Hello Dr. Nakatsui,
That's very impressive density. Is it really over 60/cm2?

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My Hair Loss Website - Hair Transplant with Dr. Siporin

Dr. Nakatsui,

Thanks for posting some very nice patient photos. They help affirm Pat's faith in your work and also help us assess your current techniques and results.

After viewing the photos, I have a couple of questions:

1. It seems as if your methods consistantly produce a very red scalp, usually indicative of higher levels of trauma to the scalp. I have wondered if exclusive use of laterals in a dense pack session create higher levels of scalp trauma. If you could elaborate please?

2. On patient #5, did he request a lower hairline than you originally thought he should have? IMO, it looks a tad "pinched", almost like it should have been moved back a bit and perhaps broadened, because it looks like it is out on an island a bit. It borders on "odd-looking" or what I like to call the "second look because something is not quite right syndrome". I understand if the patient is planning on doing additional surgeries, but I would appreciate your thought process for this patient.

Again, thanks for posting and I look forward to your dialogue and additional patient photos.

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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.

Dr. Wong, Spex, HK500, the B spot,
Thanks for the comments. I appreciate them very much.

HK500,
Yes, that is >60 grafts/cm2.

The B spot,
In the photos that I have shown, the recipient areas do appear quite red, but this is due to the overlying blood and scabbing. I do not remove the blood and scabs as vigorously as other surgeons seem to, but as it does not seem to affect growth rates, I have not changed this practice.

You will notice that there seems to be more blood and scabs for the first 2-3 cm of the hairline as it is in this area that the grafts are most densely packed. As a result, there is very little space where you can see normal scalp. However, in the less densely packed areas further back, if you look at the skin in between the incisions, it looks virtually normal (as long as you recognize that the red color is from the blood and scabs, not from any scalp abnormality.)

So, in response to your first question, I believe that the use of dense packing does not produce scalps that are overly red. On the other hand, I would agree that using higher graft densities does produce more trauma than lower graft densities, all other parameters being equal (e.g. same incision size, same incision depth). It is for this reason that it is extremely important for surgeons who dense pack to use very small incision sizes to minimize trauma to the underlying vasculature and hence decrease trauma to the scalp. It is in this way that we can achieve growth rates in excess of 95%.

As for your second point, I think I will leave that for another post, as I have rambled on enough already.

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

Thanks Doc!

I appreciate the response and explanation on your methodology.

I look forward to your response to my other question, when you have time of course =) I hope you don't feel as if that is a negative view of your work. I just asked a question based on the hairline in relation to the native hair.

Thanks Again Doctor, and thanks for your continued involvement with this community.

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.