ok I have a question about the number of grafts per session. I looked it up and I know it has been discussed many times before, but I am still curious...when I was reseaching for a doctor a couple said I needed about 1800 to 2000 follicular unit grafts, one doctor told me he could do 5000 follicular unit grafts. how is it that one can do 5000 and the others can't. Are they counting the grafts differently or is one counting by number of hair? can falceros answer....does follicular unit mean one hair or one hair graft.. when a graft has two hairs is it two follicular units and it counts as two grafts or is it one graft. when two seperate hairs are placed in one site is it one graft or two graft...please if anyone knows explain to me.....I am actually trying to have fal answer because he seems to know his stuff...thanx

Hey a-s,
A follicular unit is a unit or bundle that can contain 1 hair,2 hairs,3 hairs or 4 hairs in a given graft.

Forgot to mention,this is how hair grafts occurr naturally 1's 2's 3's 4's grafts.
non-modern hair transplanting was done with mini-grafts or micro-grafts which were more than 4 hairs cut/disected in bundles and required larger incisions and were not refined.
make sure you stay away from these procedures because believe it or not there are still dr's doing this outdated procedure out their.
keep asking questions and gaining knowledge before committing to a HT.

thanks, let me rephrase my question. Is there a universal language used by the hair transplant doctors to count the number of grafts done in one session. Is it by the number of hair transplnted, or the number of units or by the number of incisions made on the head? can a doctor or an expert answer please.

Albal Smith,
The total number of grafts planted in a hair transplant procedure simply refers to the number of "building blocks" used in that case, whatever their size or composition. In modern hair transplantation, that usually can range from a 1-hair follicular unit graft up to usually a double follicular unit graft of 4-5 hairs, both dissected under microscopes. Ordinarily the number of grafts equals the number of recipient site incisions with two exceptions:
One, if extremely tiny incisions are made over the entire planting area and the physician feels that 3 or 4-hair FU's are too large to use and instructs the assistants to split them into two smaller grafts each. Actually, two 2-hair grafts made by splitting a 4-hair FU will still count as two grafts, because the work was taken to cut them into separate units and two separate incision sites are made to place them in.
Two, if a patient has a larger percentage of naturally occurring 1-hair FU's in the donor tissue, often two 1-hair FU's will be "paired up" and placed into a single incision, which then becomes a 2-hair site, as opposed to making two separate sites and placing 1 hair into each one.
Fortunately most patients have around 20% 1-hair FU's, which works out to about the number needed to create a natural front hairline, and rear border. From the viewpoint of minimizing injury to the scalp and creating density, if there is an excess of 1-hair grafts, placing two into a single incision is probably preferable. Whether one charges for 1 or for 2 grafts for the grafts placed in such sites can sometimes be problematic, as you have carried out the work to dissect two separate grafts, but only one placement act is performed, as they are usually gripped together as they are placed. In our practice we prefer to keep 3 and 4-hair FU's intact and simply make sure that a few of the micro-slits are slightly larger than the others in order to accomodate them.
An earlier commentator spoke of minigrafts and micrografts as both being over 4 hairs each. That is true of the definition of a "minigraft," which was a cut-to-size graft cut under loupe magnification in the past. But a "micrograft" is a different animal and has always simply been a 1 or 2-hair graft, which in the "old days" was split off from a larger graft usually. The concept of the naturally occurring follicular unit wasn't appreciated back in the 1970's and early 1980's. Many of us still use the term "micrograft" to refer to a 1-hair graft that is the result of splitting up a 2-hair FU to make two single 1-hair grafts. This is sometimes necessary when a patient has hardly any naturally occurring 1-hair FU's and they are needed for either eyebrow work or for the edge of the front hairline.
Many people, including myself, feel that giving the NUMBER OF HAIRS transplanted is a more accurate way to describe what was accomplished in a single transplant procedure. My experience is that most patients require somewhere around 10,000-12,000 hairs on the top of the head (frontal and midscalp regions) to look relatively full. Persons with extremely fine hair sometimes require more.
Mike Beehner, M.D.

Nicely put Dr. Beehner.

Many clinic will keep track of the number of grafts as well as breaking down the number of each follicular units for each patient so you know exactly how many 1's, 2's, etc.. you received. This gives you the exact number of total grafts and total hair count. Most clinics charge per graft and not by the hairs. The patients with really good density yielding many 3's and 4's technically get a better deal all around.

thanks so much Dr. Beehner. Very nicely put. I have one more question. Since all of these terminology is not ususally explained, and I am sure there are many others like me that are confused it would be nice for the coalation doctors to come up with an agreeable terminology so patients know what tey are getting. As to the number of grafts vs. number of incisions, is it possible for some doctors to make two single hair Fu and place in one incision and charge for two grafts?

Albal,

Yes, this is possible and probable. As Dr. Beehner described in his detailed and informative post above, there may be times when a patient has an abundant number of single haired follicular unit grafts and it may be determined that coupling these hairs and transplanting it into single recipient sites may be more beneficial overall, especially to potentially minimize scalp trauma and the risk of shock loss.

A physician may still charge you for 2 follicular units even though they were combined. After all, the technician did the work to cut the separate follicular units.

A physician / clinic may decide to cut you a break and charge you for the actual grafts after all coupling or DFUs are created however, many will charge for how many follicular unit grafts were cut rather than how they were transplanted.

You may want to ask your clinic their philosophy on this before entering into surgery.

Dr. Beeher, thanks for your detailed professional input on this thread.

Best wishes,

Falc

So if two single hair grafts are put in one site is the patient charged for one graft?