There are a set of questions a patients always asks and one of is
“How many sessions of hair transplant will I require?”
This question is asked by the patients in utmost innocence not knowing that it opens up a vast gamut of considerations. The doctor will need to see availability of grafts and donor areas, the objectives of the patient in the short and long term and the level of baldness the patient is likely to progress to. Last but not the least the age of the patient will suggest whether to even take up the patient for a procedure.
Baldness is progressive and so is the expectations of the patient. What the patient desires now as part of his objective is not taking future hair loss into consideration. However the aim of the doctor is always to recalibrate the patient’s expectations and rationalise them. Most patients are swayed by advertisements and false hopes raised by seeing film stars with dense hair purportedly due to hair transplants. Lack of research especially in the Indian market makes things much more complex for the hair transplant doctor who wishes to practice honestly and ethically. Many a times a single procedure will not be able to restore a head full of hair especially in a patient with extensive baldness of Grades 5 & 6 baldness. Also as baldness progresses, more procedures may be required which presently cannot be predicted as this depend upon the severity of genetic encryption of the male pattern baldness gene; and this varies from one person to another.
The following factors may determine multiple procedures:
* Degree of hair loss
* Philosophy and skill of surgeon and his Team
* Progress of hair loss with time
* Objectives of the patient
Usually men can get a head full of hair in one session upto Grade 5 pattern of baldness. Body hair may also need to be harvested to fulfil this objective. However Grades 5 and 6 may require more than one procedure in selected cases. The length of each session is usually 6-10 hours and this is determined by the cohesiveness and skill of the team in the clinic.
Baldness is a progressive condition and may require additional coverage in future. It is not always that each individual may experience multiple sessions, but is determined by degree of hair loss, expectations and availability of donor supply. In the event that one may have advanced level of baldness with low scalp yield, it is more likely that one may require more tan one sessions.
The Hamilton-Norwood scale is a classification system used by the medical community to define hair loss with the aim to assist in planning a hair transplant procedure and to follow up progressive baldness. It works effectively as a benchmark for the consultants to diagnose, treat and follow up over time. The Norwood scale is progressive depending upon the severity of baldness commences with Type 1 which is considered normal. Type 2 denotes the normal recession with age and progresses through Types 3,4,5,6 to the most severe form Type 7 which mostly is quite a challenge for a hair transplant to restore hence mostly declared unfit for the procedure.
This chart depicts pictorially the various types-
Stage 6 and 7 have large areas of baldness and are almost always difficult to cover even after 2 sessions. The graft availability is the limiting factor that restricts the surgeon from doing a single stage procedure. Hair transplant density that can give a semblance of a good density can never be less than 20 follicular units per square centimeter and hence the request of many such patients to spread out the available grafts to the whole head can only be agreed to.
FUT was earlier thought to be the Holy Grail of hair restoration surgery for extensive baldness with or without in combination with FUE. However, as operative skills and better tools and teamwork became a common thing, FUE surpassed FUT/FUT+FUE in fuller coverage. You can learn more about this in far more detail at-
FUT entails removal of a strip of skin from the back and sides of the head and the donor wound is stitched back. The strip is then slivered and then dissected on the table by assistants into grafts. FUT causes a tight scar and this can on occasion increase the surface area of the crown that is sought to be covered therefore belying the stated purpose of greater number of grafts by the FUT method. FUE has come into its own today and is the modern day Gold Standard of hair transplant. Done by over 90% of doctors around the world and over 97% in India, this is the modern day minimally invasive procedure with less downtime and good results when done in the right clinic.
The patient should seek consultation with an experienced surgeon on whom he trusts. He should after the consultation go through the options with a level head and not try to push the procedure in an irrational manner. The surgeon should on the other hand advise the patient about how quickly if at all, he can give him a head full of hair keeping in mind that every session he does will further prolong the time before the final result emerges. The limitations and contraindications are well known which act as a barrier to offering one procedure that fits all patients seeking hair transplant and this should be clearly explained to the patient in the language he understands.
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