It is vital the thought of multiple procedures be analysed before the first HT takes place, this is part of long term planning to achieve the best result. There are many factors to consider when planning hair restoration, age, degree of thinning, rate of loss, hair characteristics, donor density, scalp laxity, styling preferences, and previous procedures.
• In some respects the man with more extensive thinning makes a better candidate for a single procedure, generally having more realistic expectations in respect of density and coverage than a man in relatively early stages. Also for the doctor this makes it easier to see his hair loss pattern, making it easier to determine future hair loss.
A man in say Class 3/3V for instance, or just limited crown balding is hard to determine how quickly and how extensive his hair loss may become. A large, single session, to dense pack the thinning areas may not be the best option, this may hasten hair loss via effluvium, or his hair loss could accelerate during the growth period of the new hair. In more advanced stages of thinning a single large session may be the best option, as the rate of hair loss is more progressed. A large session, 3500 FU +, be it FUE or Strip, can recreate a hairline and framing for the face, mid central areas and crown coverage may be possible, if the hair characteristics are good. This result could stand on its own, with a perfectly natural appearance.
• If the donor area is limited and the thinning progresses rapidly you could find yourself unhappy with the result and unable to have further procedures. In this case it may be sensible to have multiple procedures to follow the progression of the hair loss, and to maximise the effectiveness of the donor area.
• A man who sees he is rapidly moving towards a Class V needs to appreciate that complete hair line to crown coverage with high density is unlikely and unadvisable without compromising the donor area. Men with rapid loss in the earlier stages, or who have seen an increase in shedding should possibly look at delaying their decision; and understand the need and logic for multiple procedures.
• On the whole the better the hair characteristics, the more likely a single session would suffice. Strong characteristics can compensate for extensive thinning and a weaker than average donor yield.
• If the FU density and hairs per FU are properly calculated, the total number of follicular units at disposal can be estimated with accuracy. This estimate can then be converted into the value of coverage, based on the person’s characteristics, and not just that 3000 FU will give you “this” result for all. The scalp laxity is an important and sometimes forgotten part to a good hair transplant, especially with multiple procedures. If the scalp is very tight this can limit the number and size of strips that can be excised in the future, or cause larger than expected scarring with FUE.
• If you want to comb your hair back this can lend to the illusion of more coverage; the crown area can be lightly covered, or not at all, and still appear as natural patterning. Also, the crown can be covered by the hair from the front and top of the head, if your donor is insufficient to treat the entire scalp. If you wear your hair combed to the side you will generally achieve the appearance of more fullness, but may sacrifice coverage of the crown, if you have insufficient donor.
• Although further procedures can be carried when the new hair starts to grow through, say 6 months, there are good reasons for the delay. One is allowing the scalp to regain normal laxity, which will potentially allow a greater harvest second time round, and will aid the neat closure of the donor area with Strip. Secondly, it can take 8 to 12 months for the full benefit, at which point a better judgment can be made as to further placement. A less common issue is of telogen effluvium, shock loss, in the donor area; it is prudent to give the follicles time to recover, helping to increase hair preservation and greater FU potential from the donor in the future.
