Generally, the front third to half of a completely bald area can be completely finished in 2½ – 3 sessions if
only FU,s and Multiple FU,s are being used. Some patients may be happy with the coverage and fullness of 1
session on a bald area. However most want more density than what 1 session on a bald area will achieve.
Patients who believe they can be completed in only one session and have relatively dense hair are being
unrealistic. One session of all single FU,s, (containg 1-3 hairs), can look very natural and can stand on its
own very well, however the density or fullness is for most people less than what one would expect for
reasonable density. Some hair types, ( course, wavy, with salt and pepper or light brown/blond hair )
lends itself to a very nice result with 1 session. A patient with straight, sparse and black hair would
have an understandably thinner look and unless the patient had low expectations , he would probably want
the benefit of the density of 2-3 sessions. Patients should be wary of doctors that claim most of the bald
area of the scalp can be completed in 1 session, unless a thin look is desired.
Transplant sessions may be done as far apart as the patient wishes; however, they are not done in any given
area without a minimum 8-12 month interval between sessions. The number of grafts that should be transplanted
at one session and the frequency of transplant sessions depend on the characteristics of each individual case;
this can be planned out in advance for each patient. Additionally, larger sessions that cover both the front
half of the scalp as well as the crown, in appropriate patients, can also be performed at the same time.
It is becoming more common for patients to have one or “early” transplanting session, before hair loss has
reached an advanced stage. The benefit of these early sessions is threefold: the remaining hair provides
natural camouflage for the initial session; the transplanted hair (once it has grown) provides additional
coverage for any later sessions; and sessions can be spaced farther apart, thus spreading the inconvenience
and cost over a longer period of time.
In less than 10% of patients there may be some mild thinning involving the pre-existing hair of the recipient
area within the first two to three weeks after a transplant. This thinning (if it occurs) is temporary and
the hair will regrow at the same time as the transplanted hair begins to sprout.
TRANSPLANTING WITH ONLY ‘1-2 Haired Follicular Units’, “MEGASESSIONS”, AND “DENSE PACKING” OF GRAFTS
If you have relatively fine and/or light coloured hair and if you feel you would be satisfied with light to
moderate hair density, you may want to consider using only 1-2 hair follicular unit grafts for your
transplanting. There are four advantages to such an approach:
In fairness it should be pointed out here that if slightly larger graft with 3-5 hairs is used behind the hair
line zone of 1-3 haired grafts instead of all 1-2 haired grafts there is virtually no damage to existing hair
and with most hair types there is essentially no plugginess either.
Transplanting an entire bald head in one or two “megasessions” of 3000 or more 1-2 haired grafts per session
is possible, but will require sessions of 8-10 hours each. As indicated above such sessions will usually
produce only relatively low hair density unless they are repeated . These operations are also more physically
and emotionally stressful than standard transplanting sessions, and should not be undertaken by any one who
isn’t in excellent physical condition. Practically speaking therefore, megasessions of 1-2 haired follicular
units are only used in relatively young or fit patients for whom time and minimum noticability is more
important than greater hair.
Patients are often anxious to have as much done as quickly as possible and are therefore anxious to believe
a physician who tells them that there is no intrinsic problem with very large, lenghthy megasessions.
However, the possibility of lesser hair yield permanently should be weighed against the temporary
convenience of a faster result.
Proud supporter of:
Dr. Cotterill is the immediate past president of the International Society of Hair Restoration Surgery
Board of Directors of the American Board of Hair Restoration Surgery
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