One of my favorite "Feller-isms" -- and there are many to chose from -- is the phrase: "like getting blood from a stone." For those unfamiliar with this saying, it basically refers to the idea of trying to get "something from nothing" or extracting from a tough source that does not want to give. Like trying to get blood or water from a stone!
In the hair transplant field, it refers to the challenge of obtaining a good quantity of quality grafts from a stubborn or barren donor. And unfortunately, it often happens in patients with a large demand (bald area) and this poor donor supply.
And that's precisely the situation this patient found himself in. He's a man in his mid-50s with a NW VI hair loss pattern. At first glance, his donor looked pretty good; something that could sustain a large session to tackle his aggressive pattern.
On closer inspection, however, his density was well below average as was his laxity. Sometimes these patients are good candidates for an FUE approach, but he came to us seeking an FUT megasession and I also didn't think he was the best FUE candidate all around.
So I decided to steal out as much as I could via FUT. I explained the difficultly of the donor to him, and warned him that graft number would not be great. He was hoping for one of the big 4,000+ graft cases, but I told him he would likely be less than 2,000. I also told him the key in these "blood from a stone" cases is strategy. When used properly to maximize the cosmetic benefit, a small graft number can go a long way.
I was able to obtain 1,800 grafts (with a large strip that would normally provide me with 3,500 or 4,000 in a better density patient); I used these to reestablish his hairline, densely fill the frontal band, and taper the density in the mid-scalp.
He returned 10 months later, and was very pleased with the result! Huge benefit from a smaller graft number.
Norwood stage 6
The balding areas at the temples join with the balding area at the vertex. The band of hair across the top of the head is gone or sparse.