My Surgeon is Reluctant to Do a 2nd Hair Transplant!

Dear Dr Rassman,

Great blog with an incredible depth of information. I had a hair transplant 12 month ago with a reputable European surgeon. I am very pleased with the result; I had 1500 grafts placed at the front, restoring my hairline as i have quite thick hair. However, I was considering having further surgery to further thicken the frontal areas and also increase the density around the temples.

My question is two fold:

1. Would you recommend such as course of action? My surgeon is reluctant to do so in case there is future recession behind the grafted hairline, thus causing a splitting effect. I am currently on propecia and have not noticed any further recession but am aware this may happen.
2. How many hair transplants can you reasonably have and what is the optimum amount of hair you can transplant? I ask this because I am slightly conscious that if i do have further surgery to thicken up the front then i might not have enough supply if i do further recede.

1. I have no recommendation. How can I? I have never seen you, examined you, or even have any idea of what your balding pattern and level of thinning or your donor hair density, etc. Before any surgery, you must have specific goals and a Master Plan, which is a plan for your future balanced with your donor hair reserve (this is very important).
2. The number of surgeries or the optimum number of hairs you can transplant is highly variable on each individual. It depends on your hair density, scalp laxity, the number of grafts you attempt for each surgery etc etc. These are very basic questions that your surgeon can easily answer. I want to help you but you need to first start by talking to your doctor and asking these same questions to him. Maybe you can write your questions down on a piece of paper and ask those questions one by one to your surgeon. I am not trying to be facetious but I do realize that maybe when confronted face to face with a doctor your mind may go blank.

For your general knowledge, the donor area is between 25-35% of your total scalp area. That means that the average person with 100,000 hairs on their head have around 30,000 donor hairs. Keeping half and transplanting half means that this person with average sustained laxity can move up to 15,000 hairs or 7,500 grafts in his lifetime. Those with higher densities can move more, those with lower densities can move less.

The Asian man with 80,000 hairs or the African man with 60,000 scalp hairs still must maintain 15,000 hairs (approximately) in the donor area. That means that the number of transplantable hairs in the lifetime of a person with low density will be less (you can do the math). With these numbers, your having 1500 grafts means that you probably had 3000 hairs transplanted (assuming that you have an average hair density) leaving you with lots of reserve hair for future hair loss. This is a general rule, and your doctor will modify it based upon his examination and your vital statistics. If your scalp became tight after one strip harvest procedure, then you may not be a good candidate for another surgery, but possibly follicular unit extraction (FUE) would be a good alternative.

Further reading on this topic:

• How Many Donor Grafts Does an Average Person Have?
• How Much Transplantable Hair Does A Person Have?
• Follow-Up: Are Doctors Promising More Grafts Than Can Possibly Be Delivered?