I wrote the following text as many members of the forum asked how we present nice results with less grafts than the usual. The answer to that is that at DHI we achieve better results by using fewer grafts because we do not separate and generally we do not handle the grafts which we receive from the donor area.
The explanation for the above comes down to the fact that for density in the recipient area, the number of hairs implanted is mainly responsible and not the number of grafts. Due to the fact that each graft does not have, most of the times, only one hair but more, the variable that plays a key role in achieving a good result is the “ratio” between the hairs that sprout from the exported grafts and the number of grafts (hairs / grafts). This way, the higher the ratio the higher density of hairs in the recipient area and the better the final aesthetic result.
For example, if for an implantation of 1000 grafts, the ratio is 2,6 then in the recipient area a total of 2600 hairs are implanted. If the ratio of an implantation of 1200 grafts, in the same recipient area is 1,7 then in the area about 2000 hairs are implanted. From the above example it is understood that even though in the first case (1000 grafts with 2600 hairs), the number of grafts is smaller, the final result is expected to be better than the second case (1200 grafts with 2000 hairs), since there still remain 600 more hairs in the same recipient area. Of course the above requires a proper design and distribution of grafts in the recipient area. So for example, even though multiple hair grafts are desired in most cases, there are sections of the recipient area which mainly need single hair grafts, such as the hairline.
The tactic of separating grafts that have been received, which is common amongst other doctors and clinics, leads to a great reduction of the ratio’s variable. For example, a triple hair graft is divided by many into two grafts (1 single haired and 1 double haired) and a quadruple graft into three grafts (2 single haired and 1 double haired). The above tactic, may increase the available number of grafts with the goal to be implanted over a larger dermal area, but as mentioned above, it decreases the ration between the number of grafts toward the number of hairs with the result of having a more sparse final image of hair growth in the recipient area, even if the grafts used were in total more. Moreover, the tactic of dividing grafts, if not done correctly, involves a greater danger and is none other than the extensive trauma and possibly even the necrosis of some of the divided grafts.
So, at DHI we uphold one basic principle which has been our compass during our course through all these years: “we respect each and every graft we extract, every time, everywhere”. Our goal is not the “virgin birth” of grafts by separating them but the safe implantation of unaltered healthy hair follicles, which have not been subjected to any unnecessary handling and which are inserted in the recipient area either within seconds from extraction (Direct method) or within a short time from extraction (Direct In method).
This is the basic reason why DHI stopped charging by graft many years ago, and ensures that depending on the type of session that each patient requires and agrees on, the hair follicles which will be extracted will be as many as possible, implanted intact in the recipient area with no traumatic procedures and handling, in the correct depth, in the correct angle and direction and appropriately distributed, depending on the number of hair follicles contained, in order to ensure the highest percentage of growth and an absolute natural result.
In total, the final growth result and the image of restoration that the patient receives has to do with the following factors:
During extraction a satisfactory combination of number of hairs and grafts is desired. A high extraction ratio, which means lots of hairs, is always preferred but extraction continues even if the fair number of hairs has been ensured, until a satisfying number of grafts have been extracted, so that the skin between the implanted grafts isn’t perceived as thinned density.
What is of great importance for the final density result is the high percentage of graft survival. The non traumatic technique, the proper instruments, the correct preservation of the grafts but also respecting the skin tissue during the procedure, ensures smooth healing and high graft survival therefore reaching almost 100% of growth.
Finally, a very important parameter is the correct distribution of grafts. Even with few grafts and with an average ratio, it is possible for the result to be satisfactory when the appropriate grafts have been put in the proper place.