Graft Count Estimates

Hi Dr. Rassman,

I am a 32-year old male who had HT surgery in San Francisco in 2002. At the time they intended to do only 600 grafts, but since my car got towed during the consultation, the doctor threw in 100 free grafts, for a planned total of 700.

Interestingly enough, when they harvested the strip from the back of my head, they had 800 (!) grafts available, and of course all of those got put in. I have a very nicely shaped hairline and some diffuse crown thinning, but I have been taking propecia since 2002. My father is 67 next month and has a full head of black hair, but my mom’s father was bald by 25.

I’m considering going in for another 2000 grafts to really increase the density in the front and maybe lower the hairline if it’s appropriate. I’m going to be running for public office in 2010 (I don’t want to say which office to preserve my anonymity, but suffice to say this would be a career change). One doctor told me he felt I had a donor density of around 120 grafts/cm2 and another consultant (not a doc) said I probably had 7000 grafts available in my head. Would 2000 grafts deplete my donor density or does 7000 sound really likely? Moreover, what are the chances of them going to take out 2000 and getting like 2300, based on my previous HT.

Thanks!

You need an experienced doctor, not a salesman, to tell you what your density is and what your reserves are like. This conforms to the Master Plan I continuously talk about. Depleting the donor supply can occur with 2000 grafts, so you must be confident that your doctor levels with your and it honest about your future.

To estimate the number of graft, one must know the density of the donor area. A density of 2.1 hairs per mm square will produce approximately 100 follicular units per square cm. The calculation is relatively simple by figuring out the number of grafts one needs and plan on excising that size of a strip that conforms to the above density. There are adjustments that are required which reflect the amount of tumescence (fluid and local anesthesia) that is injected into the donor strip. As the density goes up by 20%, then the yield will go up by 20%. The same is true for 20% reductions in density (as occurs in the average Asian). The adjustments must be made and tied to the measured density of the donor area as seen in a number of sampled areas. I published the formulae for this process in International Journal of Aesthetic and Restorative Surgery back in 1995 (see article).