Here are few examples of patients in which I believe dense packing in the hairline area is appropriate. I consider planting at densities between 40- 60FU/sqcm as dense packing. There are patients in whom I will plant at densities from 60-80 FU/sqcm, but they are the rare exceptions and need to be perfect candidates for what I would call super dense packing.
In order for me to feel comfortable dense packing the hairline I think the following criteria need to be met:
1) The patient must be at least 30 years of age
2) The patent should have a family history that suggest his balding will not progress furhter then a Norwood type IV.
3) The donor area has to have at least an average density of 80/FU/sqcm
4) The donor area has to have good laxity
5) The hair behind the hairline should have no or little evidence of miniaturization.
6) The crown should have no or little evidence of hair loss or miniaturization.

At SMG we have a camera which can take close up photographs of a 1 sq.cm area of the skin which allows us to get a measurement of donor density and the density of our incisions. That is how we can get an accurate measurement of density. As you can see, to get an accurate count the existing hair has to buzzed. We rarely take postoperative density photographs because most post op patients do not want to buzz their new hair. Even it the patient did buzz his hair it is difficult to tell previous existing hair from transplanted hair in post operative photos. That is one of the reasons it is so difficult to do accurate post operative density studies. These cases were both done within the last month so I do not have 6 month results. I will post them when they return for their follow up visits.

Case #1 I packed at a density of 60-80 FU/sq cm. He had all the criteria for a case in which I feel comfortable packing at super high densities. He is a 33 year old male with no family history of hair loss more than a Norwood type IV. He has great donor density of greater then 100 FU/sqcm., and no miniaturization or hair loss behind his hair line. He also had no evidence of hair loss or miniaturization in his crown. I must stress we do not get many patients like this. But he is a good candidate for super dense packing. The photographs show my incisions ranged from 60 -80 FU/sq.cm. A total of 2164 FU's were planted.
Below are photographs showing his donor density, the density of my incisions, and day of surgery photos: (in the photos where the title is Hairs/sq.cm., it should read FU's sq.cm)

DONOR DENSITY


INCISION DENSITY


DAY OF SURGERY PHOTO, (before and after comparison)


Case #2 I packed at densities of 40-50 FU/sqcm. He represents the more typical patient I see in which I feel comfortable doing dense packing. He is a 38 year old male with most of the males in his family not progressing to greater then a Norwood type IV, but he did have an uncle who had Norwood type V hair loss. His donor density was not as good as case #1 and there was some evidence of miniaturization in his central core and crown areas.

DONOR DENSITY


INCISION DENSITY



DAY OF SURGERY PHOTO, (before and after comparison)

This is a very informative thread, but when you describe the DONOR DENSITY with 106 and 80 hairs in the pictures you mean FU's, right?

Dr. Paul,

This informative article and photo demonstration will help prospective patients help to understand when dense packing is and isn't appropriate. I've taken the liberty of transforming this post into a blog on our highly popular Hair Loss Q&A Blog.

To see this article, view "Who are Optimal Candidates for Hair Transplant Dense Packing?.

Thanks again for helping to educate the members and guests of this community.

Best wishes,

Bill

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To learn about how I restored my hair, view my my hair loss website.

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.

Very nice post; and that work looks truly beautiful!

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*A Follicles Dying Wish To Clinics*

1 top-down, 1 portrait, 1 side-shot, 1 hairline....4 photos. No flash.

Follicles have asked for centuries, in ten languages, as many times so as to confuse a mathematician.

Enough is enough! Give me documentation or give me death!

Makes me feel happy that I could have some form of dense packing, my natural hair is thicker than this guys and I'm near 34 now.

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Very informative and great pictures. I know it's dense-packing, but it's as if I can almost see all of the grafts in these photos. It makes me jealous, cause I'm pretty sure that I don't qualify for dense packing!

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2008 Dr. G – presumably 1,000 grafts / 2,142 hairs
2009 Dr. Paul Shapiro – 2,348 grafts / 4,258 hairs
2011 Dr. Paul Shapiro – 1,999 grafts / 3,624 hairs

My Hair Transplant Journey with Shapiro Medical Group

Additional to my first question (hairs vs. FU's) I would like to know how many percent of your patients did you treated with dense packing like this example? And is it possible to see more photos from SMG with dense packed hairlines!?!?!

Thank you in advance...

I'm a little confused by this. In the original post, Dr. Shapiro says dense packing would be in the 40-60 FU/CM2. I thought 40 FU/CM2 would be considered a normal density to do an HT? Is the normal HT usually done at 20-30 FU/CM2 or is it that only the hairline is not usually packed at this density?

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Yes I did mean FU's not hairs. Sorry for the confusion. I need to change the titles of the slides. Where ever the slide said hairs I did mean to put FU's.
It is only within the last two years we have started to take detail photos of patient's donors and recipient sites and we only started to do this consistently within the last year. One of the reasons I started to take these detailed photos is because we did not have very good documentation on what we were doing during our surgeries. And I wanted to know in more detail exactly what I was doing in a surgery.
I also was interested in documenting the average donor densities since that seemed to be a constant question.
So unfortunately I can't give you an accurate answer to your question. I would say that very few patients qualify for the extra dense packing. I would guess that 1%-5% of our patients qualify for extra dense packing.
We end up planting grafts at densities of 40 to 50 FU/sqcm in many of our patients, but I can't give you a percentage. In some patients we only pack at these densities behind the hairline, especially in the central core area but in some patients we do pack this densely in the hairline. As I take more photographs during surgery I will be able to answer this question more accurately. Remember 20% of the male population will be a Norwood type V to VI by the time they are 60, and 10% will be a Norwood type VII. So in patients who are too young to tell how they may progress or in patients in which we have a lot of evidence they may progress to a Norwood type V or greater we tend to pack more in the 30 to 40 FU/sqcm densities. The densities we pack at also depend on the cosmetic goals of the individual patients. Some patients don't care too much about their balding crowns and would rather look denser from the front, while others are very concerned about their crown loss. The difference in each patient's goals will affect the density in which we make our incisions.
I hope this is helpful
Dr. Paul

I would of thought that 40-50 isnt dense packing, just average.

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