About Norwood scale, the bald people and graft estimates

Hair Transplant
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How does one determine where they will ultimately end in the norwood scale if they are in their 20s?

How does one determine the graft requirements if one is a norwood 6?

How does one decide the hairline one wants or whether one wants a hair transplant at all?

What is a graft estimate? Is it what you, as a patient will need? Or, is it what your doctor can deliver?

By using common sense, trusting ones own instincts and researching thoroughly it is possible for the layman patient to answer these questions.

Its not difficult and I will try to illustrate some points that I tell all my consults.

But first, I would like to hear inputs from the veteran posters and readers to get untainted insights about the above questions.

Regards,
Dr. A

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1. How does one determine where they will ultimately end in the norwood scale if they are in their 20s?

Hope for the best, but always prepare for the worst.

Be prepared that your hairloss may progress to norwood 6 level no matter what your current hairloss status.

That way, there will be no unpleasant surprises in future.

All plans for hair transplant should keep this in mind.

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2. How does one determine the graft requirements if one is a norwood 6?

Whatever the norwood scale, start from calculating the follicular units that have been lost to MPB.

A full non balding head has, on average, 40,000 to 45,000 follicular units.

A Norwood 6, for example, has lost atleast 50% of nature given hair follicular units (that is 20,000 to 25,000 follicular units).

Any conventional attempt to restore hair will need atleast 50% to 60% of the follicular units lost. That is 10,000 to 12,000 grafts.

Else, the patient will have to settle for high hairline, deep temple recessions and a bald crown. This will reduce the recipient area to manageable proportions.

This is plain and simple mathematics and should be clear to the patient before he decides to get his first HT.

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3. How does one decide the hairline one wants or whether one wants a hair transplant at all?

The decision to undergo hair transplant is a very serious one.
Once, the prospective patient knows the large number of grafts that may be required at present and in future, he is better equipped to decide whether to undergo hair transplants. He may decide not to undergo hair transplants.

If he is committed and decides he wants to undergo hair transplants, he should decide the hairline he wants.

Choosing ones preffered hairline in the first HT itself is very important.

Why?
Because, in most clinics around the world, he will be given the option of only strip FUHT. And only scalp graft procedure.

A situation may arise when most, (if not all), scalp donor is used up creating a very high hairline and top-vertex area.

Thereafter, if the patient wants a lower hairline, it becomes difficult because the hairline should consist of mostly scalp donor hair.

Therefore, if you want a lower, youthful hairline, its better that be done at the first or atmost second HT.

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I would like to use the approach of creating a lowish dense (scalp hair)hairline and complete coverage of vertx ad crown in one session by leaving all the density behind the hairline low (25fu/cm2). The density would then be increased with subsequent procedures. Unfortunately it seems that surgeons no longer like to go back into an area once transplanted but they don’t mind going between native non transplanted follicles. I suppose we can’t have our cake and eat it-or can we?

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» I would like to use the approach of creating a lowish dense (scalp
» hair)hairline and complete coverage of vertx ad crown in one session by
» leaving all the density behind the hairline low (25fu/cm2). The density
» would then be increased with subsequent procedures.

Dear marco,
Why do you wish to follow this approach?

Regards,
Dr. A

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» » I would like to use the approach of creating a lowish dense (scalp
» » hair)hairline and complete coverage of vertx ad crown in one session by
» » leaving all the density behind the hairline low (25fu/cm2). The density
» » would then be increased with subsequent procedures.
»
» Dear marco,
» Why do you wish to follow this approach?
»
» Regards,
» Dr. A

Hi Dr. A, sorry that probably wasn’t very clear.

On the basis that 6000-7000 robust grafts would be needed then, if this would need to be done in two sessions, I would rather get total but thin coverage in the first session and improve density in the second. This is as opposed to covering half densely in one session and then the other half densely in the second session.

Of Cause, if you believe that the total number could be achieved in a single session then that would change the premise.

Thanks, Marco.

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»
» Of Cause, if you believe that the total number could be achieved in a
» single session then that would change the premise.
»
» Thanks, Marco.

Yes, for most individuals 5000 to 8000 grafts is possible in a single session (visit).
Most will require a combination of donor sources, and even techniques, to acheive this and higher number of grafts in 1 visit.