What is Hair Graft?

A single follicular unit or a small piece of scalp tissue that carries harvested hair. To have a healthy hair graft, you need to have a healthy scalp and a healthy integumentary system. If you don’t have enough conditions to support your hair follicles and nourish your dermal layer, you will have unhealthy hair and they may lose often. A healthy person has 2-4 hair strands in one graft (follicular unit) [1], [2].

Anatomy of Hair Graft

The physiology of hair graft is divided into 7 basic parts. Let’s analyze these parts closely to better understand hair transplant procedures.

Definition of a Healthy Hair Graft

To understand the components of a hair transplant, let’s start by exploring what a healthy hair graft is. Whether you are undergoing a DHI or FUE hair transplant procedure, the number and health of available hair grafts will directly determine the success of your hair transplant surgery. The number of hair grafts in the donor area is the first signal of hair graft health. A healthy hair graft should contain at least one healthy hair follicle and must show good vitality.

 

under skin structure of hair Graft

 

Hair Shaft

Each hair strand consists of 2 structures. These are

  • the hair shaft, which forms the visible part outside the skin,
  • the hair follicle located beneath the skin surface.

 

In short, the visible part of the hair strand is called the hair shaft, it also has three layers:

  • cuticle,
  • cortex,
  • medulla [3].

 

Bulb of Telogen Hair

Telogen is the name given to the ‘resting’ phase of the hair growth cycle. In the telogen phase, when the hair follicle is inactive, there is a white keratin bulb at the root. Club hairs are grown at this stage.

Sebaceous Gland

The component responsible for sebum production is called the sebaceous gland. Sebum is very important for moisturising the scalp and nourishing the hair.

Outer Root Sheath

ORS, a layer of tissue, surrounding the hair follicle, providing structural support and helping hair growth. During a hair transplant surgery, preserving the integrity of the ORS is crucial as it contains stem cells responsible for regenerating new hair follicles and supporting graft viability, it facilitates a successful hair replacement and long-term hair growth.

Dermal Fat

Subcutaneous fat (dermal fat) provides support in blood vessels and stem cells; so, it promotes graft survival and facilitates the growth of transplanted hair follicles. Moreover, dermal fat helps to achieve natural-looking hair results because it provides volume and contour to the recipient area.

Dermal Papillae

The dermal papilla plays a major role in the hair transplant process due to its ability to stimulate bulge stem cells, essential for hair follicle regeneration and growth. Growth factors produced by the dermal papilla promote the proliferation of these stem cells, influencing the duration of the hair growth cycle.

Bulb of Terminal Hair

The layer containing the dermal papilla and the hair matrix is called the bulb of terminal hair. It is important for the dermal papilla to develop newly transplanted hairs, which promotes hair growth.

Types of Hair Grafts

The number of hair follicles in a single hair graft affects the type of hair transplantation procedure and the duration of treatment. The number of hair follicles in a graft is not stable, but hair transplant specialists state that, on average, a hair graft usually contains 2 hair follicles [4].

Single Hair Graft

It is a graft containing a single hair follicle. It can be used in bald areas that require a natural-looking hairline. If you are in the advanced baldness stage on the Norwood Hair Loss Scale and have mostly single grafts, you may not be able to achieve a dense hair appearance.

Double Hair Graft

A follicular unit contains two hair follicles and is usually used to add density to areas with moderate hair loss, to cover patchy bald spots or to blend with existing hair.

Triple Hair Graft

A follicular unit (graft) contains 3 hair follicles. It is a very good number for a patient with healthy grafts. It can even help to treat male-pattern hair loss at Norwood stage 6 or 7, even in a single transplant session.

Quadruple Hair Graft

A group of hair tissue that contains 4 hair follicles and is reserved for areas requiring maximum coverage and density, such as the crown (vertex), temples, and mid frontal scalp.

Role of Hair Graft in Hair Transplant Process

 

hair grafting working procedure

Minimally invasive graft harvesting techniques have become the first choice of modern surgeons. Skillful surgeons prefer these up-to-date methods:

 

  1. Follicular Unit Extraction (FUE): Surgeons remove individual follicular units (hair grafts) from the donor site directly using a tube-like punch tool.
  2. Direct Hair Implantation (DHI): With the help of Choi implanter pen, surgeons first extract and then transplant the follicles.
  3. Robotic Hair Transplantation: Surgeons use robotic systems to assist in the precise and consistent removal of hair grafts instead of manual follicular unit extraction.
  4. Sapphire FUE: The surgeon uses a special sapphire blade to make the incision during the FUE procedure. It is a good choice for smaller incisions and fast recovery [5].

 

Hair Graft Transplant Process

The hair transplant procedure requires precision. Each stage is important to ensure the health of your hair follicles. In order to have full and healthy hair, your surgeon will follow some steps. Please keep in mind that these steps may vary slightly depending on the hair transplant method.

 

  • Preparation before Graft Transplantation

 

In preparation for hair graft transplantation, your surgeon performs a comprehensive evaluation to minimise the risk of surgery and help you achieve the results you desire. The evaluation includes

  • assessment of whether you are a suitable candidate for graft transplantation,
  • assessment of the health of your donor and recipient sites and the number of hair grafts,
  • discussion of your expectations and assessment of whether the outcome of the operation meets your expectations,
  • discussion of pre-operative care, such as what to do for a healthy scalp.
  • informing you about the instructions you need to follow after the operation [6].

 

  • Collecting Hair Graft from Donor area

 

In Follicular Unit Excision, your surgeon removes healthy grafts from the recipient area under local anaesthesia to harvest the grafts from the donor area. Generally, the recipient area is the healthy graft-filled area on the sides and back of the head. Rarely, the beard, chest or other parts of the body with strong grafts can be the recipient area [7].

 

  • Perpetuating Hair Grafts before implant

 

Before the implantation step in a hair transplant procedure, permanent hair grafts are prepared. Depending on the chosen method, the permanent hair grafts are carefully collected, sorted and trimmed in preparation for implantation.

 

  • Graft implant process

 

In the hair graft implant process, harvested hair follicles are implanted into the recipient area. Using specialized tools, tiny incisions are made in the recipient area, following the desired hairline or pattern.

Important details required before Hair Graft Transfer

Before hair graft transfer in a hair transplant procedure, it’s crucial to consider:

  • patient suitability and overall health,
  • donor hair assessment,
  • evaluation of scalp condition.

 

Moreover, following the current developments in techniques and preparing an individualised hair loss treatment are critical stages.

 

The importance of a healthy donor area

For a healthy donor area, it is vital to get a successful hair transplant surgery without any complications. Here are some basic steps to protect it:

  • Stay hydrated, drink water
  • Avoid chemical shampoos, hair products, and hair dyes
  • Follow a healthy diet
  • Protect from sun damage (UV radiations)
  • Use keratin protein treatments

 

How many hair grafts does a healthy person have?

The number of hair grafts in a healthy person can vary depending on such factors:

  • genetics,
  • age,
  • gender,
  • ethnic background.

 

On average, a healthy patient may have 10,000 of hair follicles available for transplantation. But, please note that the exact graft number that can be harvested and transplanted in a single session may vary because of the characteristics of the patient’s physiology and the technique used by the surgeon.

 

How many hair grafts can be transplanted?

Even on the last stage (7) on the Norwood scale, approximately 7000 grafts can be transplanted. Your surgeon may divide the operation into 2 sessions if deemed necessary. There will be roughly 9 to 12 months between sessions.

 

What is the maximum number of grafts that can be transplanted in one session?

In a single session, more than 5000 grafts are not recommended to maintain graft viability and patient’s scalp health. If you need more than 5000 grafts to cover your bald spots, it is better to complete the hair transplant procedure in multiple sessions. In doing so, it is also possible to see how the healing process progresses and where you may need to increase the hair density. Multi-session hair transplants usually give superior results.

 

How long does it take for transplanted hair grafts to grow?

In the treatment of male androgenetic alopecia, hair usually grows 1 to 2 cm per month after hair transplantation. To clearly see the result of the hair transplant, you need to wait a few months for the scalp to heal and be patient for 6 months to 1 year [8].

 

How much of the transplanted hair grafts are lost?

This depends on the success rate of the treatment, your post-operative care and genetic factors. Even though it’s rare, it’s possible to see hair grafts fall out after hair transplant. In successful hair transplant operations, approximately 5% of the transplanted hair falls out. No shock hair loss process is included in this data as it is temporary.

 

How many hair 1000 grafts include?

Considering that there are an average of 2 hair follicles in a graft, it is approximately 1700 to 2300 hair strands.

 

How many hair 2000 grafts include?

2000 grafts are about 3700 to 4300 hair strands. The 2000 graft hair transplant procedure (at Norwood Stage 3) can be performed under general or local anaesthesia. The procedure can take between 4-6 hours.

 

norwood hair loss scale stage 2 2000 grafts

 

How many hair 3000 grafts include?

3000 grafts would contain a total of 5,400 to 6,600 hairs (at Norwood Stage 4).

 

norwood hair loss scale stage 3 3000 grafts

 

How many hair 4000 grafts include?

As the number of grafts increases, the probability of survival during surgery may decrease. Therefore, between 7000 and 8200 viable hairs can be transplanted.

 

norwood hair loss scale stage 4 4000 grafts

 

How many hair 5000 grafts include?

Realistically, between 8500 and 9000 hairs can be estimated.

norwood hair loss scale stage 5 5000 grafts

 

How many hair 6000 grafts include?

That’s over 10,000 hairs. It may be sufficient to treat frontal balding. It can also give great results for receding hairline.

 

norwood hair loss scale stage 6 6000 grafts

 

How many hair 7000 grafts include?

It can reach up to 15,000 hairs. It is enough to cover the head of a fully bald person.

norwood hair loss scale stage 7 7000 grafts

Graft cost based on the numbers you need

Take a look at the Cost and Details regarding the number of Grafts:

1500 Grafts

2000 Grafts

3000 Grafts

4000 Grafts

5000 Grafts

6000 Grafts

7000 Grafts

8000 Grafts

FAQs about Hair Graft

How many grafts are needed for a full head of hair?

Depending on the person’s head size, the thickness of the hair follicles, the number of grafts, this figure may vary, ranging from 7000 to 10,000 grafts.

How long does hair grafting last?

Hair transplant surgery lasts between 4 and 8 hours, more or less based on the graft number. The results of hair transplantation can last a lifetime if good care is taken in the 2 months following a successful operation.

Ref.

 

  1. 7000 Grafts Hair Transplant Turkey – Operation and Cost. Heva Clinic. Accessed May 16, 2024. https://www.dentalhairclinicturkey.com/7000-grafts-hair-transplant-turkey/#norwood-scale
  2. Hoover E, Alhajj M, Flores JL. Physiology, Hair. PubMed. Published 2020. https://www.ncbi.nlm.nih.gov/books/NBK499948/
  3. ‌What Is the Structure of Hair and How Does It Grow? Institute for Quality and Efficiency in Health Care (IQWiG); 2019. https://www.ncbi.nlm.nih.gov/books/NBK546248/#:~:text=The%20shaft%20is%20the%20visible
  4. ‌What Is a Hair Graft? – 1 Graft Equals How Many Hairs? Heva Clinic. Accessed May 23, 2024. https://www.dentalhairclinicturkey.com/blog/what-is-hair-graft/
  5. 8000 Grafts Hair Transplant in Turkey. Vantage Hair Restoration Istanbul. Accessed May 23, 2024. https://hairrestorationistanbul.com/hair-transplant/8000-grafts/
  6. ‌Cisterne JM, Rostaing L, Durand D. [Preparation for transplantation and graft patient management]. La Revue Du Praticien. 1997;47(18 Spec No):S38-42. Accessed May 23, 2024. https://pubmed.ncbi.nlm.nih.gov/9501595/
  7. ‌Garg AK, Garg S. Donor Harvesting: Follicular Unit Excision. J Cutan Aesthet Surg. 2018 Oct-Dec;11(4):195-201. doi: 10.4103/JCAS.JCAS_123_18. PMID: 30886473; PMCID: PMC6371717.
  8. Vasudevan B, Neema S, Ghosh K, Singh S, Khera A. Hair transplantation by follicular unit extraction for male androgenetic alopecia: A retrospective observational study from two centers. Med J Armed Forces India. 2020 Oct;76(4):430-437. doi: 10.1016/j.mjafi.2019.11.001. Epub 2020 Mar 12. PMID: 33162652; PMCID: PMC7606102.

 

 

Article Review By: Dr. Jyothi Shenoy V
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MBBS, MD – Obstetrics & Gynaecology, MRCOG(UK)
23 Years Experience Overall