Why Didn’t You Transplant 5000-6000 Grafts For a Norwood Class 6?

In the piece dated October 19 “Goodbye Combover, Hello Hair!”, I am critical of your choice to limit the graft numbers. You should have performed 5000-6000 grafts in a Class 6 patient. Why didn’t you?

Here’s the post you’re referencing.

The number of grafts that were transplanted on this patient was the maximum safe amount that could be harvested, reflecting the density of this man’s hair in the donor area. If the grafts were cut down to single hair grafts, the number would have been more, but the amount of hair would have been the same. Some doctors would have cut the follicular units down to single hair grafts to make some more money out of the patient (since they charge by the graft). Not only will that not produce more hair, but it would be unethical to milk this patient’s pockets for more money. Cutting the grafts down would have yielded less hair in the long term, as all of the cut grafts may not grow as well.

With his fine hair character, this patient needs 5000-7000 grafts to get excellent coverage. On the day the initial blog post was published, I repeated the procedure and only got out 1706 more grafts — again, because that was what was safe (there are no results photos yet, as the procedure was just over a month ago). Each person is different, and while some people have enough scalp laxity to allow for a larger strip (with more hair), some people will only have enough for a smaller strip.

The photo on the left is before; the photo on the right is after one procedure of 2590 grafts. You should note that the transplants were artistically weighted to the frontal area to produce the best frame for his face and distributed to the back with a much lower density to reflect the limited number of grafts. Click the photos to enlarge.

More photos of this patient can be see at the original post —Goodbye Combover, Hello Hair!