When baldness has progressed significantly, patients face a very different set of questions than those in the early stages. In this article based on his Q&A video, Dr. John Watts — dermatologist, trichologist and hair transplant surgeon in Hyderabad — addresses an advanced-stage baldness planning question and a scalp health query.
How many grafts does advanced baldness require?
D Venkatraman asked about being at an advanced stage of baldness covering almost 80% of his scalp. He wanted to know how many grafts would be needed for the front, middle and top, whether beard hair could supplement donor supply, and how many sessions would be required.
Dr. Watts gave a frank assessment. “In such a scenario, the donor hair can come from the limited stock of donor hair grafts at the back of the scalp, but they would be inadequate. Hence, we may have to look at the chest, beard and hair grafts from the pubic regions. Still, it won’t suffice,” he explained.
The graft estimates: approximately 3,000 grafts for the front hairline, 2,000 for the top, and 2,000–3,000 for the crown — a total of 7,000 to 9,000 follicular units. “This means that the available donor hair would not be enough,” he confirmed.
What are the alternatives when donor hair is insufficient?
Dr. Watts outlined practical alternatives for advanced-stage patients. One option is a hair patch or wig for immediate coverage. Another is Scalp Micropigmentation (SMP), which simulates a close-cropped look naturally. “If your goal is to have natural hair that does not look very dense, then you can opt for a hair transplant procedure. You will still have decent hair to show off,” he noted.
How to manage oily scalp with dandruff while using minoxidil?
Ricky described wearing a bike cap daily to avoid dust, bathing twice a day, yet still struggling with dandruff — all while using minoxidil.
Dr. Watts acknowledged that some people naturally have an oily scalp and that washing twice a day is not unusual. For dandruff, anti-dandruff medication is the standard approach.
However, he advised against continuing minoxidil until the oily scalp issue is resolved first. A simple home remedy: apply lemon juice to the scalp once a week, leave for 15–20 minutes, then rinse off. “If the problem persists, consult a dermatologist,” he recommended.
This article is for educational purposes only and is not a substitute for professional medical advice. Consult a qualified dermatologist for diagnosis and treatment.
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Frequently asked questions
How many hair grafts are needed for advanced baldness covering 80% of the scalp?
Dr. John Watts estimates 7,000-9,000 grafts: roughly 3,000 for the front, 2,000 for the top, and 2,000-3,000 for the crown. Available donor hair often falls short.
Can beard and chest hair supplement scalp donor hair?
Yes, body hair grafts can be used, but even combined sources may not fully meet requirements in very advanced cases.
What should I do if I have an oily scalp and dandruff while using minoxidil?
Dr. Watts advises addressing the oily scalp first with lemon juice applied weekly before continuing minoxidil. Anti-dandruff medication helps with dandruff.
