How many hair transplant grafts for a full head?

Although hair loss is a common aesthetic issue for men and women worldwide, modern medicine cannot do much to prevent or treat it.

Hair transplant surgery is still a gold standard for hair loss treatment. Technological advances have made it widely available and significantly more effective.

The cost went down too. But, it is still a valuable factor.

Therefore, it is not surprising that many patients ask themselves: How many grafts do I need?

There is no uniform answer to this question. The truth is each patient is different.

To answer the question individually, doctors need a full consultation and evaluation.

They need to assess the patient's goals and look at the donor and recipient areas before saying what's doable and how many grafts are necessary.

The Average Patient

Every patient is different, and these differences dictate the number of grafts for a cosmetically pleasing outcome. There are also various causes of hair loss, but hair transplant surgery remains the only effective treatment for "dead" hair follicles.

Once a follicle stops producing hair, it's impossible to bring it back to life.

So, what can hair transplant surgeons do?

They can move some healthy hair follicle cells or entire hair follicles from one location on the scalp to another.

For a successful operation, we need a donor area.

That means there is a limited amount of healthy hair follicles available for transplantation.

An average patient has approximately six thousand grafts available.

The average size of the balding area in, what is considered, a “totally” bald patient is approximately two hundred square centimeters.

However, there is often more than one bald area. The most common combination is hairline (front part) + back half, or the crown.

Here's what a surgeon can do in such situations:

Option 1 – We can distribute the available grafts evenly. Such an approach creates a uniform density throughout the bald spots of approximately thirty follicular units per one square centimeter.

Most patients are not happy with this because the outcome looks like widespread hair thinning.

Option 2 – A surgeon can transplant four thousand grafts in the front half and two thousand grafts in the back half.

That creates the appearance of fullness in the hairline and the front half and a thinning look in the crown and the back half.

The patients are usually content with this as the thinning part is not visible from most perspectives.

It usually takes two to three hair transplant sessions to move six thousand grafts and achieve a maximum effect.

Patients who do not have enough donor hair often choose to receive fewer units in the crown area.

Some individuals are not good candidates for surgery at all.

Factors That Influence What Can Be Done

Many variables determine what can be done in a certain case. These are the top eight:

1. Donor site density

The more hair you have available for transplant, the larger the bald area you can cover, and vice versa. We already said that the average patient has around six thousand grafts available.

However, some only have four thousand while others may have as many as eight thousand grafts. In many cases, it is not easy to predict the exact amount.

Scalp skin elasticity

Scalp elasticity is only important with strip hair transplant procedures. More laxity increases the number of available grafts and therefore, enables the covering of a larger area.

With tighter scalp skin the opposite applies. However, some medications can help increase the donor area laxity.

3. Hair quality

If you have thick, wavy, and bright color hair in the donor area, you can usually expect more from a hair transplant procedure than individuals with fine, straight, and dark hair.

4. Hair loss severity

Patients with a large recipient (bald) area need more grafts to achieve an aesthetically appealing result.

5. Head size

A larger head typically requires more grafts than a smaller one.

6. Hair loss potential and age

Older patients have a minimal risk of future hair loss.

The opposite applies to younger patients, as they might need additional grafts in the future.

However, this is hard to predict. So, factors such as family history and the speed of hair loss progression are valuable for determining the patient's hair loss potential.

7. Willingness to take medications

Some prescription drugs, such as Propecia can prevent hair loss progression and, therefore, limit the size of the recipient area.

8. The amount of the pre-existing hair

There is such a thing as wanting a hair transplant too early.

Patients who notice early thinning and still have plenty of pre-existing hair can be difficult to treat. There are three main reasons for this:

· Is difficult to main incisions without damaging or transecting healthy hair

· Is possible to cause indirect trauma and inflammation that leads to hair loss (e.g. telogen effluvium)

· A significant loss of pre-existing hair can occur during the twelve to fourteen months it takes for newly transplanted hair to start growing.

How many grafts per hair loss area per procedure?

The number of necessary grafts differs according to specific areas of hair loss. Also, a surgeon can extract more grafts if the patient allows them to shave the donor area.

A single hair transplant session can achieve a density of thirty to thirty-five follicular units per square centimeter.

For higher density, more sessions are usually required.

The following are the numbers of recommended grafts per procedure for specific areas of hair loss:

· Hairline – 800 to 1500 grafts for hairline only, plus additional 150 grafts for each temporal point.

· Front third (hairline + central core) – 2000 to 2500 grafts.

· Front half – 2500 to 3000 grafts

· Front two-thirds – 3000 to 4000 grafts

· Crown – 800 to 1500 grafts to turn a bald spot into a “thinning” area.

The Bottom Line

The amount of necessary graft for a hair transplant surgery is always individual.

It depends on the number of available healthy hair follicles in the donor area.

That also directly influences the success of the procedure because the number of grafts may not meet the need for the desired outcome.

References:

· Jimenez F, Vogel JE, Avram M. CME article Part II. Hair transplantation: Surgical technique. J Am Acad Dermatol. 2021;85(4):818-829. doi:10.1016/j.jaad.2021.04.063

· Jimenez F, Alam M, Vogel JE, Avram M. Hair transplantation: Basic overview. J Am Acad Dermatol. 2021;85(4):803-814. doi:10.1016/j.jaad.2021.03.124

· Zito PM, Raggio BS. Hair Transplantation. In: StatPearls. Treasure Island (FL): StatPearls Publishing; August 25, 2022.

· Jiménez-Acosta F, Ponce I. Técnica actual del trasplante de pelo de unidades foliculares [Follicular unit hair transplantation: current technique]. Actas Dermosifiliogr. 2010;101(4):291-306.