Graft estimates

Just take me to the automatic graft estimate chart...

The Do-it-yourself graft estimation method

I think it will be best learnt by carrying out an actual exercise in estimation of the optimum graft requirement for a particular person.
The first step is to see the donor area and determine the skin and hair characteristics.
(1). Curly / straight. (2). hair color. (3). skin color (and thereby the skin-hair color contrast).
(4). hair shaft diameter (thick, thin or medium thickness of the hair shaft).
Following are a few pics.
You can follow the same steps for yourself that we perform for this case.
In case you have any queries or questions you can ask me in this thread or you can email me at poswalarvind@yahoo.co.in

In the next step, we calculate the actual donor area in sq.cms
One does not have to be a mathematical genius here- we are aiming to get a rough idea about the grafts required. For purpose of this case the area can be divided into the back half and the front half.The back half can be measured easily as almost a square / rectangle.

It is approx. 11 cms by 8 cms.
Area = 11 x 8 = 88 sq cms.

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For purpose of simplicity of calculation let us consider it as 90 sq.cms
The area in front of this can be viewed as more of a triangle.

That will be 11 cms (the base of the triangle) and 6 cms (the height of the triangle).
Area of triangle = 1/2 x base x height
= 1/2 x 11cm x 6cm
= 33 sq.cms

Remember we have not included the hairline zone as yet.
The area to cover till now becomes 33sq.cm. + 90sq.cm. = 123sq.cms.
This area can vary in people with similar looking stage of hair loss. The next step is to take care of the variables in terms of the hair color, curl, shaft diameter etc.
For this purpose, you may trim hair over 1sq.cm. of the non balding scalp.
And measure the FUs in 1sq.cm.
We have trimmed hair of this patient prior to his procedure.
You may count his FUs as nature gave them.
He is a native of Spain but lives in Australia.
His hair color is dark brown.
He has a fair skin.
He has straight, medium thickness - shaft diameter wise, hair.
The skin - hair color contrast is on the higher side.
I think a person who gets the knack of this method can not be duped by a salesman consultant into believing that 1000 grafts would be enough for him, if his hair loss matches that of the current patient.
Following is the pic of his donor area.
Please do check out the no. of FU's per sq. cm.

We have to take into account the 10% hair that may be in telogen and may have shed.
Similarly, we have to add 10% to the figure as the person has a reasonably higher degree of skin hair color contrast.
If he has very thin / fine hair we will have to add another 10% to the final figure.
Like the hairline and the temples, the crown whorl area (though comparatively small) also needs to be treated differently.
In the whorl, the hair all point in a centripetal way and the center of the whorl has more 1 hair FUs than 2 hair ones.
For people with thin straight hair and high degree of skin hair color contrast, a circle of roughly 2 cm diameter should have the graft estimated in a way similar to that done for the hairline.
For people with curly, coarse hair or lower degree of skin hair color contrast, a 1 cm diameter circle will do.
After we have done the calculation for the 2 areas mentioned above we calculate the hairline zone.
Following are the pics of the hairline proposed at present.

We plan to keep a 1cm. zone of mostly 1 hair FUs.
Following are pics of the last day of the patient's surgery.
We placed 2620 grafts over 42 sq.cms(approx 60 grafts per sq. cm.)
The hairline was filled with mostly 1 hair FUs at 70 grafts per sq. cm. whereas the inner areas were filled with 2 - 3 hair FUs (some very few 4 hair ones too) at 40 FUs per sq.cm
The grafts could have been placed at a higher density. But one has to weigh the actual cosmetic benefit achieved to the fact that there would be a donor depletion by the time we try to fill up the remaining areas in his next trip.

Why did you not deal with the crown as well ?
The patient wanted to go for 2500 grafts at present, not 5000 or more.
He, therefore, had 2 options -
1. To spread the grafts thinly over the entire area - including crown, and then to get more hair transplanted later in between the previously transplanted area.
2. To dense pack one area - the front - and to take care of the crown at a future session.
He chose the second option. Another factor was that he wanted to see the results of his body hair transplant (we placed 300+ grafts) and then in the 2nd session, he may opt only for a body hair transplant and not touch his head donor area again.

One of the questions that often comes up is how many grafts per sq. cm.?
There is a lot of confusion in the mind of a newly balding person.
30 grafts or 130 grafts per sq. cm.?
I think it needs to be addressed.
How much do you think is the no. of grafts per sq. cm. in this person ?
Will the density, in your opinion, be satisfactory ?

Graft estimation charts are available but the logic behind the graft estimates is not explained. Mostly, they are subjective.
Secondly, the graft estimation charts are of a very generalised nature. That is to say, the variables of the particular patient

Hair color.
Hair shaft diameter.
Skin hair color contrast.
Hair curl / wave.
Location of the hair loss.
Patient expectations / aspirations.

are not objectively taken into account.

There is a way to be able to objectively calculate what the patient may require for a full looking head. No selective lighting, no combovers.
One way to account for most of the variables is to see one's own donor area (at the back of the head) or the non balding areas.
Comparing one's own non balding areas removes the problems of many of the variables (hair color, curl, shaft diameter etc.).

Q1. Does the density in the scalp donor areas satisfy you ?
Most / all will be very happy to get similar looking hair growth in their presently balding zone.
The minimum no. of FUs required to achieve that look will be the optimum / maximum no. of grafts a person may require.
Now we have to calculate that "optimal graft requirement".
The first step towards calculating that will be (if the answer to Q1. is yes) to count the FUs per sq. cm. in that area.
You can do this yourself or with the help of one of your friend.
Trim hair over 1 sq. cm. and photograph with a good camera.
Load the image in the computer.
Open it in paint or photoshop. Choose a pencil marker tool and count the FUs as they emerge from the scalp.
Let us assume a person X has 70 FUs per sq.cm. in the non balding / scalp - donor area. 50% of the density of the donor area will give a visual appearance of a non balding head (as per studies already carried out by previous hair transplant doctors).
That will come to 35 FUs per sq. cm.
Since the person is checking out his own hair, all variables like hair curl, color etc. are accounted for.
Now we calculate the actual area of hair loss in sq. cm.

  Please omit the hairline zone and the temple areas presently.Their calculation be separate.
Supposing a NW 5 / 6 has 200 sq. cm. of bald scalp. His Optimum graft requirement will be
35FUs x 200sq.cm. = 7000 FU grafts.
The first step towards one's treatment is to know what it will involve.
This is partly the way to calculate how many grafts you may require to give a non balding look - not a comb over alone or very thin look.
Whether the patient can afford that many grafts or has that much donor supply is an issue to be dealt after the principle of optimum grafts has been understood.

  Note:   This method is not meant as a substitute to what your hair transplant doctor decides. It is merely a method by which you may realize the approximate nos.
Hair line and temple areas have a much larger proportion of 1 hair grafts. Since the hair density (in the non balding head) is similar in the hairline zone as compared to the scalp donor areas, it means the no. of FUs is more.
If a person has 70 FUs per sq. cm. in the donor area (average 2.3 hair per FU), then his non balding hairline area is likely to have as much as 150 grafts per sq. cm. (average 1.15 hair per FU).
The front 1cm. (in people with a high degree of skin - hair color contrast) to 0.5cm. (in people with lower degree of skin hair color contrast and curly hair) is to be considered the hairline zone for purposes of hair transplant and graft estimates.
Thus, the prospective hair transplant patient should mark out this hairline zone (possibly in conjunction with his hair transplant doctor).
In this he has a lot of leeway in terms of planning a V shape or a rounded hair line.
After measuring the area of the hairline zone in sq. cm. he has to multiply that figure with 70.

  Example:
Donor area FU density is 70 FU per sq. cm.
The patient has straight dark hair and a fair skin.
He measures the length of the proposed hair line as 20 cm.
The hairline zone area = 20cm. x 1 cm. =20 sq. cm.
Graft requirement for the hairline zone at 70 FU per sq. cm. works out to
20sq.cm. x 70 FUs = 1400 FU grafts.
A similar approach has to be used in the temporal areas. Adding the figure one obtains from the hairline zone to those we calculated for the rest of the balding areas one gets the total optimum graft requirement.
7000 + 1400 = 8400 grafts.
It goes without saying that a person with a higher or lower FU counts in the donor area has to accordingly adjust his calculations.
This mathematical model that i have proposed is a way of estimating the graft requirements in conjunction with your hair transplant doctor's advise in an objective way.
This is to safeguard against a salesman consultant who may advise 1000 grafts to a person (who may actually require much more) to get him started.

Graft Estimate chart


Not a good hair transplant candidate.		Not a good hair transplant candidate.

Minimum requirement: 800 grafts. Moderate requirement: 1400 grafts. Optimum requirement: 2000 - 2500 grafts.		Minimum requirement: 1200 grafts. Moderate requirement: 1800 grafts. Optimum requirement: 2500 - 3000 grafts.

Minimum requirement: 2000 grafts. Moderate requirement: 3000 grafts. Optimum requirement: 4000 grafts.		Minimum requirement: 1800 grafts. Moderate requirement: 2500 grafts. Optimum requirement: 3500 grafts.

Minimum requirement: 3000 + grafts. Moderate requirement: 4000 + grafts. Optimum requirement: 6000 + grafts.		Minimum requirement: 3500 + grafts. Moderate requirement: 4500 + grafts. Optimum requirement: 6000 + grafts.

Minimum requirement: 6000 + grafts. Moderate requirement: 8000 + grafts. Optimum requirement: 10,000 + grafts.		Minimum requirement: 7000 + grafts. Moderate requirement: 10,000 + grafts. Optimum requirement: 15,000 + grafts.