Why Didn’t My Surgeon Just Make My Hair Dense in 1 Surgery — Now I Need Another Procedure?

I had a hair transplant 15 months ago using the strip method procedure. I only had the temple areas done for my receding hairline. I am happy with the procedure, however i would of liked slightly more density. I told this to my surgeon who said he could preform another transplant but i was confused to why he couldn’t of transplanted such two small areas in one session. My worry is that my scar although really well concealed and unnoticeable it is very long. Im worried i dont have enough donor hair now incase i developed into a norwood 7 (completely bald). I know unless you seen me face to face and analyzed my head you couldn’t tell however here is my question. If my transplant surgeon has used alot of donor supply another strip procedure would obviously not be a good idea.

Here is my thinking and i might be wrong so please explain if i am. If i have already had a strip procedure and i wanted another transplant i think FUE would be a better second procedure as you have ability to choose hairs from different areas from the donor area thus being able to use more hairs than you could from a strip procedure. The reason for this is that a strip procedure can only can only be extracted in one long strip which is wasting useable hairs, however with FUE i feel that if someone has had a strip procedure which has used a large amount of surface area obviously another strip procedure would be difficult as theres not enough space for another slit and but with FUE you could extract hairs from all over the donor area. Am i thinking correctly. The doctor told me he transplanted 1464 hairs. is that too much for a receding hair which goes back 2 inches, which means he mustn’t of transplanted that many? Please reply. Thank you NHI team.

I really don’t have a clue as to the size of your recipient area for those 1464 hairs. Assuming that it was 1464 hairs (not grafts), that means that the strip taken should not have been very large (in surface area, that is). The normal person has 1250 hairs (or 625 two-hair grafts) per square inch. At a transplant, you can calculate just what you received by figuring out the square area of the recipient area. Let’s say, for example, that you had 4 square inches of hair transplants in an area that was originally bald. That means that if you had normal hair without balding, the area we are talking about would have had 5000 hairs (or 2500 grafts) in it. If your surgeon put in 183 grafts per square inch, that reflects about 29% of the original density into that recipient area for an average Caucasian density. That is a reasonable number of grafts from a density point of view, but fullness reflects many other factors, including thickness of the hair shafts (coarser produces much more bulk than fine hair), color contrast between hair and skin color (the lower the contrast the better), the degree of wave or natural curl (straight hair is not as good as wavy hair), and the hair styling you use (short requires more density, but long does not unless the hair is fine).

The average donor supply for a typical male is about 20,000 hairs (or 10,000 grafts) and this is dependent upon the laxity (looseness) of the scalp. Based upon the number of grafts you receive as discussed above, you should have a great deal of donor hair left. The scar should be managed by your doctor and removed with the next surgery and a trichophytic closure should be done to manage the scar. Be sure that your laxity is good and do the exercises before the next surgery (see video). There is much controversy to the issue of just how dense one has to make it. I generally shoot for 25% or the original density, but in the very front of the hairline I might go a bit higher (35-40%) if the hair is fine. Transplanting hair into a bald area has mechanical limits that may reflect growth, graft damage and other factors unique to the surgical team and your unique circumstances.

FUE as a unique procedure is not very efficient in most surgeon’s hands. I believe that you are incorrect about FUE vs strip surgery. The strip method may be more efficient in the long term. Once you had a strip, it may be better to remain with it. With regard to your scar, some people just form wider scars than others. The use of special closures like trichophytic will automatically force hair to grow through a wound, but it does not sound like that is the type of closure the doctor used on you.

Progressive balding is something that occurs in every person with genetic hair loss, but fortunately only about 7% of the male population will end up with the Norwood Class 7 pattern. All good surgeons should have a Master Plan for your worse case scenario for balding, so if you should be unfortunate in developing a Class 7 pattern (even with good drug therapy) you should still have a normal appearance. I have been doing this for 18 years, and I admit that did not have the same type of common sense in my first year in practice as I do have now. There is no real substitute for that type of experience, particularly in determining the rate and degree of balding progression.