I did personally speak to Dr. Keller about this patient and he did mention that he would reply here.

Though he typically uses all follicular unit grafting, Dr. Keller believes that this particular patient had enough existing native hair in the crown and the right hair characteristics to use a number of 5 hair grafts in the crown. He believes in exceptional cases that he can create a greater illlusion of density in the crown by strategically placing larger grafts in between and around existing natural or transplanted hair in certain patients.

Personally, I've always leaned toward all follicular unit grafting in all cases. But many surgeons have made cases for the occasional use of DFUs (double follicular units) on this forum including Dr. Paul Shapiro who has been presenting very impressive results for some time now.

This result looks great from these pictures however, more detailed photos of the top of the head and crown would certainly be helpful.

Best wishes,

Bill

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