FUE - Maximum No. of grafts in single session ?

Question

There seems to be a lot of conflicting information out there in regards to the no. of grafts per session . Opinion seems to vary enormously , even by the specialists . Indeed , you see some clinics offering up to 5000 plus in a single session ? I appreciate there are many variables as to the no. of grafts possible , but is there a red flag number where concerns should be made ? Thank you.

Jae Pak, MD · Answer

What is possible for maximum FUE is different that what is normal or safe.  If you consider an average STRIP surgery is usually under 3000 grafts, the FUE surgery which is less efficient than a strip surgery should be around or below the 3000 graft range in GENERAL.  There are always exceptions to the rule.

Tim Neavin, MD · Answer

NeoGraft uses automated FUE.  We have performed over 4,000 grafts in a day using this (preferred) technique.  Manual FUE is likely a slower process.  With strip method, the graft number can be greater but one is left with a large scar.

Koray Erdogan, MD · Answer

The maximum number of grafts that may be extracted from the donor in one session depends on several factors: donor capacity, calculated density, density, caliber and number of hairs per follicle. These factors are calculated from all parts of the donor area (parietal, temporal and occipital) and are combined in what I call Coverage Value. Other factors must also be taken into consideration such as DUPA, miniaturization and future hair loss in the donor area. (Most people experience up to 25% progressive hair loss over their lifetime, therefore the idea that there is a “safe donor area” is a misconception). All these factors must be considered in order to maximize density and homogenization. It is my professional opinion that the average donor capacity has risen to from 6,000-10,000 grafts. This is due to improved techniques and instrumentation as well as expertise on the part of the hair surgeon who is well trained and experienced in FU.

I began practicing the FUE technique using the manual punch (which I still use exclusively) in 2004 and have since that time, performed surgery in over 1000 cases with over 5000 grafts in a single session. (A session constitutes 2 days of surgery with this graft number). The maximum number of grafts that I have been able to extract in a single session is 6,500, however, I have performed surgery on 12 patients with a 10,000-graft extraction over several sessions.

Earlier on, from 2000-2007 I performed the FUT technique as well as the FUE technique and at that time, I accepted the common opinion that the regrowth rate using FUT was greater than that of FUE. Since 2007, I have determined that this to be untrue. I have witnessed amazing growth rates in FUE in my own practice that equal and surpass those of FUT. The key is the experience of the FUE surgeon.

Jeff Donovan, MD, PhD · Answer

It's a great question and yes, it is controversial.In my opinion it comes down to the patient's donor characteristics, the efficiency of the team, age of the patient.Grafts ideally need to get back in the body as soon as possible after taking them out. A big FUE case can take a lot longer than strip- meaning grafts are out of fhd body longer and survival is likely less. The team can be more fatigued wirh huge sessions and quality of work drops.Survival of grafts in FUE is less than strip. Also with sessions beyond 3000, it is very likely that the surgeon is taking grafts from an area that might undergo thinning in the future. (ie too high).If you compare the outcome of two 2500 graft procedures done one year apart to one 5000 graft procedure, you'll likely see far superior results in option 1.

William Rassman, MD (retired) · Answer

As you said, this is a controversial issue. The actual size of the donor area is a band that is between 2.5-3 inches high (measured from the occipital notch upward and then extended around the head. This area can be best seen in a man with a class 7 balding pattern. If the area where the harvest extends upward, it goes into the non-permanent zone and if the transplants would eventually be extended upward, then the grafts would be taken from the non-permanent zone. Many doctors take the FUE grafts to push the numbers up. My own preference is to limit the size of a single FUE session to no more than 3000 grafts in those individuals with a high density; however if the person's density is average or low, then the size of the session should be reduced. I strictly adhere to the concept that FUE should be limited to the PERMANENT zone and not extended upward. See many writings on this subject in the web reference below.

Omeed Memar, MD, PhD (license suspended) · Answer

Realize that the higher the number of grafts the greater fatigue on the patient,  the grafts in a Petrie dish,  the staff and the doctor. I max out at 4000 grafts per days session. I find beyond that number, the quality of work might get compromised.

FUE - Maximum No. of grafts in single session ?

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