Dr. Rassman, I’m surprised no one else has raised this issue with you given the activity on various hair transplant discussion boards during the last few months. My question concerns the quantity of grafts in the donor reserve.

On these boards, I see a new trend of very young men wanting high density transplants to restore their juvenile hairlines and being transplanted under the assumption that they have, *on average*, 10K-15K grafts available via both strip and FUE. When the blarney of the clinic(s) making these graft count claims is questioned by more critical posters, the young men in question usually get very defensive and end up expressing their confidence in their doctor(s), and say that even if such estimates are exaggerated, surely some new drug, or hair maintenance, will come along to help them by the time their balding progresses to the point of making their transplants looks unnatural.

Since you believe in documenting scientific findings and have published the pathbreaking papers in this field, do you feel that these young men are being sold a false bill of goods? Can any clinic in good conscience be promising to be able to harvest twice as many grafts as we previously believed available? Has there been some breakthrough in graft harvesting capabilities that the laymen has yet to hear about? And should hope about the availability of future technology being able to benefit patients ever be part of a Master Plan?

You raise a very good point and concern. A typical hair transplant procedure of an average male with good scalp laxity will yield 3000 to 3500 grafts in Caucasians (who often have higher densities than Asians). The most that we were able to yield in one single surgery was about 5800 grafts from a patient with a very high donor hair density and good scalp laxity. This was the exception to the rule, of course. Some doctors split the ‘follicular units’ into smaller units and then charge the value of the ‘split’ number. So if a doctor got 3000 grafts, by dividing the grafts into smaller units, he/she may be able to charge for 5000 grafts and give the patient a feeling that he got more than he really did.

Thus, I very highly doubt that any clinic can yield 10,000 to 15,000 grafts in one procedure. They may be cutting all these grafts (which contain one, two, three, or four hairs) into single hair grafts. See my recent post titled How Do I Know I Am Getting the Number of Grafts I Am Paying For?. I feel strongly that splitting grafts to make money from patients is highly unethical and desperate patients are ultimately paying a price -– not only in financial terms, but in a lifetime of potential disfigurement from a depleted donor supply.