Besides the decision as to graft type, another important decision regards how many sessions are likely to be needed to achieve the patient’s goal of a “full, natural head of hair.” With rare exceptions, this process usually takes 2-3 sessions in our practice. Most of our female patients and those males with some remaining hair on top are completed in two visits. Most men who are totally bald take three sessions to complete. We believe there are several good reasons to accomplish a patient’s transplant over time in 2-3 sessions:
Such an approach respects the blood supply of the scalp, leaving some space for blood to reach all the grafts planted, with a resultant high-percentage yield of survival for those hairs.
The surgeon can be more artistic, similar to a painter, who goes back to his easel repeatedly, making artistic “touches” to his work as he views it unfolding.
A larger area of the scalp can be worked on. We offer a “dense-packing” 1500-3000 FU session, which seeks to fill in the area transplanted in one session, but it is a very laborious and expensive way to transplant, and only certain patient have the necessary hair characteristics that will enable this method to work. The hair must be reasonably coarse, the scalp’s thickness must be above average, and the number of 2 and 3-hair FU’s must be higher than average. (See section on “Dense-packing mega-sessions”). The great majority of our patients, both male and female, present to us requesting that at least the front 75% (all but the rear vertex) or the entire “U” shaped balding area be filled in. Using “combination” grafting, this is a do-able project and we have been very successful with our approach of using 2-3 sessions to accomplish the task. If all FU’s were scattered over such a large area, it would have a very uniform and “thin” look without the usual natural gradients of density we see in the natural state.
Gradients of density can more easily be created. In our transplanting, we try to reproduce a pattern of hair that could be naturally seen on someone’s head, such as in a man who is only starting to thin in the crown or the crease areas.
The financial burden of having a transplant is spread out over time a little more. In the meantime, even 6-8 months after the first session grows out, there is an immediate positive change in the person’s appearance. The patient can then control over how much time he wants to have the sessions and can schedule his follow-up procedures according to his wishes for more density and his ability to pay for the added work.
Hair survival percentages are very high. We have conducted 4 different research studies (see research section) looking at the survival of different types of grafts. Our studies suggest that the multi-FU type of graft more consistently survives in the near 100% range, and can be an important contributor for later density.
There is less risk for a wide donor scar. By limiting the width of the donor strip to 1cm in width, and then going to whatever length is necessary for that session, and spacing the sessions at least several months apart, the scalp in the donor area has time to once again becomes lax. At the next transplant session, the donor hair is obtained from just above the old scar, with a single thin scar resulting at the end of the 2-4 procedures. We feel that trying to obtain 3000+ FU’s at a single session requires a much wider strip and carries with it the risk for a wide scar later on.