This question was posed by a female hair loss sufferer seeking hair loss help on our hair restoration forum and answered by Dr. Michael Beehner of Saratoga Springs, NY who is one of our recommended hair restoration physicians. His professional answer is below.
The total number of hair grafts planted in a hair transplant procedure simply refers to the number of “building blocks” used in that case, whatever their size or composition. In modern hair transplantation, that usually can range from a 1-hair follicular unit graft up to usually a double follicular unit graft of 4-5 hairs, both dissected under microscopes. Ordinarily the number of grafts equals the number of recipient site incisions with two exceptions.
One, if extremely tiny incisions are made over the entire planting area and the physician feels that 3 or 4-hair follicular units are too large to use and instructs the assistants to split them into two smaller hair grafts each. Actually, two 2-hair grafts made by splitting a 4-hair follicular units will still count as two grafts, because the work was taken to cut them into separate units and two separate incision sites are made to place them in.
Two, if a patient has a larger percentage of naturally occurring 1-hair follicular unit grafts in the donor tissue, often two 1-hair follicular units will be “paired up” and placed into a single incision, which then becomes a 2-hair site, as opposed to making two separate sites and placing 1 hair into each one.
Fortunately most hair transplant patients have around 20% 1-hair follicular units, which works out to about the number needed to create a natural front hairline, and rear border. From the viewpoint of minimizing injury to the scalp and creating hair density, if there is an excess of 1-hair follicular unit grafts, placing two into a single incision is probably preferable. Whether one charges for 1 or for 2 grafts for the grafts placed in such sites can sometimes be problematic, as you have carried out the work to dissect two separate grafts, but only one placement act is performed, as they are usually gripped together as they are placed. In our hair replacement practice we prefer to keep 3 and 4-hair follicular units intact and simply make sure that a few of the micro-slits are slightly larger than the others in order to accomodate them.
An earlier commentator spoke of minigrafts and micrografts as both being over 4 hairs each. That is true of the definition of a “minigraft,” which was a cut-to-size graft cut under loupe magnification in the past. But a “micrograft” is a different animal and has always simply been a 1 or 2-hair graft, which in the “old days” was split off from a larger graft usually. The concept of the naturally occurring follicular unit wasn’t appreciated back in the 1970’s and early 1980’s. Many of us still use the term “micrograft” to refer to a 1-hair graft that is the result of splitting up a 2-hair follicular unit to make two single 1-hair grafts. This is sometimes necessary when a hair transplant patient has hardly any naturally occurring 1-hair follicular units and they are needed for either eyebrow work or for the edge of the front hairline.
Many people, including myself, feel that giving the NUMBER OF HAIRS transplanted is a more accurate way to describe what was accomplished in a single hair restoration procedure. My experience is that most patients require somewhere around 10,000-12,000 hairs on the top of the head (frontal and midscalp regions) to look relatively full. Persons with extremely fine hair sometimes require more.
Mike Beehner, M.D.
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