• Grafts per cm2 = number of grafts transplanted / area of transplant
• Distance of grafts per mm = length / number of grafts
  
  The length and width of the hair transplant recipient area are measured. The number of grafts are counted and inserted into the slits in the transplant area.

Here is an example:
NHT’s calculation shows that this eyebrow transplant has 92 grafts per cm2 (555grafts in 6 cm2) and approximately 0.8 mm between each graft (110 mm for 125 grafts in one row.)

In the latest ISHRS meeting in September 2006, Dr. Jerry Wang was asked about the estimated transplanted hair growth rate in his megasession presentation. His answer was “I don’t know.” He has an honest and straightforward answer.

To answer this question, one needs to answer the following two questions:

• How could anyone count thousands of hairs in the recipient area?
• How do you distinguish the growth versus the original hair in this area?

Honestly, no one could answer these two questions in a scientifically acceptable methodology. Approximately ten years ago, NHT started to conduct such tasks in the eyebrow hair restoration surgery. Eyebrow hair restoration is chosen for the reason that it simplifies the parameters, such as:

 

• The hair-transplanted area is bordered by “no hair” zones. Hence, one can easily count the total number of hairs in the recipient area after the surgery.
• The shapes of the original and the transplanted hair are different. Hence, the transplanted hair can be distinguished from the original hair.

 

NHT used a 0.8 mm slit and the growth rate was about 75%. Later the slit was changed to 0.9 mm, and it resulted in a growth rate of 83%. Recently, NHT switched to a 1.0 mm slit, which results in a growth rate of about 92%.

Dr. Jeffrey Epstein published an article regarding eyebrow transplants on page 121, Forum July/August 2006. He calculated a growth rate of 70%. We guess that the lower growth rate is due to a smaller slit size of 0.5 to 0.6 mm, which results in damages of FU during the graft insertion. The facts tell us that even too small of incisions can reduce damage of microcirculation but increase the difficulty of insertion, leading to a lower growth rate . And to achieve the best growth rate is our final goal.

Please also keep in mind that the growth rate for hair transplants on the scalp should be more than eyebrow transplants. This is because it is easier to transplant hairs onto the scalp.

 

There are a number of reasons why many surgeons today use only SFU for hair transplants. Exclusively using SFU for hair transplants provides a more even "look" and fewer scabs immediately after surgery. As an additional benefit, surgeons can pack SFU more densely than modified follicular units.

However, there are three concerns:

1. Higher telogen (resting) stage hair loss due the process of thin graft preparation
2. Poorer growth rates when using thin grafts compared to "chubby" grafts
3. Cost to patient is almost double when using SFUs only

Humans typically shed 60 to 100 hairs per day. These telogen stage hairs, or resting hairs, amount to 10% to 15% of our total hair at any given time. After about three months, the hairs re-grow and start the natural process over again. Telogen stage hairs are of concern for hair transplants because they are effectively invisible. In the process of preparing an SFU, the technician must trim off the tissue next to the SFU grafts possibly discarding the invisible hair inside the tissue. 10% to 15% of hair may be lost in this trimming process.

Dr. Seager, Dr. Beener, Dr. Beeher, Dr. Reed and Dr. Raposio each conducted studies to compare the results of chubby and thin grafts. These studies found that growth rates for chubby grafts' are 20% to 51% faster than the thin grafts. So far we haven't heard any report indicating that the thin graft's growth rates are better.

The cost associated with a hair transplant surgery is also an important issue. We work hard to earn our incomes - why should we waste it if we have a more affordable alternative to achieve our goal.

For example, here is a cost estimate for a typical SFU-only hair transplant for a hypothetical patient.

Assumes:

• A recipient area of 80 cm2
• A donor size of 40 cm2 needed for a 50% transplanted density
• Donor area contains about 100 FUs in one cm2
• Total grafts needed are around 4000 SFUs
• Total cost is around $20,000 at $5 per graft

In reality this surgery would likely cost much more than this estimate; in this calculation we didn't take into consideration potential hair loss during surgery or the growth rate.
Remember that hair loss is a life long process. A patient needs to receive touch-up hair transplants once in a while to maintain a good "look". Over the longer term, the exclusive use of SFUs adds up to quite a sum!

For more information about this topic, please review this study we
conducted couple years ago.

Comparison Study between the Follicular Unit and Modified-Follicular Unit on a Single Patient
Patient's progress photos updated every month. (Posted on 05/27/2002. Last photo update: 12/04/2002.)

 

No at all, NHT has prepared a 30-minute DVD video to answer this question. In the DVD, you will see the details of the hair transplant results. The patient’s recipient area is combed, so that this area is exposed and scrutinized. The DVD includes several patients that had a hair transplant 10 years ago. At that time, graft sizes went up to 8 hairs per graft. If you would like to view the detail on dvd, please e-mail or call us for free copy.

If you are interested in this theory please read:

Surgical Correction of ‘Plugginess’ in Hair Transplants
Published on Hair Transplant Forum International
January/February 2006 Volume 16, Number 1

 

 

NHT has the knowledge, skills and experience in performing hair transplants with only SFU or Ultra Fine grafts. However, NHT’s experience with these procedures indicate that there are drawbacks, as mentioned before in the SFU hair transplant, NHT takes hair transplantation very seriously and enjoys each time a patient comes back just to say hello. We just can’t let them down.

We will present "One Week in NHT", to show you some of our patients that came to visit our clinic from December 1 to December 8, 2006.

 

Yes, if the patient’s scalp is loose enough. NHT currently has five skilled technicians with combined hair transplant experience of more than 60 years. Each technician can cut 400 to 500 grafts per hour, regardless of how many technicians are available for inserting grafts, as it is limited by the working space. Typically, three technicians start to work around the patient’s head. It is then reduced to two and finally only one technician can work to finish up the job. It is harder to cut modified FU than the SFU due to the complexity involved in selecting two FU with four hairs maximum. As placing SFU is the easiest one to do. Because it is so small, it always fits the slit easily.

 

Yes, for patients with curly hair or white hair, we especially do not recommend the practice of using only single follicular units. The reason for this is that curly hair is not only curly on the outside, but even the hair stem within the tissue is curly (photo). It is extremely difficult to avoid damage to these grafts. The more one cuts the strip, the more damage one will make. White colored hair poses a different problem because it is extremely hard to see even under the microscope. The reason for this is that white hair is the same color as the tissue. Just like writing with black ink on black paper, no matter how much you enlarge a white hair in the donor strip, it will still be very difficult to see. Even under the microscope, white hair is not clearly visible. Therefore, the more grafts that you cut from a curly donor strip or white donor strip, the more risk of damage you will incur. But, the result of them always looks very natural even used modified FU only.

We believe that one’s hairline should be designed according to one’s preference. In general, a hairline design shall take into consideration the shape of one’s face. For instance, most Caucasians have longer and narrower faces, therefore, longer and narrower hairlines shall be considered. In addition, a flatter hairline may suit a square face better, such as most Asians’ faces.

We also recommend that the center of hairline should be at least 1.5 cm higher than the highest wrinkle in the face.

But every human being is unique, everyone has a different preference. A few people prefer to have lower and flatter hairlines. Adults are mature enough to drink, vote, and serve a jury. Why can't they decide what kind of hairline they want? In situations where there isn't complete agreement we will give our advice repeatedly, but also respect the decision that the patient has the right to have what they want. As long as the patient feels great about his/her hairline, we won't pressure anyone with our standard.

Yes, we also perform hair transplant with all SFUs. Our main consideration is whether the patient has sufficient donor hair in the expected life span. If he has ample donor hair, we will then perform an all SFU hair transplant with this patient. However, if a patient has a large bald area and minimum donor hair available, or a young patient whose hair loss pattern is uncertain, we recommend NHT’s mixed size graft approach. A mixed size graft approach will reduce the chance of removing hair in the “resting phase” between follicular units. Therefore, it is expected to have a higher growth rate in the mixed size graft approach. We judge each patient’s situation on a case by case basis, and provide recommendations accordingly.