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Although hundreds of questions are asked and answered on the Hair Restoration Discussion Forums daily, the most common is likely hair loss patients asking how many follicular unit grafts are necessary to fill their balding scalp. Despite the fact that this question is quite common, it’s difficult to answer and unique to nearly every patient.

Various physiological and personalized factors determine the number of grafts required to cover balding scalp. Factors such as the size of the transplanted area, characteristics of the donor hair (circumference of the hair shafts – fine versus coarse and texture of the donor hair -wavy versus straight), desired density in the transplanted region, color difference between the scalp and follicular unit grafts, laxity (“looseness”) in the universal donor region, age, and hairline design all affect the number of grafts required for an aesthetically significant result.

However, despite the numerous variables associated with graft counts, there is a way to estimate the required number of follicular unit grafts in any given hair transplant surgery. The hair loss learning center graft calculator is a tool that allows patients to input their personalized information and calculate the number of grafts required for the desired amount of coverage.

The calculator takes variables such as current level of hair loss, the area of the balding scalp, and desired density in the transplanted area into consideration, and creates a helpful estimate of the required graft count. Although the tool is not a replacement for a consultation with an experienced hair restoration physician it’s a useful tool that can help many patients answer the infamous question: how many follicular unit grafts will it take to fill my balding area?
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Blake Bloxham – aka Future_HT_Doc

Whether or not to tell your friends and family about your hair transplant procedure is one of the most important post-operative decisions a patient will make. While many hair loss sufferers keep their hair restoration secret or on a “need to know” basis, they may be forced to create elaborate explanations for their pink scalps and sudden profusion of hair growth or fess up and admit that they’ve spent thousands of dollars to restore their formerly balding hair.

So, who do you confide in? Do you post it on Facebook for the world to see? People often divide the people in their lives into one of several categories; family, close friends, acquaintances or colleagues. In many cases, your hair transplant can remain hidden from at least one of these groups. Just as a great magician guards the secrets of his illusions to preserve their mystery, hair transplant patients often guard the secret of their newly restored head of hair.

Recently, forum member “Can’t decide” started a thread asking members to share their thoughts and experiences. To find out how other hair transplant patients have dealt with this important issue, follow the link, Why Not Be Open With Others about a Hair Transplant?

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David – aka TakingThePlunge
Assistant Publisher and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum
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This question comes from a member of the Hair Restoration Social Community and Discussion Forums:

A past follicular unit transplantation procedure left me with a less than desirable hair transplant scar. I’m now investigating a scar revision procedure and I’m wondering the potential pitfalls and risks of this operation?

Although revising a follicular unit transplantation (FUT) scar is usually considered less invasive than a hair transplant procedure, there are still certain risks and issues involved. In most cases, the undesirable strip scar is removed in the same fashion as the donor portion in a FUT procedure – by removing a portion of scalp (varying in width and length) from the universal donor zone and closing the wound with sutures or staples. Because of this, some issues associated with traditional hair transplant operations – scar stretching, laxity (“looseness”)  in the donor region, and closure tension, are still relevant in a revision procedure.

However, one of the most significant complications from a scar revision procedure comes from many patient’s desire to obtain and implant additional follicular unit grafts from the excised scar region. During many revision operations, excess scalp (containing implantable grafts) is removed from around the scar region and the additional follicular grafts are transplanted into balding areas. However taking excess scalp (around the excised scar tissue) simply for the intent of obtaining extra grafts can often create another sub-optimal scar. In various cases, it may be advantageous to simply remove the scar tissue and close a smaller area instead of trying to revise the scar and obtain additional grafts.

This question was posed by a hair loss sufferer seeking hair loss help on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY.  Dr. Beehner is one of our recommended hair restoration physicians. His professional answer is below.

My doctor told me that I will end up with a 1mm wide donor scar. But now, 70 days after my hair transplant surgery, my donor scar is at least 2mm wide. Will it take much longer to shrink or do I have to live with this 2mm scar?

A hair transplant scar doesn’t ordinarily get slimmer over time although, at 70 days post-op, I think it almost certainly is as wide as it’s going to be. What does happen over that first year is that the color of the donor scar goes from a pinkish hue to a white one similar to the surrounding scalp so that it is much less noticeable.

Because of the huge variance from one patient to the next as to the elasticity of the scalp, I would say your doctor went out on a limb promising you a 1mm or less wide donor scar. In my own practice, first time hair transplant patients end up with a 1mm or less scar probably 80% of the time. But, some of the others end up with 1.5, 2.0, or rarely 3mm. This latter happens in those with “hyper-elasticity” of the scalp. When we inject the tumescent fluid into the donor area prior to making the cut, we can often tell who is hyper-elastic and then plan the excision and post-op care to try and help the donor scar end up as narrow as possible. Ways to do this are the following:

This question comes from an interesting thread started on the Hair Restoration Discussion Forums:

Which member has received the most follicular unit grafts throughout their series of hair transplant surgeries? How many grafts were available in your donor area? How many hair restoration procedures did it take?

Although this topic is discussed quite frequently, it’s difficult to provide a universal, generalized answer. Since each patient is unique, the maximum number of grafts available in the universal donor area, the number of hair transplant procedures necessary to harvest these units, and the number of follicular units that can be safely harvested vary. Variables, such as donor laxity (the “looseness” of the scalp), hair characteristics, level of baldness, type of procedure (follicular unit transplantation -FUT versus follicular unit extraction – FUE) performed, and density in the donor region all contribute to the number of available grafts, the number of procedures necessary to extract the grafts, and the number of grafts that can be safely transplanted.

Despite these numerous variables, members at the Hair Restoration Discussion Forums are discussing the issue and trying to discover which hair loss patient has received the largest number of grafts, how many procedures it took, and if there are units left in the donor area. Very large numbers, ranging from 10,000 to 13,000 grafts, 4 to 5 procedures, and different methods of extraction are being reviewed. Do you think you’ve received the greatest number of follicular units, or know the maximum number of units available in your donor area? If so, feel free to participate in the ongoing thread – Who has had the most work done?

This insightful answer was provided by Dr. William Lindsey of Mclean, VA who is one of our recommended hair restoration physicians.

I had a hair transplant done about 3 months ago (my 3rd procedure) and it went a bit differently than what I experienced before. This procedure was done at a clinic that only used one technician. I had 2000 grafts done and it took the tech about 4-5 hours to dissect all the follicular units. The entire procedure, start to finish, took about 9 hours. Is this normal? How long can hair follicles remain alive after they have been removed?

At our office, the duration of a hair restoration procedure is directly related to three factors:

1. Manpower

2. Contrast between hair and skin color

3. Curly vs. straight roots

In general, we can transplant 3500 grafts starting promptly at 8am and finishing by 5pm. Occasionally, a cutter is sick or out for some reason and things may take an extra 45 minutes or so but, with sufficient manpower, even larger cases shouldn’t take forever.

With light hair roots and light skin, the cutters take longer so as to preserve every root. Therefore, with gray or blond hair, we add an hour to the estimate. With curly hair, e.g. African American hair, we figure an extra hour just to get the follicular units out cleanly and without a lot of extra tissue. It’s often like cleaning off a corkscrew. Asian hair, in contrast, is more like cutting the teeth off of a comb (very easy). Nevertheless, our longest case to date started at 8am and ended at 6:30pm including a half hour lunch break.

View the official Press Release.

The patient members of our hair loss forum in collaboration with quality physicians have revolutionized the hair transplant profession by demanding only the best results. That’s why only those physicians with a solid reputation for producing outstanding hair transplant results are approved for recommendation on the Hair Transplant Network.

Dr. Parsa Mohebi, his technique, and results were carefully reviewed over the last year and a half by our hair restoration forum and social community in consideration for recommendation. We are pleased to announce that Dr. Mohebi has been approved for recommendation by our online community. To learn how we prescreen and recommend hair transplant surgeons, click here.

After completing a one year fellowship with Coalition member Dr. Bill Rassman, Dr. Parsa Mohebi opened his own clinic “US Hair Restoration” where he’s been performing hair transplant surgery exclusively for almost 3 years. Dr. Mohebi operates on only one patient per day and has the staff and experience to perform large sessions exceeding 3000 grafts when appropriate for the patient.

After seeking input from the patient and physician members of this community and carefully evaluating his results on our hair loss forum for almost 2 years, we’d like to congratulate Dr. Mohebi in becoming our newest recommended physician on the Hair Transplant Network. To congratulate and welcome him to our community, visit the “Potential Recommendation of Dr. Parsa Mohebi of Los Angeles, California”.

This hair loss question was answered by Dr. Glenn Charles of Florida who is a member of the Coalition of Independent Hair Restoration Physicians. His professional answer is below.

When is a patient too young to have a hair transplant? How long should someone wait? How thin does your hair really need to be? I don’t understand how a doctor can do surgery on a twenty-two year old guy knowing the high risk he may end up a 6 or 7 on the Norwood Scale.

There is no perfect age for a hair transplant. When surgical hair restoration is considered in younger patients it should be done very conservatively. A long term plan should be established between the doctor and the patient taking into consideration the good possibility of continued balding.

I always discuss the worst case scenario with the patient: the possibility that they will go on to a stage 6 or 7 on the Norwood Scale and are likely going to want additional hair transplant procedures in the future. I also try and assure, if the patient does have more hair loss and for some reason cannot do more surgeries, that the first procedure will look acceptable on its own.

Dr. Glenn Charles

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David – aka TakingThePlunge
Assistant Publisher and Forum Co-Moderator for the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog, and the Hair Restoration Forum
Follow our community on Twitter
Watch hair transplant videos on YouTube

I keep reading about shock loss – why does it happen? Does it all grow back? That has to be very depressing when the hair you think is going to grow falls out.

Hair is one of the fastest growing tissues in the body. You may have heard that hair has three stages of growth: anagen, catagen, and telogen. A simple way to look at it is that hair may be in the growing phase (anagen), transition phase (catagen) or resting/shedding phase (telogen). At any given time, most of one’s hairs are in the growing phase (80 to 90 percent) but some of one’s hairs are always shedding.

Any type of trauma can cause more of your hair to shift from the growing phase to the shedding phase. Emotional stress as well as poor nutrition, a high fever, etc. can all cause telogen effluvium or shock loss. The shock loss you are experiencing means that more of your hair is in the shedding phase, which is part of your hair’s natural life cycle.

The stress of hair transplant surgery put more of your hair into the resting phase and then shedding phase. Since this is a part of the hair’s normal life cycle most of it should come back. However, there may be some of your hair that was miniaturized and on its way out and that hair may not come back

This question, asked by a member of the Hair Restoration Social Community and Discussion Forums, was answered by Spex – a senior member and consultant to Coalition physician Dr. Alan Feller:

I’m wondering, if a hair loss patient was only going to undergo one type of hair transplant surgery, either follicular unit extraction (FUE) or follicular unit transplantation (FUT), which procedure would yield the greatest number of grafts in the long-term (meaning multiple procedures over the entire duration of a hair restoration journey)? Which procedure (if given the option) should I choose?

Every patient is so very different that the answer to the question varies and there is no definitive solution for every hair transplant patient. Unfortunately, hair transplantation is not an exact science.

For example, I know some patients who have received 3000-4000 follicular unit grafts via FUE over multiple sessions very successfully because they possessed the donor supply, surface area, and the appropriate physiology to enable safe extractions over a large enough area without visible scaring. On the other hand, something like 7000+ grafts (over multiple sessions) via FUE is certainly a very rare and individual case, but has been accomplished many times through FUT operations. Also, this would definitely be the exception and not the rule, and basing hypothetical FUE grafts numbers on this one case along is highly inaccurate and misleading (in my honest opinion).