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Average donor density for a successful hair transplant

T

Triathlon

member
I recently had a consultation with a reputable doctor who stated my donor density was below average, 1.7 hairs per follicular unit to be exact. I was quoted 2200 grafts to fill my hair line, then continue backwards into sparser areas. He advised that my hair characteristics were good (I have wavy hair) Bearing this in mind, do you think I'd be able to achieve a natural cosmetic look? Without it looking like a hair transplant
I don't want to start the ball rolling if I can't achieve a natural look that will last. I'd be grateful for any advice.



 
W

wanda

Member
Average density is around 2.2 hairs per graft........ FUE will allow the doctor to select single grafts for the hair line and as many doubles/trebles as possible to add density behind......... FUT will restrict the choice to the width of strip removed.
Which procedure are you considering?

The shingling effect utilised by doctors allows less hair to create the illusion of more density....... Using Coronal incisions the grafts are planted at acute angles allowing the hair to lay on top of each other.

I've copied an extract from Dr Rassman which explains hair density............

Donor Area:

The donor area is always the rim of hair that is seen in the Norwood Class 7 patient (see art at right). It starts at the occipital prominence of the skull (back of the skull) and goes up in the midline to a height of about 2 1/2 inches. It runs from the temple prominences by the forehead from one side to the other. The total measurement depends upon the size of the head. Large heads might have a 15 inch measurement from temple prominence to temple prominence and let €™s say 13 inches to be safe, of which 1/2 inch on each side is not usable because any hair extraction from that close to the forehead will show as a thin donor area or a scar from the frontal view. So if you were to harvest the donor area (either by strip or FUE) the donor area would measure 12 inches long multiplied by 2.5 inches high or 30 square inches of scalp in a person with a typical size head. Half of that 30 square inch number would produce 15 square inches of usable donor hair. Each square inch in a Caucasian €™s scalp with average hair density contains 1250 hairs which if multiplied times 15 square inches (half the donor area) would give 18,750 permanent movable hairs or in theory 9,375 two hair follicular units (grafts). I know this estimate is high, because the side rim of the donor area usually has a lower donor density than hair in the main part of the scalp.
Density:
We must really talk about the amount of hair that must be left behind after harvesting not the hair we are going to take out. In the average Caucasian with average hair density, both residual and donor hair amounts are equal so that we will not be able to €˜see through €™ the remaining donor area after the maximum number of transplants are taken; however, the lower the donor density, keeping the 18,750 hairs in place (to prevent a see-through look) causes the surgeon a problem and in removing the donor strip, the remaining donor skin will almost certainly stretch, reducing the remaining density.
Hair Character:
When a typical Asian patient comes for a hair transplant, the removable hair is substantially reduced (it will leave behind 80% of 18,750 hairs or 15,000 hairs). Let €™s go through the calculations again for a typical Asian patient with 20% less donor density than a Caucasian. The Asian patient would have 15 square inches of usable donor hair and 15,000 remain after the donor strip is harvested. The total supply of the donor area for the hypothetical Asian would be 15,000 hairs or 7,500 grafts. If we then go to a person of African heritage, that number reduces even further (densities in the African can average as low as 60% of a Caucasian €™s density). The removable donor area will yield 11,250 hairs or 5,625 grafts. As the donor area is harvested, it will stretch, reducing the remaining density substantially for future procedures.
It should be evident to the reader, that the size of the bald area is a critical determinant (need vs availability), a conundrum of clear proportion as the real donor hair availability becomes apparent. The quality of the hair (thin vs thick) the character of the hair (straight vs wavy or kinky) and the color of the hair and skin (donor contrast between hair and skin color) must play a significant role in the art of the hair transplant and where to put what hair is available. Make no mistake, this is an art form.
Keeping Some Doctors Honest:
By the above calculations, the Asian patient or the African patient has substantially less hair that can be used for hair transplantation. These calculations assume that the looseness of the scalp is not a variable (of course this is not really true) and that scarring is not a problem (everyone scars to some degree and those that scar worse are in a difficult situation for taking larger number of grafts).
Maybe you will understand better why I get so angry when doctors say that they can transplant numbers of grafts that are in the stratosphere. Some of the recommendations I hear smell of dishonesty or a naivety of the doctor to the basic mathematics of the hair transplantation process.
 
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T

Triathlon

member
wanda wrote:
skin color) must play a significant role in the art of the hair transplant and where to put what hair is available. Make no mistake, this is an art form.
Keeping Some Doctors Honest:
By the above calculations, the Asian patient or the African patient has substantially less hair that can be used for hair transplantation. These calculations assume that the looseness of the scalp is not a variable (of course this is not really true) and that scarring is not a problem (everyone scars to some degree and those that scar worse are in a difficult situation for taking larger number of grafts).
Maybe you will understand better why I get so angry when doctors say that they can transplant numbers of grafts that are in the stratosphere. Some of the recommendations I hear smell of dishonesty or a naivety of the doctor to the basic mathematics of the hair transplantation process.

There should be more doctors willing to post information like this. Not that I suspect what I've been told is untrue. I have dark brown hair and a pale complexion which probably makes me slightly worse off in the skin tone stakes.
The shingling effect sounds positive, I'll run that by the doctor.

 
W

wanda

Member
Glad to be of help my friend....... Don`t rush into anything, research, consult, ask questions and make sure you`re 100% sure before proceeding with any type of treatment.

If in doubt..... Wait!!
 
T

Triathlon

member
I'm all booked up for surgery in October. I'll reveal which doctor after the event which I plan on writing a full account.

 
Bigmac

Bigmac

Administrator
Staff member
As long as you have researched thoroughly and know your expectations. With less than average donor density the doctor will have to plan carefully the best use of your donor supply.
I hope it all goes well for you, it'll be great if you could document your story.
All the best.
Bm.
 
JoeTillman

JoeTillman

Valued member
I recently had a consultation with a reputable doctor who stated my donor density was below average, 1.7 hairs per follicular unit to be exact. I was quoted 2200 grafts to fill my hair line, then continue backwards into sparser areas. He advised that my hair characteristics were good (I have wavy hair) Bearing this in mind, do you think I'd be able to achieve a natural cosmetic look? Without it looking like a hair transplant I don't want to start the ball rolling if I can't achieve a natural look that will last. I'd be grateful for any advice.

Donor density is not measured by how many hairs you have per follicular unit. It is measured by how many follicular units and how many hairs you have per cm2. You could have 1.7 hairs per follicular unit but have 100 follicular units per cm2 (170 hairs per cm2) thereby making your donor supply roughly the same as the overall average of 80 FU per cm2 with a hair count of 2.2 per FU (176 hairs per cm2). It balances out.
Now that you are booked for surgery, how did the doctor explain what your future is like after you have 2200 grafts? For instance, how many grafts do you have as estimate for the total available over "x" # of surgeries? What is your current hair loss pattern and your predicted final hair loss pattern? Are you taking preventative meds to mitigate the chances of reaching your genetic final pattern?
What procedure are you having? FUSS or FUE? Regardless of which procedure I hope you were able to see multiple examples of the work produced by the technique you are having.

 
T

Triathlon

member
Sorry to have left out the donor density and supplying only the hair per graft ratio. I was told I have an average density of 80 per cm2 with more 1 and 2 hair grafts than loads of 3's and 4's which is a bummer for me. I guess that's what stuck in my head. The doctor estimated that I have a range of 6k-7k donor supply. The frontal third of my scalp will be transplanted with the FUT/strip method.

I'm classed as nw 3, possibly progressing slowly to nw 4 stage. I'm counting on branded Propecia and Biotin supplements to prevent this.
I have realistic expectations, my hair will never be as it once was, but I do want it to look natural.
 
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