Observations at the ISHRS Convention

After coming back from the ISHRS convention in New York (October 2003), I am glad to see that more and more hair transplant surgeons are beginning to recognize the benefits of bi-follicular units (modified follicular units). One hair transplant surgeon explained methods to achieve ideal density and growth through the use of a combination of different sized grafts while another surgeon mentioned that he could combine two small follicular units together and insert it into one slit to increase density. Bi-follicular units not only grow more hair and still look very natural, but also save patients thousands of dollars. These presentations concur with the same theory that I have been promoting in my discussions about the third generation of hair transplant seven years ago.

Ten years ago, the maximum number of grafts for one surgery was from 50-60 grafts per section, and increased to up to 3000-4000 grafts per surgery today. After seeing the presentations at the ISHRS convention, I believe that hair transplantation will move in the direction of using bi-follicular units as part of the procedure. Therefore, in the future the number of grafts per surgery should come down to around the range of 1500-2000 grafts.

Clearly, bi-follicular units (modified follicular units) are a great benefit for the patient. Yet, the emergence of bi-follicular units will be met with some resistance by some surgeons. The problem is that most of us charge by the number of grafts and the maximum donor size is fixed. Therefore, if we use bi-follicular units then the number of grafts will be cut to 50%, meaning that the income of physicians will be cut about 50%. Now, there are some facilities that only charge $3 per graft, using the high quantity of grafts to keep their income. So I am sure there is going to be a lot of resistance changing from single follicular units to bi-follicular units.

Steven C. Chang, M.D.