What is the maximum number of follicular unit grafts I can get in a single hair transplant session? Why are some hair loss doctors constantly pumping out larger numbers while others aren't. Are these physicians superior to those who do smaller sessions?
No hair restoration physician has magical powers so therefore the number of grafts is based on a few constants and a few variables that must be taken into consideration. In my below description, let's assume we are talking about a single patient going for the largest session size possible.
First, the constants: no matter which physician a patient sees, these constants remain the same for a single hair transplant patient
- Donor hair density (the number of follicular unit grafts per square centimeter in the area where the strip is to be taken)
- Patient's donor scalp elasticity (this refers to the laxity of the skin in the donor area which will inevitably affect how many grafts can be safely taken)
Now, the variables that will vary between hair transplant clinics
- The width of the donor strip taken: Some physicians are willing to push the envelope on the scalp elasticity, while being careful not to compromise integrity, by taking a wider strip (from top of the head to the bottom)
- The length of the donor strip taken: Simply put, if you want more grafts, take a longer strip (ear to ear and sometimes beyond). Some physicians are willing to go outside of the universal safe zone if the patient has a low chance of balding in those areas. I am an example of this (see my experience below and follow to my third surgery with Dr. Hasson).
- The size of the graft: Follicular unit grafts are hairs as they occur naturally in groups of 1, 2, 3, and 4 haired grafts.
- There has been some speculation that some clinics cut smaller grafts. Whereas one clinic may see one 4 haired follicular unit graft, another clinic may see one 3 haired grafts and another 1 haired graft. Clearly clinics who cut smaller grafts will have inflated graft counts even when the number of hairs will be the same.
- Some clinics will create what is referred to as a DFU or double follicular unit which combines 2 follicular units into a larger unit.
- Most if not all clinics will occasionally cut larger grafts into smaller singles to use for the hairline.
- Whether or not these clinics count grafts before or after they combine or further cut grafts.
- Physician experience and philosophy: Some physicians don't have the experience to perform these larger hair transplant megasessions and simply fear change. They'd prefer doing what they are comfortable with and won't evolve with the times. Others have the experience but prefer doing multiple smaller sessions as to minimize the risk of donor scar stretching. However many clinics who perform regular large sessions have proven that these sessions can be performed without causing additional donor scar stretching.
- The size of the hair restoration clinic's staff: Though some physicians have the ability, experience, and philosophy that allows them to perform larger sessions, some simply don't have a large enough staff. A greater number of grafts require more hair transplant technicians carefully cutting and placing.
Taking all of these into consideration, this is why maximum session sizes vary from clinic to clinic.