Please Clarify Why The Asian Patient Could Not Get 6,000 Grafts in One Session

On August 12th, you wrote a post about megasessions suggesting that the Asian patient would probably not be able to to get 6,000 grafts in one session. Please explain your logic.

A Caucasian with an average hair density would have 1250 hairs per square inch found in 625 follicular units which average 2 hairs per follicular unit. A typical Asian patient would have 1000 hairs per square inch found in the same number of follicular units (625) averaging 1.6 hairs per follicular unit.

This particular patient was measured by me to have 500 follicular units in a square inch, thus averaging 1.4 hairs for each follicular unit. In a FUT strip surgery, one would have to remove 12 square inches of scalp (from the strip) to get 6,000 grafts. In other words, to get 6,000 grafts from a strip surgery, the doctor would have to remover 12 square inches of scalp with a width of 1 inch and a length of 12 inches (imagine a school ruler sized area of scalp removed)! This is a very wide strip for very low hair yield of 9600 hairs from the targeted 5,000 follicular units (a typical Caucasian would yield 15,000 hairs) from that same strip size.

The issue of safety is the real issue here. What are the risks of removing a 12 inch by 1 inch strip from the scalp? In the hands of any surgeon, the main risk will relate to (a) wound closure, (b) wound healing, and (c) scalp necrosis. In some hands, this type of surgery might work when good judgments are used. All of these are huge risk categories for the patient and most of these complications come with significant infection that sets in after the surgery. I remember one patient who had a strip taken that was too wide. He suffered from Scalp Necrosis

The first time I saw him was about a month following the strip transplant. He presented with active necrosis and an infection of the wound. As he healed and the infection was controlled, he developed a very wide scar. With the help of Dr. Kabaker (Oakland Surgeon) and we put in a balloon tissue expander into his head and after 10 weeks of constantly inflating the balloon, we removed the scar successfully. He was lucky as his infected scalp could have killed him. The scar he ended up with was minimal. He was very grateful. I remember another patient who came to see me 6 months following his second session of FUE, bringing his total FUE count to 6700. He had poor growth and loss of much of his donor area hair. The grafts probably were taken too close to each other impacting (I believe) the blood supply to the donor area.

For this Asian patient, his scalp was tight and his donor density was poor. His balding pattern was a Norwood Class 5, which meant that we felt he could not achieve his goals of a full head of hair in one large transplant session.

What is the take-away here? Be careful and do your homework when checking out your doctor for any cosmetic surgical procedure. If something sounds too good to be true, get a second opinion. We are talking about not only your looks for the rest of your life, but possibly your life. This is true about any elective surgical procedure and hair transplantation is just one of the examples which I defined here.