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Hairs Per FU vs Grafts Placed


#1

Much of the talk when someone is enquiring about a hair transplant revolves around the topic of density, how many FU per cm2 will be placed in the hair line and behind, will it be natural, and will it be thick. Of course this is a relevant question but possibly too much emphasis is placed on this and other factors that make up the result are forgotten about; such as hair characteristics and one rarely discussed; the number of hairs per follicular unit. There is always a mean number and some say there are more hairs per FU with FUE or Strip/FUT but the fact remains if an intact is removed it will average whatever the person has, and generally it works to approx. 2.2/3 hairs per FU. This is not necessarily the natural average but normally the extracted average, hence being able to easily calculate it. And this can vary dependent on the procedure and the placement, hair line requiring more single hairs so the number drops whereas if the placement was behind a hair line with mainly multiple hairs the number increases.

FUE and FUT/Strip both rely on the number of grafts placed to give a result, but more importantly is the number of hairs per follicular unit because this can make a large difference in the result; this is the distribution of hair. The placement of the FU in a skilled and artistic manner will get the most thickness and coverage to assimilate a head of hair.

Depending how the FU are extracted with FUE will determine whether a “true” FU is removed and this will be a large factor in the result. For example if an FU is removed intact be it one hair or a multiple FU up to 4 hairs then the hairs per graft will reflect this in the % split. A number of factors can attribute to the number of hairs per graft, for example incorrect extraction could lead to removing more than one FU or transecting an FU; this can either mean larger grafts or if transacted could mean more grafts are created accidentally but the hair count is greatly reduced per graft.

This is important to understand as the distribution of FU decides the result; as most realise, a hair line will typically take 600-800 SINGLE hair FU and if there is temple point rebuild this can be over 1000. Behind the hair line a gradual increase needs to be created from 2 to 3 to 4 hair FU. BUT if a greater number of single hairs are placed then this will impair the distribution, so a larger number with lower “thickness” in a smaller area. You may be able to place a density of single hairs at 90 FUcm2 behind a hair line, but the actual THICKNESS will be less than three hair FU placed with a low density of 35 FUcm2; almost a third density placed but more hairs and more importantly more thickness.

DISTIBUTION of intact FU= results, the number of grafts is relative to the number of hairs, if there is not a balanced distribution of hairs the appropriate placement will not equal the thickness required and coverage to achieve what probably everyone would aspires to in a hair transplant.

Here is a working example:

Take a case of approximately 2500 grafts or follicular units with a hair count and split of

Follicular Unit Numbers: 1 hair 704; 2 hair 765; 3 hair 689 & 4 hair 358

A total of just over 6000 hairs, all in their natural groupings allowing for the educated distribution to gain a solid result. Then take a 4000 case with an almost even split of single and two hair follicular units with a few three’s; reaching approx. 6700 actual hairs. 1500 more grafts but only 700 more hairs.

Naturally some people have smaller hair numbers (groupings) per FU and in some cases this may render them not suitable for a hair transplant; or possibly transection when punching may cause the FU to be split into a smaller hair group, either way it must be recognised that graft numbers are only relative to the hair count and the distribution of the FU when being placed. Either way, be it natural small groups or transacted it can lead to a sub standard result and so when calculating density for example in the donor area the hair count should also be considered as a major factor.


#2

» Much of the talk when someone is enquiring about a hair transplant revolves
» around the topic of density, how many FU per cm2 will be placed in the hair
» line and behind, will it be natural, and will it be thick. Of course this
» is a relevant question but possibly too much emphasis is placed on this and
» other factors that make up the result are forgotten about; such as hair
» characteristics and one rarely discussed; the number of hairs per
» follicular unit. There is always a mean number and some say there are more
» hairs per FU with FUE or Strip/FUT but the fact remains if an intact is
» removed it will average whatever the person has, and generally it works to
» approx. 2.2/3 hairs per FU. This is not necessarily the natural average but
» normally the extracted average, hence being able to easily calculate it.
» And this can vary dependent on the procedure and the placement, hair line
» requiring more single hairs so the number drops whereas if the placement
» was behind a hair line with mainly multiple hairs the number increases.
»
» FUE and FUT/Strip both rely on the number of grafts placed to give a
» result, but more importantly is the number of hairs per follicular unit
» because this can make a large difference in the result; this is the
» distribution of hair. The placement of the FU in a skilled and artistic
» manner will get the most thickness and coverage to assimilate a head of
» hair.
»
» Depending how the FU are extracted with FUE will determine whether a
» “true” FU is removed and this will be a large factor in the result. For
» example if an FU is removed intact be it one hair or a multiple FU up to 4
» hairs then the hairs per graft will reflect this in the % split. A number
» of factors can attribute to the number of hairs per graft, for example
» incorrect extraction could lead to removing more than one FU or transecting
» an FU; this can either mean larger grafts or if transacted could mean more
» grafts are created accidentally but the hair count is greatly reduced per
» graft.
»
» This is important to understand as the distribution of FU decides the
» result; as most realise, a hair line will typically take 600-800 SINGLE
» hair FU and if there is temple point rebuild this can be over 1000. Behind
» the hair line a gradual increase needs to be created from 2 to 3 to 4 hair
» FU. BUT if a greater number of single hairs are placed then this will
» impair the distribution, so a larger number with lower “thickness” in a
» smaller area. You may be able to place a density of single hairs at 90
» FUcm2 behind a hair line, but the actual THICKNESS will be less than three
» hair FU placed with a low density of 35 FUcm2; almost a third density
» placed but more hairs and more importantly more thickness.
»
» DISTIBUTION of intact FU= results, the number of grafts is relative to the
» number of hairs, if there is not a balanced distribution of hairs the
» appropriate placement will not equal the thickness required and coverage to
» achieve what probably everyone would aspires to in a hair transplant.
»
» Here is a working example:
»
» Take a case of approximately 2500 grafts or follicular units with a hair
» count and split of
»
» Follicular Unit Numbers: 1 hair 704; 2 hair 765; 3 hair 689 & 4 hair 358
»
» A total of just over 6000 hairs, all in their natural groupings allowing
» for the educated distribution to gain a solid result. Then take a 4000
» case with an almost even split of single and two hair follicular units with
» a few three’s; reaching approx. 6700 actual hairs. 1500 more grafts but
» only 700 more hairs.
»
» Naturally some people have smaller hair numbers (groupings) per FU and in
» some cases this may render them not suitable for a hair transplant; or
» possibly transection when punching may cause the FU to be split into a
» smaller hair group, either way it must be recognised that graft numbers are
» only relative to the hair count and the distribution of the FU when being
» placed. Either way, be it natural small groups or transacted it can lead to
» a sub standard result and so when calculating density for example in the
» donor area the hair count should also be considered as a major factor.

Good post. Translation: doctors should be charging on a per hair basis and not per graft. In your example the guy who is paying for 1500 more grafts end up having only 700 more hairs.


#3

Hairs are what cover the scalp. Hair count or estimation is as critical as graft count.


#4

» Hairs are what cover the scalp. Hair count or estimation is as critical as
» graft count.

I think this whole thing about charging based on graft count is just a scheme to squeeze more money out of the patients. There is no reason why doctors could not charge based on hair count.


#5

» » Hairs are what cover the scalp. Hair count or estimation is as critical
» as
» » graft count.
»
» I think this whole thing about charging based on graft count is just a
» scheme to squeeze more money out of the patients. There is no reason why
» doctors could not charge based on hair count.

I also want to know how did it become industry standards? Who started charging by the grafts first?


#6

» » » Hairs are what cover the scalp. Hair count or estimation is as
» critical
» » as
» » » graft count.
» »
» » I think this whole thing about charging based on graft count is just a
» » scheme to squeeze more money out of the patients. There is no reason
» why
» » doctors could not charge based on hair count.
»
» I also want to know how did it become industry standards? Who started
» charging by the grafts first?

There is no correct way of charging for HT. A liposuction is not charged based on the ounces of fat taken out.
I will like to see the day when hair transplants be charged on a lumpsum basis.


#7

Some docs will do all the work themselves just so they can jack up the prices.The more labor intensive a procedure the more it costs. Very clever marketing.


#8

» » » » Hairs are what cover the scalp. Hair count or estimation is as
» » critical
» » » as
» » » » graft count.
» » »
» » » I think this whole thing about charging based on graft count is just
» a
» » » scheme to squeeze more money out of the patients. There is no reason
» » why
» » » doctors could not charge based on hair count.
» »
» » I also want to know how did it become industry standards? Who started
» » charging by the grafts first?
»
» There is no correct way of charging for HT. A liposuction is not charged
» based on the ounces of fat taken out.
» I will like to see the day when hair transplants be charged on a lumpsum
» basis.

What do you mean there is no correct way of charging for a HT ? What is wrong with charging based on # of hairs? I agree with the other posters, it makes more sense than charing based on # of grafts.


#9

» What do you mean there is no correct way of charging for a HT ? What is
» wrong with charging based on # of hairs? I agree with the other posters, it
» makes more sense than charing based on # of grafts.

It would be WAY cheaper to charge per graft. A graft is a graft and you would pay say $5/graft, 1, 2, 3. But if you charged per hair, the cost would be $5/single, $10/double, $15/tripple.


#10

» » What do you mean there is no correct way of charging for a HT ? What is
» » wrong with charging based on # of hairs? I agree with the other posters,
» it
» » makes more sense than charing based on # of grafts.
»
» It would be WAY cheaper to charge per graft. A graft is a graft and you
» would pay say $5/graft, 1, 2, 3. But if you charged per hair, the cost
» would be $5/single, $10/double, $15/tripple.

Except that if you are getting only hairline work then you’ll be screwed. Hairline grafts usually only contain 1 hair. I agree with those who propose to charge per hair. It is what it is, it is accurate, verifiable, no argument no foul play. Whoever came up with the idea of charging per graft is not thinking in the best interest of the patients.


#11

» » » What do you mean there is no correct way of charging for a HT ? What
» is
» » » wrong with charging based on # of hairs? I agree with the other
» posters,
» » it
» » » makes more sense than charing based on # of grafts.
» »
» » It would be WAY cheaper to charge per graft. A graft is a graft and you
» » would pay say $5/graft, 1, 2, 3. But if you charged per hair, the cost
» » would be $5/single, $10/double, $15/tripple.
»
» Except that if you are getting only hairline work then you’ll be screwed.
» Hairline grafts usually only contain 1 hair. I agree with those who
» propose to charge per hair. It is what it is, it is accurate, verifiable,
» no argument no foul play. Whoever came up with the idea of charging per
» graft is not thinking in the best interest of the patients.

Therapy,

Everyone should be able to understand what you just said. It gets costly when you need 4,000 grafts or 15,000 to 18,000 hairs. Anything goes at that point.:frowning:


#12

If they were charging per hair, they will do 4 hair extractions only and you will end up with a hairline that looks like an obvious transplant.


#13

» If they were charging per hair, they will do 4 hair extractions only and
» you will end up with a hairline that looks like an obvious transplant.

That’s the stupidest argument I have heard.


#14

Well,
Some 5% of the hairs are in ‘sleeping’ modus. Even under the microscope they are very hard to see and may need a lot of extra manipulation … something you want to avoid. Some grafts are so glass fiber like that it is nearly impossible to see anything at all.
So who is going to count what ?

Furthermore if you are going pro hair price calculation you may get a suprise at the cashier when doing FUT since you never know exactly what you are going to get.

But hey, I would welcome a new mechanism if someone comes up with something.


#15

» » What do you mean there is no correct way of charging for a HT ? What is
» » wrong with charging based on # of hairs? I agree with the other posters,
» it
» » makes more sense than charing based on # of grafts.
»
» It would be WAY cheaper to charge per graft. A graft is a graft and you
» would pay say $5/graft, 1, 2, 3. But if you charged per hair, the cost
» would be $5/single, $10/double, $15/tripple.

I disagree. I don’t think you understand the essence of the debate here. Why in your example the price for per hair and per graft are the same? If the doctor is charging per hair, the price will have to come down to make sense.


#16

» » » What do you mean there is no correct way of charging for a HT ? What
» is
» » » wrong with charging based on # of hairs? I agree with the other
» posters,
» » it
» » » makes more sense than charing based on # of grafts.
» »
» » It would be WAY cheaper to charge per graft. A graft is a graft and you
» » would pay say $5/graft, 1, 2, 3. But if you charged per hair, the cost
» » would be $5/single, $10/double, $15/tripple.
»
» I disagree. I don’t think you understand the essence of the debate here.
» Why in your example the price for per hair and per graft are the same? If
» the doctor is charging per hair, the price will have to come down to make
» sense.

Exactly. If normal price is $5 per graft and on average each graft has 2.5 hairs, then the price per hair shall be $2.0, when someone has 3000 grafts done for the hairline which contains only 1 hair graft, he will be paying $6000 instead of $15,000, he would be overpaying by $9000 or 250% more !!!


#17

» » » » What do you mean there is no correct way of charging for a HT ?
» What
» » is
» » » » wrong with charging based on # of hairs? I agree with the other
» » posters,
» » » it
» » » » makes more sense than charing based on # of grafts.
» » »
» » » It would be WAY cheaper to charge per graft. A graft is a graft and
» you
» » » would pay say $5/graft, 1, 2, 3. But if you charged per hair, the
» cost
» » » would be $5/single, $10/double, $15/tripple.
» »
» » I disagree. I don’t think you understand the essence of the debate
» here.
» » Why in your example the price for per hair and per graft are the same?
» If
» » the doctor is charging per hair, the price will have to come down to
» make
» » sense.
»
» Exactly. If normal price is $5 per graft and on average each graft has 2.5
» hairs, then the price per hair shall be $2.0, when someone has 3000 grafts
» done for the hairline which contains only 1 hair graft, he will be paying
» $6000 instead of $15,000, he would be overpaying by $9000 or 250% more
»
!!!

That’s outrageous, only hair transplant consultants will convince people that paying by the graft is fair.


#18

» » » » » What do you mean there is no correct way of charging for a HT ?
» » What
» » » is
» » » » » wrong with charging based on # of hairs? I agree with the other
» » » posters,
» » » » it
» » » » » makes more sense than charing based on # of grafts.
» » » »
» » » » It would be WAY cheaper to charge per graft. A graft is a graft and
» » you
» » » » would pay say $5/graft, 1, 2, 3. But if you charged per hair, the
» » cost
» » » » would be $5/single, $10/double, $15/tripple.
» » »
» » » I disagree. I don’t think you understand the essence of the debate
» » here.
» » » Why in your example the price for per hair and per graft are the
» same?
» » If
» » » the doctor is charging per hair, the price will have to come down to
» » make
» » » sense.
» »
» » Exactly. If normal price is $5 per graft and on average each graft has
» 2.5
» » hairs, then the price per hair shall be $2.0, when someone has 3000
» grafts
» » done for the hairline which contains only 1 hair graft, he will be
» paying
» » $6000 instead of $15,000, he would be overpaying by $9000 or 250%
» more
» »
!!!
»
» That’s outrageous, only hair transplant consultants will convince people
» that paying by the graft is fair.

In essence, this debate may be based on the variable that each patient could benefit on the number of transplanted grafts/hairs based on a given patient’s degree of hair loss and donor area characteristics. If a surgeon observes that a Norwood 3’s recipeint area requires more larger grafts than smaller hair grafts then a the patient having lesser hair loss may benefit less than the patient having a higher class of hair loss. Hypothetically, a NW4 patient would obtain a better price per graft than a Norwood 2 patient needing finer follicular units that typically contain single hair grafts.

It’s possible to have this pricing structure standardized but it is very difficult to implement as no one donor is the same. Some coarser single hair grafts can provide more coverage value than a patient who has larger FUs of a lessor caliper.

This standardized pricing system is seen more in-depth when you consider that most strips are removed from the donor based on the best donor region of the donor area. After the strip is removed, the patient gets an unknown amount of grafts/hairs FUE is removed as the donor supply is examined throughout the “safe zone” and the strongest FUs ( 1-5 hair grafts) may or may not benefit a given patient by providing more coverage value based on the the demand in the recipient area. Remember that almost every patient has a certain percentage of 1 to 5 hair FUs

Theses are just conditions to consider, that’s all. The honest in-person consultation will tell most of the story about what amount of grafts/hairs should be placed on a patient’s recipient area(s)based on hair characteristics and analysis of hair on the donor and recipient areas.


#19

Or maybe they could bill by the hour for their service… but wait… who would pay $3000/hour? That is more than a heart surgeon!

Let’s face it… the HT doctor’s hourly rate is absurd… graft/hair pricing is irrelevant… time is what we buy… and they are charging absurd hourly prices… no debate on that… although I expect it…


#20

n/t