What are grafts?
Grafts are small units of hair that have their own blood supply. These units can range from one to four hairs. Therefore, when a clinic quotes “4,000 grafts,” it does not automatically mean that the patient will receive high density hair. Hair caliber, curl pattern, and scalp contrast influence how full the final result appears, making graft count a poor indicator of success in a hair transplant.
Can pursuing a high graft count lead to adverse consequences?
Yes, it can. While a high graft count may appear attractive, a high graft count without a diagnosis can cause the same problems that occur when the plan ignores the diagnosis. One such problem is that a clinic may over harvest the donor area to reach a large number of grafts. The result can be a donor zone that is almost completely depleted, causing a transparent appearance of the donor zone and or an unnatural looking hairline. Furthermore, a patient’s potential for future hair restoration is reduced due to donor area limitations.
Possible Risks Include:
• permanent thinning in the donor zone
• unusual density and poor angles
• shock loss in remaining hair
• reduced donor availability for future hair loss treatments
What Does Correct Diagnosis Mean in Hair Restoration?
What Does Correct Diagnosis Involve?
A correct diagnosis includes determining the extent and rate of hair loss, as well as the condition of the donor area. In addition, the doctor should assess the scalp for inflammation, scarring or active shedding that may affect graft survival. In short, a correct diagnosis provides the answer to the key question of whether surgery is appropriate at this time.
Which Types of Hair Loss Can Change Transplant Plans?
Many patients believe all hair loss is caused by male pattern baldness. However, there are several types of hair loss and each requires a specific approach. An accurate assessment may determine if the hair loss is caused by:
• androgenetic alopecia or male pattern baldness
• a diffuse thinning pattern
• telogen effluvium and stress related shedding
• traction alopecia
• an inflammatory or scarring condition affecting the scalp
Why is Diagnosis More Important Than Graft Number?
Diagnosis dictates the overall plan. First, it establishes whether medical treatment should precede surgery. Second, it affects the design and density strategy of the hairline. Third, it forecasts future hair loss, thereby enabling a natural appearance for longer.
A diagnosis led plan allows you to:
• determine whether you are a suitable candidate
• preserve your donor area
• anticipate your future hair loss
• avoid costly surgical correction for an ill planned procedure
Why is the Donor Zone Your “Bank Account”?
Why is the Donor Zone Important?
Your donor zone is your permanent resource for funding your hair restoration. Once spent, it can never be replaced. Thus, diagnosis must confirm the stability of your donor zone prior to extracting grafts from the donor area.
What Makes a Donor Zone Strong or Weak?
A strong donor zone has dense hair, thick hair shafts and little to no miniaturization. A weak donor zone displays thinning or miniaturization in the areas that are considered the “safe zones.” Therefore, the same graft number could represent safety for one patient and danger for another.
A Good Donor Evaluation Will Assess:
• donor zone density and hair shaft thickness
• miniaturization in the donor zone
• pattern stability and family history
• previous procedures and donor zone depletion
How Does Diagnosis Protect Your Future Donor Zone Availability?
Diagnosis will prevent your surgeon from harvesting grafts from unstable hair and will help your surgeon avoid donor zone depletion. Therefore, your donor zone will remain healthy, and you will maintain viable future hair restoration options.
Why Do Hairline Design and Density Strategy Trump Graft Numbers?
What determines a natural looking hairline?
A natural result is determined by the design and placement of the grafts and not by the hype surrounding them. A skilled surgeon will design a hairline that matches your facial features, age, and risk of progression, then place the grafts at the correct angle and direction to mimic natural hair growth.
Important Elements Include:
• placement of single hair grafts along the front edge of the hairline
• creation of gradual density behind the hairline
• placement of grafts at the correct angle, direction and spacing
• design of realistic temples and transition zones
There are times when a lower graft number will produce a better result.
Some patients may require less grafts to achieve a better result because the surgeon placed the grafts where they would provide the most value. Early recession often necessitates strategic frontal placement rather than just providing blanket coverage. Likewise, thicker hair or curly hair can produce a fuller result with fewer grafts.
A Few Examples Include:
• thicker hair or curls can produce a fuller result with fewer grafts
• low scalp contrast
• early recession that is limited
• a focus on creating a natural hairline above all else
Scenarios Where Diagnosis May Save the Patient
What Happens When Diffuse Thinning is Mistaken for Male Pattern Baldness?
While diffuse thinning may resemble typical recession, the risk associated with diffuse thinning is greater because the donor zone may also thin. Over harvesting the donor area to meet the larger number of grafts desired may result in the donor area becoming almost completely depleted, leaving the transplanted area appearing patchy and nearly impossible to repair.
Why Should Treatment for Inflammation or Active Shedding Occur Prior to Surgery?
Active shedding or inflammation can decrease the survival rate of grafts and prolong the recovery period. Many patients therefore derive significant benefits from stabilizing the scalp prior to undergoing hair transplantation surgery, which can also reduce the risk of complications discussed in this peer reviewed complications overview.
Why Do Young Men Require Diagnosis Led Planning?
Younger men tend to experience more hair loss following surgery than older men. Therefore, an overly aggressive design of a low hairline can ultimately appear unnatural. In general, a conservative design and staged plan will age more naturally.
Clinique de Monsieur’s Approach to Diagnosis and Planning
What Should a Proper Consultation Include?
A consultation with a qualified physician should feel like a medical appointment and not a sales pitch. At Clinique de Monsieur, our doctor led approach is focused on diagnosis first, then planning.
A quality consultation will generally include:
• a detailed history and progression timeline
• a thorough examination of the scalp and donor zone
• an assessment of miniaturization and donor zone stability
• achievable goals and a long term plan
Where Does Direct FUE Fit into This Process?
Following diagnosis, the choice of technique becomes important. Direct FUE allows for precise extraction and controlled placement of grafts which facilitates the management of angle and direction for a more natural appearance. Direct FUE also promotes careful donor management, which is critical to long term planning, and this aligns with professional definitions of FUE.
Questions to Ask Before You Agree to a Graft Quote
What Questions Will Protect You From a Poor Plan?
Ask:
• What is my diagnosis, and what evidence supports this diagnosis?
• Is my donor zone stable, and how will this be measured?
• What results can I reasonably anticipate based on my hair characteristics?
• What happens if I experience additional hair loss after surgery?
• Will you take steps to avoid over harvesting and protect my donor zone?
• Why is this graft number required for my particular situation?
Conclusion
The number of grafts quoted may seem impressive, but the correct diagnosis is the only factor that will determine if the transplant will produce a natural result, will heal appropriately and will continue to look good as the patient ages. A diagnosis led plan will protect your donor zone, limit unnecessary errors and ensure the best possible long term result. If you wish to have a doctor led assessment and a customized plan utilizing Direct FUE, contact Clinique de Monsieur to confirm your diagnosis and develop the safest possible strategy for your hairline, donor availability and future hair loss.