Great stoic philosophers like Seneca liked to point out that moderation was the key to attaining harmony in the self – ‘a sound mind in a sound body.’ This tidbit of ancient Roman wisdom also holds true for hair transplants. One of the more common questions that our patients tend to ask during consultations is: “Doctor, can we do more?”
We understand you completely. Hair transplants are a big deal for our patients, most of whom (very understandably) want to do as much as possible in a single session, obtain optimal results, and then never have to undergo another surgery again. So back to the question: is more better? Would a massive single transplant of, for example, upwards of 5,000 grafts ever be a good idea? Does having more grafts indicate a better quality transplant? Would using more grafts than recommended and packing them closer together produce thicker, more aesthetically pleasing results? The answer to these closely related questions is- not necessarily. As often happens in medicine, and in life, the answer isn’t always that simple.
Technically speaking, most patients simply don’t need 5,000+ grafts in one go. To give you some perspective, it would take about 5,000 – 6,000 grafts to cover every inch of an entirely bald scalp with adequate density. Most patients end up in our clinic far before that level of hair loss has set in. Most common cases of hair loss involve isolated thinning restricted to certain portions of the scalp. The standard recommended treatment of such cases tends to call for around 2,500 grafts to 3,000 grafts.
Consider this, if it takes 5,000 grafts to cover the entire scalp, we shouldn’t need more than 2,500 or 3,000 to treat thinning of the frontal scalp. Anything more would be simply unnecessary. In fact, it would be very undesirable to force in twice as many grafts as required into a given area; just as it would be highly medically inadvisable to take such grafts from the donor area and then not use them. The donor area only possesses a limited number of grafts and when they’re gone, they’re gone. Hair transplants only address areas of the scalp that are currently thinning or balding. The grafted hair, under normal circumstances, will remain in place for the rest of your life; however, hair transplants do not prevent hair loss in untreated areas of the scalp. Therefore, you may very well want to save some of those extra potential grafts for later.
But what if yours is a case of advanced hair loss calling for around 5,000 to 6,000 grafts to treat? Can we do 5,000 in one sitting then? It depends on several factors. If such a large number of grafts can be safely harvested in one sitting, then certainly. There are some important caveats here though. Firstly, most clinics are simply not equipped to perform a surgery of this magnitude. Secondly, only the FUT (Follicular Unit Transplantation) procedure would be appropriate for such large cases. FUT also known as the ‘strip’ procedure is somewhat invasive and should only be attempted by highly qualified surgeons in a state of the art clinic. Attempting this level of FUT at a clinic which lacks the adequate experience and resources can only lead to disastrous results. Scarring, destruction of the donor area and of the highly sensitive harvested grafts, risk of infection and/or poor final results are all serious risks involved when practitioners and clinics are pushed past the limits of their facilities and expertise.
Moreover, when considering a massive transplant many factors also depend on the individual patient. The average patient is not physiologically capable of safely rendering 5,000+ grafts in one sitting. The laxity (that is, the potential for movement or the ‘stretch capacity’) of the typical human scalp and/or the donor area density often prevents this. Unfortunately, some unscrupulous clinics will go ahead with a 5,000+ graft transplant anyway. As mentioned above, more often than not the results aren’t pretty.
Certain rare patients do possess a broad donor area and excellent laxity. We can safely harvest a reasonably sized strip from them for use in large grafting procedures. The scalps of most patients, however, can only safely provide between 2,500 – 3,000 grafts at one time. Patients in need of 5,000 – 6,000 grafts to cover the whole scalp would simply need to undergo two procedures instead of one. For advanced hair loss, this eliminates the unpleasantness and many of the complications associated with massive grafting procedures and is how the vast majority of such hair restoration procedures are carried out. Anything else would be an exception, highly qualified by individual factors, and most certainly not the norm.
It is also important to let the scalp heal and not to push too much surgery on it at one go. Scalp laxity tends to return within 12 months of surgical recovery by which point it is perfectly safe to undergo a second procedure. As an added perk, due to our highly specialized grafting technique you will still only ever have one incision scar no matter how many times we harvest from the donor area.
Finally, to address the last question: ‘does putting in more grafts than required produce thicker and more aesthetically pleasing results?’ The short answer is a definite no. There are serious and potentially detrimental consequences associated with purposeful excessive grafting. Here at Modena Hair institute we practice dense graft packing to achieve a full and healthy restoration; however our highly trained and specialized professionals understand that the grafts can only be placed so close.
More grafts do not necessarily produce a better appearance and, furthermore, a region of the scalp subject to excessive incisions will suffer inevitable and irreversible tissue damage. In fact, such tissue damage can even lead to necrosis and infection killing the new grafts and leaving the unfortunate patient with some very nasty scars. There is also no guarantee that badly damaged tissue will be receptive to future grafting. So to go back to our Roman philosophers- moderation is key. A smaller number of judiciously placed and safely harvested grafts, in the hands of our experienced surgeons, will always yield better results than an ill-conceived and equally ill-advised ‘mega graft.’
Want to know how many grafts you may need or may be able to do in one sitting?
For more information about hair loss and cutting edge surgical treatments contact our hair restoration surgery center today. Here at Modena Hair Institute we always strive to provide our patients with the highest standard of custom hair restoration treatment available, directly tailored to their individual needs. Our specialists are eagerly awaiting your visit or digital consultation. Contact us today!
Dr. Amir Yazdan, MD, is an internationally renowned hair transplant surgeon, expert guest on Dr. Phil and The Doctors, creator of the GroMD hair restoration product line, ISHRS member, accredited member of the IAHRS and a visceral advocate for patient care. Learn more about Dr. Yazdan or read rave reviews from his patients.