J

__________________
Go Cubs!

6721 transplanted grafts
13,906 hairs
Performed by Dr. Ron Shapiro

Dr. Ron Shapiro and Dr. Paul Shapiro are members of the Coalition of Independent Hair Restoration Physicians.

__________________
Go Cubs!

6721 transplanted grafts
13,906 hairs
Performed by Dr. Ron Shapiro

Dr. Ron Shapiro and Dr. Paul Shapiro are members of the Coalition of Independent Hair Restoration Physicians.

The following quote by my brother Dr. Ron Shapiro eloquently summarizes what we are doing when we perform a hair transplant surgery:


'In hair restoration surgery we are trying to redistribute a limited amount of donor hair, with minimal waste and maximum survival, to a potentially expanding bald or thinning recipient area. We want to accomplish this redistribution in a manner that insures the patient will be satisfied with the results now and in the future. Patient satisfaction is dependent on meeting his/her expectations of naturalness, density, and amount of work needed.'

The guidelines I mentioned in my post on dense packing take these basic principles in mind. ( http://hair-restoration-info.c...21087683&m=929107493)
At what densities we get minimal waste with maximum survival is a judgment call that we need to make on an individual basis with each patient. The guidelines I set in my post are just guidelines. I think they represent common sense. I chose the age of 30 because I think it is very difficult to predict future hair loss when a patient is in their 20's. I feel more comfortable predicting future hair loss in patients in their 30's but even then it can be difficult. There are times that going outside of these guidelines may be appropriate as long as the risk and benefits are discussed in detail with the patient. Sometimes to get the high graft count needed in large cases we go outside the textbook 'safe' donor area. And sometimes in order to dense pack we use up donor in the front half knowing that there may not be enough donor to plant at similar densities in the temporal humps or top of the crown if the patient progresses to a Norwood type 6 or 7. I have had patients who say they are comfortable with this risk because they would rather look their best while they are young. It is judgment call to decide whether the benefits outweigh the risk. At the same time I do feel that younger patients sometimes do not completely understand the risk they are taking in using up a lot of donor and/or dense packing, especially if they are in there 20's. When I was in my 20's, fifty years old sounded like an old man to me. But I am going to be 55 my next birthday and that does not feel old to me at all. And a lot of my peers are single and in the dating scene and want to look the best they can. Unfortunately the divorce rate in the US is greater than 50% so a lot of guys will be single again even if they are married.

As I showed in my post on dense packing that at SMG we can dense pack at densities up to 75FU/sqcm using the proper magnification and small custom cut blade. But this type of cases should only be done in the appropriate patients and I find that the majority of patients do not qualify for this type of sessions.

Below is a quick review of the math involved in hair transplantation. When we are transplanting in the front ?? to the front 2/3 of the scalp we are covering an area that can measure from 80sq.cm. up to 150 sq.cm. If we were to plant at a density of 40Fu/sqcm we would need 3,200 to 6,000 FU grafts. If we were to plant at densities of 60 FU/sq.cm we would need 4,800 to 9,000 FU grafts. You can see that if we plant at the higher density of 60 FU/sqcm that does not leave much donor left for future hair loss. (This is the surface area needed to cover if one becomes a Norwood type 6 and the area can vary depending on how high ones temporal humps are)

We need to carefully pick which patients we chose to dense pack. Even thought the procedure could look great today, we could paint ourselves into a corner so that 10 to 20 years down the road patient has an unnatural look and there is not enough donor left to make the transplant look natural. Unfortunately it takes that long to sometimes see the downside of what we do in a hair transplant.

Dr. Paul Shapiro

Thank you for taking the time to elucidate that for me Doctor. I can definitely understanding those who are slowly receding taking the "risk because they would rather look their best while they are young". Forest, at that density does your ht hold up under harsh light? Cheers