What's considered a realistic expectation for dense packing? I've heard people claiming up to 80 grafts psqcm! But I thought most people had 90 naturally? And according to the HTN multimedia animation, it only take 45 to give the illusion of fullness.

Also, what factors contribute to how dense a doctor can pack? Does hair shaft size have anything to do with it? Scalp laxity? Any input would be greatly appreciated.

I'd love to hear some of the communities opinions on this matter. I'm getting my HT in about a month so I want to know what I can realistically hope for.

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My Hair Loss Website - Hair Transplant with Dr. Dorin

1,696 FUT with Dr. Dorin on October 18, 2010.

1,305 FUT with Dr. Dorin on August 10, 2011.

Several factors figure in to how dense a doc might pack an area receiving the transplant:

1) hair characteristics - if the hair diameter is large, course, and of a wavy texture, they won't need to pack the area as dense because these characteristics help with the illusion of density

2) density of the donor - if the donor area is dense, then there will be more grafts to use for transplanting, which may factor into the decision to pack denser. Not everyone has 90 grafts/sqcm, some may have much more and some much less

3) density of natural, non-miniaturizing hair - if the doc transplants denser than the surrounding hair, the transplant will look strange... ideally, the doc wants to create the illusion that will blend the natural and the transplanted hair in a smooth way

4) scalp laxity - the laxity of the scalp also factors into how dense the transplanted area will be as it may limit how many grafts may be taken from the donor

5) positioning of the hair - some docs can transplant the hair so that they grow parallel to the scalp and may, for instance, design a hairline that--at least in some areas--appears denser because it grows very near the scalp and may not need to transplant as dense

6) technique - some docs have designed special instruments that allow them to transplant higher densities than others--this is one of the MOST important factors in considering a doc, as some docs use huge scalpels and can only transplant at low-density. Many hair mill chains even use multiple-bladed tools

7) area to cover - the more area you have to cover, the lower the density MAY be because of the limitations of your donor and potential for future loss

8) potential for future loss - if you lose more hair, you'll want to have grafts left in the donor for another transplant and you'll may need another if you lose hair behind the transplanted area. There can be no guaranty that you will not lose more hair, so they want to make sure that the area will look as natural as possible if you lose hair behind the grafts

9) age of the person getting the transplant - the younger the person is, the more time they have to lose more hair

10) history of hair loss - this includes family members that have a history of loss (how much hair they lost, their pattern, and when their loss started) and how long the patient has been losing hair, their pattern, how much hair they've lost in that time, etc. in considering how aggressive they may be while still being a bit conservative

11) medication history - the doc will want to know how long the patient has been on hair loss prevention medications like Rogaine and Propecia, etc. to judge if hair loss has stabilized

12) patient expectations - the doc must keep the patient's expectations within reason considering all the factors above

As you can tell, there are many factors for the doc and the patient to balance before an HT should take place. No matter what, an HT is always a bit of a gamble, but with the right choice of doc, you can make it an educated guess and come out looking great!

good post above

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Best
SPEX

Consultant for Dr. Feller, Coalition Member and Dr. Lindsey, Coalition Member.

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

My Hair Loss Blog with Pictures

That post seems very detailed. Do you work for a transplant clinic? If so, you are supposed to disclose that. Either way the imformation was very good. It is also important to remember that different areas on the scalp will require different densities to give the appearence of fullness.

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Dr. Glenn Charles is a member of the Coalition of Independent Hair Restoration Physicians

Nope, Dr. Charles, I don't work for a transplant clinic... yet. Was that a job offer?

I'm just a gifted amateur, for the time being. Oh, and thanks for mentioning the 13th factor to consider.

weweregods, I'll support the kudos from Dr Charles and spex.... from Dr Charles, Feller, SMG not bad.

It is important to plan densities around where one will progress too, at SMG, we evaluate our approach around where the patient is, at the moment, but because we are dealing with a moving field and a limited source we also want them to understand what can be achieved worst case scenario, if they progress and go bald.

If the average patient goes bald; average patient has approx. 4000-8000fus in your donor to move, moderate being 6000fus. At our clinic we've been measuring MPA areas for years and we have found average MPA (the top plane of the head) is approx. 200cm2 in surface area. If you distribute 6000fus over a 200cm2 area, the density yields 30fus/cm2. 30fus/cm2 is a density that may have a fuller appearance depending on the characteristics of the hair, so 30 is not bad for someone who would be otherwise bald. Now, how most patients would distribute the hair would be rather then 30fus/cm2 over the entire area evenly and treating everything equal, most would prefer 40fus/cm2 in the frontal half (front 100cm2), a fuller appearance and 20fus/cm2 in the crown (back 100cm2), generally just enough hair to hide the scalp when dry.

Now, as Dr Charles mentioned there is what is called selective distribution; which is by making certain areas thicker you'll make other areas around it appear fuller. Two particular areas: are the frontal core area and anterior crown. By making the frontal core thicker it will make the hairline and everything around it appear thicker, by blocking the light. And, because the crown sit on a slope the hair falls downward, by making the anterior crown thicker, there is more hair to shingle over the remain crown area.

So, if you are an average patient and you show a strong disposition to progress and go bald, and have an interest for complete coverage, one should not exceed these designated densities. If one is not concerned with a bald crown or can be assured they won't go bald either do to genetic predisposition or that meds will prevent it (but this can never to confirmed for sure) higher densities can be achieved.

Regards, Matt Zupan

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Patient Educator, Shapiro Medical. Going on 20years with Dr Ron Shapiro......not a regular poster, I leave that to Janna

I have heard that the survival rate of the grafts drop on anything over 40 grafts per cm2

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"Great minds discuss ideas; average minds discuss events; small minds discuss people." -Eleanore Roosevelt

Thanks Spanker. I was about to comment on the yield issues with dense packing. In theory, it's a great idea and obviously more revenue for the doctor/clininc. I have not seen however many clinics that do it well, meaning survival rates or consistently high yields to support the idea.

When we get into dense-packing we are talking about literally thousands of recipient incisions being created in one setting. And obviously the more incisions created and the more closer they are in proximity to each other, the more potential tauma that takes place, including swelling.

Oh sure I recognize the improvement of using the tiny micro-blading to allow for closer placement of the FUs and depending on the use of saggital/lateral incisions, lots more hair can be moved with less overall trauma and swelling.

But even starting with a completely bald surface, I never see the need of getting into 80 plus FU cm2 on anyone. And the better the hair characteristics and hair quality, the fewer grafts needed to achieve the illusion of coverage.

I remember when dense-packing was the buzz in these forums about 5-7 years ago and it seemed to die out simply because very few clinics were able to pull it off with high survival and do it consistently.

Generally speaking, whenever I have seen patients get above say 60 FU cm2, the corresponding yields go way down. Could that be why we NEVER saw any yields reported or even tracked with these "super sessions".

IMHO, I would rather go in and get 40-50 FU done, let it all grow, and then come back for a second pass. Just my opinion.

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Gillenator
Independent Patient Advocate

I am not a physician and not employed by any doctor/clinic. My opinions are not medical advice, but are my own views which you read at your own risk.

Supporting Physicians: Dr. Glenn Charles, Boca Raton, FL - Dr. Jerry Cooley, Charlotte, NC - Dr. Jim Harris, Denver, CO - Dr. Robert True & Dr. Robert Dorin, New York, NY

Gillinator is right that at some point there is a trade off between density and graft survival. I'm not sure its the same number for all takers, example a health 30 year old vs. a 60 year old with high cholesterol and who smokes. Certainly local flaps and skin grafts heal differently on those 2 patients, and I suspect hair revascularization is different too.

Plus not everyone needs the same numbers, as eloquently discussed above.

That is why an in person consultation is so important.

Dr. Lindsey McLean VA

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William H. Lindsey, MD, FACS
McLean, VA

Dr. William Lindsey is a member of the Coalition of Independent Hair Restoration Physicians

Would 20fu's/cm give enough coverage to the crown and midscalp to pull off a buzz cut look?