From series Hair Transplant NJ:
Many patients considering hair transplantation have concerns about the "size of surgery." While it still stands, the greater the number of follicular unit hair grafts placed, the greater the general visible result, it is not always the necessary route to success. Often there are cost considerations, continued hair loss considerations, compliance with hair-preserving medication considerations, and time-to-placement considerations (which will be explained below).
The nature of hair transplantation has changed since the time I began training over 12 years ago. Because we were primarily performing strip surgery (i.e., harvesting hair grafts from a linear strip excision at the back of the scalp), we were trading any given result for a long linear scar. While great attempts are made to minimize the visibility of any associated scar, to completely avoid scar in the region is impossible. Thus we were trading a result for a scar, and wanted to maximize the said result usually with larger surgeries consequently.
Currently I use a robotic hair transplatation technique called robotic FUE or rFUE (ARTAS). With this technique I completely avoid the introduction of a linear scar at the back of the scalp. While the technique does necessitate shaving the back of the scalp to short 1.2 - 1.4mm length hairs, there are no other visible sequelae to the technique once the hair grows over the harvest region 10 days later. As a result, smaller surgeries have become more acceptable and even commonplace.
There are times when a patient is not wishing to afford the expense for a large 2,800 - 3,200 graft case. Instead, we sometimes agree to perform a smaller surgery of 1,400 - 1,600 follicular units, focusing on building a healthy and natural frontal and mid-scalp frame to the face. We leave open the option of a secondary procedure at any point in the near or distant future, dedicated to the crown perhaps, also of a smaller or intermediate nature. Because we are not introducing a long, linear scar each time, this is a perfectly acceptable pathway assuming the patient is a surgical candidate with an available donor supply. A good example of this is demonstrated in the picture above. This person had a 1,400 graft robotic hair transplantation focusing on the frontal "frame" and midscalp. We decided to leave his crown alone for a potential future date. This kept the hair tranplant cost down, the day of surgery short and simple, and I would argue optimized success for this patient.
Surgeons who are regularly performing >3,000 follicular unit FUE cases sometimes neglect to speak about growth yield. In my practice we are very conscious of growth yield (i.e., the amount of hair growth by 12-14 months post-surgery, given our pre- and intra-operative photographs and operative reports). I personally believe there are certain factors which start to compromise hair graft survival once the transplant exceeds a certain threshold. This threshold is different between patients because of variables which affect the time-out-of-scalp duration for harvested hair grafts. For certain patients the harvest may take longer due to certain scalp laxity or skin rigidity variables. Also for certain patients, it is more difficult to place grafts WHILE we are still harvesting in other areas, because of inherent limitations in positioning considering where the grafts are meant to go. While we optimize our hair interposition storage and chilling techniques, we focus on careful consideration of every variable to maximize growth success.
The cost of hair transplantation should not be overlooked as a relevant item herein. Many patients lose their hair in their mid-20s through mid-30s. Often, this is not an age demographic with adequate disposable income for a large surgery. While we can certainly offer a large surgery, and propose realistic associated discounts, there is nothing wrong with performing an intermediate-sized surgery to create a natural and pleasant result, with the option of secondary or tertiary surgery in later years.
The overall point here, is really to say robotic hair transplantation with robotic FUE has opened the door to smaller and intermediate procedures as perfectly viable options for certain individuals. We of course would never suggest a surgery too limited in size to create a clear visible enhancement. We have learned however, great growth yields translate to happy patients with small-, intermediate-, or large-sized hair transplantation, so long as the goals of surgery are clearly defined and make sense.