal.

You are dealing with male pattern hair loss which is a genetic pattern. In fact, most men will have some type of male pattern hair loss. 20% of your contemporaries will have hair loss while 80% have lots of hair. At the age of 40 or 50, 50% will have significant hair loss while 50% will have mild or moderate hair loss.
Hair follicles which are protected by certain substances are literally chocked by something called dihydrotestosterone (DHT). Many men mistakenly believe that they have hair loss because of too much testosterone in the body. However, it is the conversion of testosterone to dihydrotestosterone that causes hair loss. To diminish DHT in the body, a drug named Finasteride was introduced during the 90’s.
In 2011, research that was done in the University of Pennsylvania discovered that certain adult stem cells called progenitor cells are responsible for the hair growth process. When they stop working, hair follicles are more vulnerable to DHT. In addition, the researchers noticed in the scalps of bald men that hair follicles are present but they did not continue to grow.
In our practice, we have developed an injection using a wound healing material called extracellular matrix (ECM) to stimulate the body to produce progenitor cells. This is used in combination with platelet-rich plasma and reverse thinning hair. This material also causes healing at the cellular level and protects the hair follicles from the effects of DHT.
The number of grafts in a hair transplant depends on the area that needs to be covered. Generally, we transplant about 1500 to 2000 hairs. However, we are always hesitant to perform hair transplants in young patients. This is because people who are in their 20s continuously lose hair even after a transplant. The new hairs are still vulnerable to the effects of DHT. I usually suggest first the regenerative technology injection before the transplant to protect the hair. After a year, we observe how much re-growth the patient had and then decide from there. If a hair transplant is done, an injection of the regenerative technology is done so that the donor area heals beautifully and so that there is increased survivability of the new hairs.

I am much more worried about the ultimate extent of your baldness in the future - you will lose a lot more hair in the future and therefore you must plan on how to use the limited donor supply. Baldness is always progressive. Being conservative I would suggest you consider limited transplants until the ultimate extent of baldness is clearly established.

If you are in your early twenties, I will bet my 40 years of experience that you will lose much more hair over the next 5-15 years. If you have work done this summer, sufficient donor material should be left to proviode for future graft sessions. Also, you should consider the pros and cons of Finasteride therapy.  These days we usually do upwards of 2000 grafts per session, especially in the first session, on someone like yourself based on these photos.  Strip harvesting is, in my opinion, a proven, predictable and economical way to produce high quality grafts to get excellent results in the recipient area where hair is seen. The FUE harvesting of donor material is more costly and equivalent results to strip harvesting occur only in the best of hands. If you are not in certain states wherein, by law all cutting of the scalp has to be done by a licensed physician (i.e. California), skilled technicians may be able to produce 2000+  good grafts in one session economically.