Do better doctors generally use less grafts?

[Ronnie]

Also, did Dr Saifi map out how many grafts you’d need for full coverage and how many grafts he’d be keeping back for later surgeries? I’m very interested to understand what number of grafts might typically be held back by a responsible surgeon as part of longer term planning.

Cheers

 

[Bigmac]

So I went and got it. Just the 2000 for now but hope to see if this will help a bit and potentially reassess next year if going for more.
Did not start on topical fin and min yet due to the operation but will start soon. Only worry is I was interested to see what the hair results were and then fin so that I could compare the 2 but I guess that's just one of those sacrifices.
Pictures are an hour after the op, 5 days after and the last one 10 days after.

Is it possible to see already from the early pics how it might end up?

Congrats on your surgery. It would be great if you could start a separate thread to document your journey as I know a few are considering Dr Saifi.

 

[Dr. A s Clinic]

Governments don't expect doctors to learn HT before offering it.
That is the ground situation.
So, there are doctors that can take out less grafts.

The corect way is -
1. Ask them how many nature given grafts have been lost?
2. Then aim for a doctor who can extract and transplant atleast 50% of that.

 

[NZK Medical]

The graft numbers should only really be a conclusion to other factors. Rather than "you need x number of grafts". Natural hair characteristics can play a vital role in hair distribution. In some cases from the average adding or subtracting 25-30% of coverage for a similar number of grafts. A clinic may like to max the density placed. Of course, if they grow it can look thick, as it should do. But, maybe not really required to create a natural-looking hair restoration. Also, if hair loss continues even to say an NW4V stage. Could create problems continuing the coverage and implied hair density. For instance, say if over a smaller area around 50% more grafts were used in dense-packing. That could create the problem of donor hair management and blending into the transplanted area and maintaining the density.

Another issue is related and as important. Is the graft extraction, FUT, or FUE. FUE being more popular the transection rate will play a big role in not how many are used. But how many are lost or damaged? If speed is a priority or the number of people punching the donor. Or, just being unknowledgeable about anatomy and skin characteristics. All can increase the number of hair units lost or damaged. That is then not available for future hair restoration. As a result, it´s a two-fold issue. Well-managed donor extraction by someone, the Dr, experienced and knowledgable who wishes to maintain and well-preserved donor. Along with getting the most out of the hair characteristics to ensure a natural hair restoration can be achieved. With the minimal change to the donor and grafts required.

 

[El Chacal]

So how was your experience with Dr Saifi overall? I’m starting to given great consideration to him, I think a conservative approach which favours fewer grafts and gives greater options in the future might be just what’s required for me. His price seems decent too.

Apologies for the late reply.

I didn't get email notifications after the first reply so wasn't aware there were more comments.

As far as my experience- Result is most important and for that I still have to wait and see. On the first day it did look good I think (though I'm not a good judge). He told me it looks amazing and seemed pleased with his work.

A friend who had a transplant in Turkey 6 years ago, who I saw before the shedding told me it looks very good and was surprised at the coverage, and a the fact that he couldn't see the gaps where the grafts came from.

That's all I have to go on for now.

As far as the experience goes, I don't have much to compare it to, but it was about what I expected. It was professional.

We had a meeting at the beginning where he examined my hair and told me what he recommends. I didn't push back and said I'll trust what he suggests. Then it was just the process. Long. Took like 9 hours I think in total. Radio playing and the nurses talking to each other.

Injections were what I expected and didn't feel anything rest of the day.

As for going for an option that requires fewer grafts at first, my own preference would still have been for more grafts the first time. Maybe not 5000 all or nothing, but still 3-3.5 that would still leave me enough to try a second one later.

i think the advice louli gave in this thread would have been best for me. My hair loss is bad and I do feel like saifi is the perfect option for those with less severe hair loss.

But for logistical saifi was the best option for me and I felt it was still better to get the 2000 done now, and see where I am than be waiting and searching for God knows how long

 

[El Chacal]

10 weeks post op this is what my head looks like.

Very much the ugly duckling phase and guessing that will still go on for a while.

As was advised by a few in this forum, I am considering starting min and fin.

I wanted to ask though, as I will hopefully at some point over the next few months be going into the period of some regrowth, if I start fin or min I fear I wont be able to differentiate between what growth comes from either of the medication and what from the transplant.

Thus would never really be able to tell in case I was a lesser responder to either medication and never really be able to tell in the future if it stopped working to stop using it.
Is that overthinking it?

And for either of these medicaitons, does the brand matter? Is it worth researching which brand to go with or just getting my hands on it and starting ASAP?

 

[Eugenix Hair Sciences]

Hi,

I am between NW4 and NW5 and considering a transplant, having previously stupidly ignored my hairloss.

Having sent my pics to 2 Turkish clinics. 1 quoted me 4500 grafts. The other quoted me 4500 grafts - if I first take fin for 6 months and get back to them then.

I am however willing to pay a little bit more to get better results, putting other countries in Europe on my radar.

I have sent my photos to a doctor who is rated maybe slightly higher than the Istanbul hair mills, and whos location would be easier for me to get to than Turkey.
This doctor said I would need 2500 grafts. Almost half what I was told in Turkey.

Is this more expensive doctor quoting me a smaller figure because he can do more with less? Or did he just misdiagnose me? I sent him the same pictures as the others.

2500 with him would still be a bit more expensive than 4500 in Turkey, but if I am paying more for similar results but to leave donor hair for future transplants I would consider it worth it.

For reference I have attached my picture below.

And if so, what clinics in Europe would best fit this mid level tier – more money, less grafts for similar result?

Thanks for any help.

View attachment 29376

Can you share more pictures of your scalp for evaluation? We would like to see the crown area also.

 

[arthurSam]

I think it is not graft count which is important but hair count. If the doctor for example use FUT he can place a lot of 4 or 5 maybe more graft because of strip extraction but if FUe he is limited to 2 or 3 max because of extraction and placement if he use dhi and no pre incisive? So total amount is not related to graft (number of inserted fu) count it depends of the strategy used by surgeon (lot of 4 5 will give less graft (insertion) that more graft with 3 4 but same amount of hair


Am I wrong ?

 

[NZK Medical]

I think it is not graft count which is important but hair count. If the doctor for example use FUT he can place a lot of 4 or 5 maybe more graft because of strip extraction but if FUe he is limited to 2 or 3 max because of extraction and placement if he use dhi and no pre incisive? So total amount is not related to graft (number of inserted fu) count it depends of the strategy used by surgeon (lot of 4 5 will give less graft (insertion) that more graft with 3 4 but same amount of hair


Am I wrong ?

Hello @arthurSam, regardless of FUE or FUT, they should adopt the method of using the natural follicular units (FU) found in the donor growing. As a result, usually, there is a mix of 1 to 4 hairs per follicular unit. With a greater number of single and two-hair units around the sides. Meaning a greater % of three and four hair units around the back of the head. On say a 2000 graft procedure the average hair count is going to be around 2-2.4 hairs per follicular unit placed. In a smaller hairline procedure when the single hair count is a higher % of the total that hair count can drop to below 2 hairs per follicle unit placed.

FUT the strip is first taken and divided into smaller strips. Then divided again to start isolating the naturally growing follicular units. Of course, larger grafts can be created by combining adjacent FUs to increase the hair count per graft. But ultimately the hair count is going to be the same. All that is achieved in this case is a larger group of hairs bunched together. This could look unnatural or create styling problems when grown out. FUE is removing the individual FU´s. The punch can encompass one intact FU. But, if the punch diameter is large enough it may overlap and remove more than one follicular unit in a single punch. This increases the risk of transection and damaging any hair follicles not removed but cut. It will increase the number of hairs per FU potentially. But that does not mean a better result is achieved. It could potentially also increase visible scarring due to the extraction pattern needed.

The placement is a separate issue, be it by custom-made incisions first and then the hair units being placed with forceps or an implanter tool after. Or if an implanter is used directly to make the hole and implant the hair unit in one action.

 

[arthurSam]

Thanks you !
But I don't understand why some surgeon make 6500 hair for front/mind scape with a FUT by doing 1300 insicives so they use 1 and 2 to hairline but a lot of 4, 5 and more graft no ? Are these surgeon must absolutely be avoided and are fooling there patients ? I have this case so I am very disappointed! My surgeon have very well advice and a lot of good returns... and practice from more than 20 years

 

[Philw]

End of the day some surgeons are better than others
So make little grafts look like more than they are
It all depends on texture of hair and the surgeon
U need to speak to top surgeon and ask them what result u can achive
Remember u will never get density u want
I

 

[NZK Medical]

Thanks you !
But I don't understand why some surgeon make 6500 hair for mind scape with a FUT by doing 1300 insicives so they use 1 and 2 to hairline but a lot of 4, 5 and more graft no ? Are these surgeon must absolutely be avoided and are fooling there patients ? I have this case so I am very disappointed! My surgeon have very well advice and a lot of good returns... and practice from more than 20 years

Hello @arthurSam, if I understand correctly, the numbers you quote don´t really make sense. So if you are quoting a real case it would be interesting to see. The reason is if 1300 grafts/ insicives are placed. With a hair count of 6500 individual hairs. That makes the average graft 5 hairs. As a result, assuming some single and two hair units were used. Some grafts contain considerably more than 5 hairs, maybe 7- 8.

FUT it is easier for this to be practiced, simply because when the grafts are divided they can be left in larger units. FUE it is still technically possible if the punch diameter was large enough and or the FU density in the donor was high. But, they still need to be placed and the recipient sites would have to be made accordingly as often the shape or size is going to be very different from the norm. With 6500 normally being in the region of 2700 to 3200 grafts. As some clinics charge per graft and not hairs this would not make sense for them to use this method. Even if a flat rate is charged it is unlikely to compensate for the difference in individual hairs placed. If you know of a case it would be best to discuss it directly with that clinic.

 

[arthurSam]

Wel it is my case and I am a bit worried about that. They show me grafts with 5 and even more hair on it during the session when I said that 1300 incisive seems very low for 6500 hair...and they told me to not worried because I have a lot of 5 even more hair... They say that I got even more than 6500 to reassure me. My scare is 29.5cm long by about 1.6 so it seems reasonable for 6500 hair I think. I don't imagine they drop out my hair... well I hope lol

But that seems weird I cannot find any other example of that... and I am worried for result too...

Perhaps it is some type of MFUG but well I don't know...

I just hope they don't abuse me ... the surgeon is very present for his clients and he respond to all my questions by phone very fast...that would be weird because they seems well established but who knows !

Nevermind thanks you for your answer that confirm me that it is not a regular hair transplant

 

[NZK Medical]

Wel it is my case and I am a bit worried about that. They show me grafts with 5 and even more hair on it during the session when I said that 1300 incisive seems very low for 6500 hair...and they told me to not worried because I have a lot of 5 even more hair... They say that I got even more than 6500 to reassure me. My scare is 29.5cm long by about 1.6 so it seems reasonable for 6500 hair I think. I don't imagine they drop out my hair... well I hope lol

But that seems weird I cannot find any other example of that... and I am worried for result too...

Perhaps it is some type of MFUG but well I don't know...

I just hope they don't abuse me ... the surgeon is very present for his clients and he respond to all my questions by phone very fast...that would be weird because they seems well established but who knows !

Nevermind thanks you for your answer that confirm me that it is not a regular hair transplant

Hello @arthurSam, you are welcome. Have you asked the clinic to comment and make sense?

29.5 x 1.6 cm strip is not particularly small. If you take an average of 75 FU cm2 around the donor area. That would give you around 3500 natural follicular units/grafts. As a result, that would equate to around 7000 hairs on the very low side to the average 8400 hairs. So, potentially could be higher.

It´s worth having a chat with your clinic, for your peace of mind. Maybe they did place larger grafts in areas to bulk up your result. It can also depend on your natural hair characteristics. Often used if the hair calibre is very fine and placing more hairs can build up the look of fullness in some areas. Best wishes,

 

[arthurSam]

Thanks again I will take contact with them using what you explain to me !

 

[Dr Arvind]

Graft availability depends upon the numbers that the doctor/clinic can extract.
Currently, that is the stumbling block as many can not extract hair from the beard, cheek and difficult areas like axilla.

If the patient has ample beard and body hair, then he should be made aware that he can go for a fuller hair transplant.

 

[El Chacal]

Hi all,

Thought I would do a quick update. Could not log in while I was away for a few months so will check back in now.

To recap, I had around 2260 grafts in April. I did not have that high expectations considering the low grafts. But I went for it because it was a convenient location and short wait list to at least get the process underway. If I had decided to go for a bigger operation somewhere else, to choose the right one, get the logistics to match and the potential waitlist, I probably would still be waiting.

Process went as expected. New hair disappears after a week. Then starts growing out slowly and mostly unnoticeably.

The first minor triumph was that 4.5 month stage I met people who I last saw 2018 and I was basically in the same position I had been 4 years earlier. I was balding then, but the further hairloss had been retransplanted so with fibres- they looked the same.

A month after that, 2 friends who knew I had a transplant commented that it looked good. One who had a transplant in Turkey himself before, and knew how little grafts I had. was very positively surprised.

So the result was, as long as my top hair is long enough - my sides short - (otherwise you can see the thinning) and when adding hair fibres I was able to walk around and look like I had some hair rather than a nw 5-6 and thats an improvement on where I was.

Id like to thank bigmac for his analysis that 2000 grafts could help if I have the right expectqations and it has.

Of course the people I know who I play sport with, don't notice a difference though as with the sweat and without fibres you can see the bald spots all over.

I have no specific photos of the hair, but as an example, this is one I have cropped from a group photo at the time that shows that with fibres, at least the bald spots were not obvious.

View attachment 37168

However.

A couple of weeks ago, as I knew I would be largely indoors for the Holiday period, I decided to shave my head. Let it all grow out again. Perhaps better absorption of minoxidil and co with less hair.

I was quite shocked once the hair grew out a little how bad it looked. It looks now like only a handful of grafts survived the operation.

Here is how it looks.

View attachment 37170

And this photo is better than what it was a few days before when the hair was shorter still.

I notice there are patches with a little more hair but largely the head is full of empty spaces in between.

I wonder, did the Dr batch a lot more grafts into specific areas of the scalp precisely because when the hair grows it will create a better illusion?

Im ok with that as long as its good once it grows out again. I cant have too high expectations with the low number of grafts I had. That said at the moment I look awful.
But at least it should look passable once it grows out again.

Hopefully months 8-14 have some more growth to add to it. And maybe the fin and min could help out as well.

If not. then I have the option of another operation to add some density. Not sure what the right time after the first transplant is.

 

[El Chacal]

Hey all.
It has now been almost 14 months since my operation, and I wanted to ask a question about moving forward.

To recap, I (33) had around 2260 grafts 14 months ago. May hairloss was bad and every other doctor suggested I should have 4000+ grafts.
Due to logistical reasons I decided to go ahead with the smaller surgery (original plan 2400 grafts). in order to at least take a step in the direction of addressing the problem.

I am quite happy with the result considering the low number of grafts. I no longer look mostly bald and if there isn't a light right above me it looks like I have hair. I also got good feedback from those who remembered how I looked like and on pictures the difference is big.

Compared to a similar angle before the transplant.

However, my hair is still obviously very thin, its pretty much just the 2000 grafts that cover the entire front where there was almost nothing.

I'm considering going back to do another surgery in the fall. This will be roughly 18 months after the first surgery. Is this too quick a turn around? Should I wait a few years for the hairloss to progress before going again?

I would like to get around 2000 to hit the original 4500 I probably should have got in the first place

At the same time, despite pushing many months through the side effects with finasteride, it did nuke my libido, even at tiny doses so I realize fin is probably not feasible for me moving forward.

I would be therefore limited to hair transplants as my sole way of combatting hairloss moving forward and don't want to overuse the grafts to save for in the future.

 

[Dr Arvind]

I would say that the question is wrong.
Better doctors can take out and transplant more grafts!
In 2001, maximum 3000 grafts could be transplanted...worldover.

2005 onwards, we could take out 6000 grafts.
Even today, we can do 8000 fue grafts routinely from the scalp and beard donor areas.

-----------------------------
Its important to first understand or ASK "How many grafts have been lost?"

Otherwise, you are limiting your options based on the lack of skills of the doctor/clinic.

Regards,
Dr A

 

[Dr Arvind]

Hey all.
It has now been almost 14 months since my operation, and I wanted to ask a question about moving forward.

To recap, I (33) had around 2260 grafts 14 months ago. May hairloss was bad and every other doctor suggested I should have 4000+ grafts.
Due to logistical reasons I decided to go ahead with the smaller surgery (original plan 2400 grafts). in order to at least take a step in the direction of addressing the problem.

I am quite happy with the result considering the low number of grafts. I no longer look mostly bald and if there isn't a light right above me it looks like I have hair. I also got good feedback from those who remembered how I looked like and on pictures the difference is big.
View attachment 40503
Compared to a similar angle before the transplant.

At the same time, despite pushing many months through the side effects with finasteride, it did nuke my libido, even at tiny doses so I realize fin is probably not feasible for me moving forward.

I would be therefore limited to hair transplants as my sole way of combatting hairloss moving forward and don't want to overuse the grafts to save for in the future.

Use Gene therapy for hairloss instead of finasteride.
I never advise Finasteride for my patients due to its serious side effects.