I have read with interest some threads detailing lower density transplants yielding good cosmetic results. I have been a proponent of higher density transplants for a number of reasons but recently a patient came into my office with a fairly large balding area and a desire to have a fairly thick frontal forelock area and a thinner look between the forelock and the temporal zones.

I thought this would a great time to prospectively look at the difference in results using higher and lower densities.

The forelock was transplanted at the highest density (55 grafts/cm2 or 110 hairs/cm2 and the other zones transplanted at lower densities (18-25 grafts/cm2). I will try to document the results when this has had a chance to grow in. I think this will be a good opportunity to compare the results of higher and lower density areas. If lower densities achieve comparable results with higher densities in terms of naturalness and apparent density, then I would consider switching. Certainly, it would be far easier and faster to transplant at lower densities. My staff would love me.

He received 983 single grafts, 1214 double grafts, and 279 big grafts, for a total count of 2476 grafts. His hair was fine and curly.

Dr N.

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Dr. Nakatsui is an elite member of the Coalition of Independent Hair Restoration Physicians

Dr. Nakatsui,

Thanks for providing such excellent photos to document this patient's surgery. Ultimately, I'm a fan of higher density transplants in the right patients and in the right situations. And given the number of grafts used for this procedure, I trust he'll have enough to cover the rest of the scalp if he wants coverage.

How was this patient's donor density? Is there a reason you and the patient opted to do a smaller session given the area of baldness? Or was it his donor laxity/density that limited a larger procedure?

Best wishes,

Bill

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Managing Publisher of the Hair Transplant Network, the Hair Loss Learning Center, the Hair Loss Q&A Blog and the Hair Loss Forum and Social Community

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Remember, true beauty radiates from within, not from the skin.

I am not a medical professional and my words should not be taken as medical advice. All opinions and views shared are my own.

This is a very nice case to show that you don't always have to dense pack. In fact the case I just recently posted (Dr. Mejia one session) is similar in that it was only 1800 or so grafts using a combination of follicular and double follicular unit grafts. THe patient achieved very good cosmetic density and he was thrilled. Kudos to Dr. Nakatsui for doing an excellent job in the photo documentation.

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Ricardo Mejia MD, FAAD
Jupiter FL
Hair Transplant Network recommended physician; photos

Bill,

Thanks for the responses and for the good questions. I too am a fan of higher density transplants so this is the exception rather than the rule for me.

This patient's donor density was a little low with limited donor laxity. In conjunction with that, his hair was on the fine side. I was concerned that he would run out of hair before he reached full coverage.

I will post the after photos once I am able. Even with the natural curliness of his hair, I am of the opinion that the lower density areas will look natural but not overly thick.

The patient is happy with this goal. I thought this would be a perfect opportunity to test out differences between the cosmetic appearance of lower density and higher density areas in the same patient.


Dr Mejia,

Thanks for taking the time to post your comments. I appreciate it.

Dr N
www.drnakatsui.com

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Dr. Nakatsui is an elite member of the Coalition of Independent Hair Restoration Physicians

Hi Dr. Nakatsui,

I know this is a very old post but you recently posted another thread about 3 weeks ago, so I hooe you're still checking.

Did you ever take those follow up pictures for this case - how did the dense packed areas compare to the lightly packed areas in the end?