You may have read about hair transplants and wondered how much of your hair can be restored. Would you be able to get 100% full coverage of your balding areas? Would you need a second hair transplant?
The short answer is: It depends.
We’ll discuss how ALL of these factors contribute to the ability to achieve full coverage with a hair transplant.
First, a little clarification on what is a hair transplant and what we mean by full coverage.
When we hear the word “transplant”, organ transplants may spring to mind: kidney, liver, heart. It’s something someone else has to donate to another person.
But with a hair transplant (including beard, eyebrow, and eyelash transplants), the hair used is your own. So, unfortunately, curly hair can not be transplanted if you have straight hair; your friend’s luscious locks can not be transplanted to your head; and synthetic hair can not be used. At least, none of these options are possible yet.
A modern hair transplant simply takes some of the hair you have left and moves it to where it has fallen out. Hair is not obtained from an outside source or created. It is redistribution of the hair you currently have on your head.
At its simplest, a hair transplant is a matter of SUPPLY and DEMAND: how much hair your balding area demands versus how much hair your donor area can safely supply.
“Full coverage” most often refers to when a high density of hair grafts can be transplanted to the balding areas a patient wishes to cover.
When faced with the prospect that “full coverage” is not possible, some patients request that hair be transplanted to all balding areas, even if the density would be low, in order to achieve “full coverage.” Most hair specialists do not prefer this method as their experience has taught them that this will not create an aesthetically-pleasing, natural look that the patient will ultimately be happy with.
If you have a limited donor area and a large balding area, most hair transplant specialists will concentrate the available hair grafts at the hairline and work back from there.
They concentrate first on achieving a good density of hair grafts at the hairline because this is the angle you see in the mirror or when people meet you.
Also, the hair in the front can be grown longer and styled in a way to give the appearance of more fullness on the top and crown even if there is a lower density of or no grafts transplanted to these areas. The appearance of fullness may be aided by other cosmetic products as well.
For some, this is sufficient and gives them the feeling of “full coverage.”
So it is important to know what your specialist is referring to when they speak about being able to achieve or not achieve full coverage. This also helps set your expectations for what a hair transplant can achieve for you.
The ability to achieve full coverage with a hair transplant will mostly depend on:
How much hair you’ve lost
-- Where does your hair loss fall on the Norwood Scale?
-- Do you just have a receding hairline?
-- Or have you completely lost hair in the front, top, and crown area of your head?
How much and what type of hair you have left in your donor area
-- Do you have only a narrow strip of hair left around the back of your head?
-- Or does the hair extend up the sides with balding occurring just on the top or front?
-- Do you have thick or wavy hair left in your donor area?
-- Or is it quite thin and not dense?
Whether you’re likely to have more hair loss in the future
-- How long have you been losing your hair?
-- Do you have a family history of hair loss that your pattern is likely to follow?
The Norwood, or Hamilton-Norwood, Scale is a classification system for measuring the extent of male pattern baldness. In other words, it gives a general reference for measuring the DEMAND of your balding area.
Keep in mind that the Norwood Scale is just a reference.
You may have hair loss that follows a pattern on the scale but still have some thin hair left in the balding areas and not be completely bald there. Your baldness pattern may not quite follow any of the patterns or be a combination.
You will hear the terms “density” and “grafts per cm²” when speaking about the number of hair grafts that can be transplanted. The extent of your hair loss and the size of your scalp will determine how many cm² need to be covered on your head.
Natural hair density can vary greatly among individuals but research has shown that average hair density often differs according to racial variations (approximately 75 grafts/cm² for African hair types; 80 grafts/cm² for Asian hair types; 90 -100 grafts/cm² for Caucasian and Hispanic/Latinx hair types.)
Many people considering a hair transplant dream about getting back the hair of their youth. Unfortunately, recreating the exact density of natural hair is generally not possible with a hair transplant. However, a hair transplant can still provide the appearance of substantial density with proper planning and styling.
A Norwood 6 or 7 pattern will generally struggle to obtain full coverage with a hair transplant because the balding area is so large and of how much hair has been lost.
Yet this does not exclude someone with this level of baldness from having a hair transplant at all, provided that realistic expectations are set. A hair transplant may still be able to create a hairline to frame the face and give you a desired look.
The type of hair that can be transplanted is limited. This is called your “donor area” and will be the SUPPLY of hair grafts.
The donor area is generally a rectangular band extending from ear to ear. It does not include the hair that goes all the way down to your neck (this area usually has less density and the hairs themselves are often thinner or “miniaturised” so not suitable to be transplanted) nor the area too far into your crown region (the top, back part of your head as this area is generally not resistant to DHT).
The most important characteristic about the hairs around the back of your head and neck are that they are resistant to dihydrotestosterone (DHT). This is the hormone that is thought to be responsible for male pattern baldness. This is why in men with the condition, that area keeps at least some hair when the hair at the front and crown thins and recedes.
When you move these hair follicles, they keep that resistance so even though they are moved to an area where hair has fallen out, this hair will not fall out like before.
Body hair transplants (using the hair from the chest, beard, and sometimes legs or armpits) have also become possible to add extra donor hair when there is not enough in the scalp area.
Because these types of body hair often differ in thickness, texture and colour, they are generally not used as main source of donor hair. They will be used in combination with the naturally-textured head donor hair to result in the most natural look.
This is because the whole follicle (containing the hair bulb, dermal papilla, sebaceous cells, dermal fat, and a little skin) is harvested. It is necessary to remove the whole follicle in order for the hair to be able to grow again when moved to another area.
Think of it like replanting a tree where you must dig up the roots with the tree so it can thrive in another location.
Most men naturally have about 8,000 - 10,000 hair grafts (or follicular units) in their donor area. Doctors have varying opinions as to how much of the donor area can be harvested without decreasing the density so much as to be noticeable, with estimates ranging from 35 - 50%.
However, even if harvesting up to 50% of the donor area is possible, that leaves a limit of 4,000 - 5,000 grafts that will ever be available for a hair transplant.
As mentioned above, body hair can help “extend” the donor area but is generally not used as a primary source.
Also, hair loss is not only genetic but affected by age. So another concern is that as you age, the density in your donor area will also naturally decrease. If too many grafts are removed for a transplant and your hair density decreases, you may end up with hair that looks very thin or “moth-eaten” in your donor area.
To keep your donor area looking full with hair and to avoid creating the very bald patches you are trying to eliminate with a hair transplant, a hair specialist will ensure they do not remove too many grafts. If they harvest too many in an effort to fill balding areas on the top and front, the hair at the back of your head is left looking thin and possibly with bald patches.
All of these factors mean the supply of donor hair available for a hair transplant will always have a limit.
It is impossible to know what the exact extent of your hair loss will be. A family history of hair loss can be a helpful predictor but, because you have genes from both your mother and father, your hair loss may not follow the exact pattern of a relative with hair loss.
It’s recommended to have a hair transplant once you have been losing hair for a while and it has stabilised. This is because a hair transplant can replace hair that has already fallen out but it can not prevent future hair loss of existing hair.
If your hair loss has only just begun and you have a hair transplant, you may assume that any hair that falls out are transplanted hair grafts and the treatment is not successful. But very often it is the natural progression of the loss of your existing hair.
If you choose to have a hair transplant before you hair loss has stabilised, you will need to keep in mind that you may need another transplant in the future if you wish to fill in areas where hair has continued to fall out.
This will need to be taken into account when planning your hair transplant so the donor area can be preserved enough to supply grafts for another treatment, if possible.
When determining hair transplant coverage, we see that multiple factors are considered. These factors take in the past, present and future state of your hair. The answer to “Can I achieve full coverage?” can not be as simple as “yes” or “no.”
Many of our partner clinics in Turkey advise that they can transplant up to 4500 grafts in one session and some patients expect that is how many grafts will be transplanted for them.
However, that number is a general guideline of what CAN be possible - but only if you are found suitable once the factors above are considered. It is a maximum and not the average or default amount of grafts.
Your hair graft estimate will reflect what is POSSIBLE for your hair loss situation, including how many grafts you NEED to achieve coverage and what that coverage will be.
This is why a hair transplant specialist can give you an early indication of how much coverage you can expect when they see clear, decent quality pictures of your head and hair but a more accurate evaluation will be made during your consultation before surgery.
Here is when you and the specialist discuss expectations and plan your hair transplant together. That may mean deciding whether to already plan for a second hair transplant now to actively preserve the donor area or transplant what is possible and wait.
In either case, it will be necessary to wait a minimum of 8-12 months (depending on your specialist’s advice) to observe how your head heals and your hair regrows.
You may just be happy with the coverage your first hair transplant achieved.
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