One procedure of 2353 Grafts by Bill Reed, MD

[Dr. William Reed]

These are the before and after photos of one session of 2353 grafts of which 300 were DFUs (double follicular unit grafts of 4 hairs each). The followup photos were taken at the time of a second procedure that was meant to increase density, especially along the part side of the hairline. These photos represent the "70% dense" result that I think one procedure can reliably produce. You can see how the styling is more important with this density which, in my opinion, looks better with the "combed across" look as opposed to styles which take the hair to the rear. Of course hair color and its fiber diameter contributes to the appearance of fullness and the acceptability of different styles and hair directions.

[corvettester]

This appears to be a good result, especially considering the number of grafts used. There is a clear and definite cosmetic improvement.

 

The hairline is conservative and age appropriate, as it should be. The transplanted hair lays nice and blends well with the rest of the hair. It all looks very natural and refined.

 

Of course, it's noticeably thinner than the rest of the hair, but that issue could be addressed with another procedure for density. I think he got a good yield and I do regard it as a stand alone procedure. The patient does not need more density, but could certainly use more if he wants it...

 

That being said, it looks good and I'd be happy with that amount of coverage from only 2,300 grafts. If anything, I would have went for 3,500 grafts initially to preempt the need for a second procedure for density, but doctor knows best...

 

If the patient isn't satisfied with the density, then I'd suggest adding another 1,500-2,000 grafts. Either way, it looks good and there is a very dramatic improvement from where he started.

 

These photos represent the "70% dense" result that I think one procedure can reliably produce. You can see how the styling is more important with this density which, in my opinion, looks better with the "combed across" look as opposed to styles which take the hair to the rear.

 

If I understand this statement correctly, Dr. Reed is saying that this patient has achieved 70% of native density with this first procedure of 2,300 grafts. If so, I disagree with his claim.

 

Although I do regard "70% dense" as an optimal standard to give a satisfactory illusion of density, I don't think that this patient has achieved 70% of native density... more like 40%.

 

From what I've seen, the 40-50% range is the bare minimum for the illusion of density and it typically looks very see-through, especially in the hairline and frontal third as is the case with this patient. Once you get into 65-70% of native density, it's very difficult for the naked eye to tell the difference, even in the hairline alone...

 

I can easily tell the difference, which is why I think that this patient needs another 1,500-2,000 grafts to get to the coveted 70% of native density threshold. I'm confident the second procedure will do just that, but like I said, it looks good as is.

 

 

Corvettester

Edited November 2, 2011 by corvettester

[RCWest]

Dr. Reed is last years Platinum Follicle award recipient. I'd trust him anyday. This is a huge, natural improvement.

[Dr. William Reed]

Thanks for your thoughtful, fair and balanced reply, Corvettetester. BTW, the number of grafts used was limited by the amount of donor obtainable. Also, more dense packing does not produce more density in my hands. Density and fullness are two different parameters, of course, but both seem to be determined more by hair fiber diameter and reliable, non-miniaturized growth (with miniaturization often and unpredictably resulting from too densely packed a pattern) than from creating a pattern of ever higher densities. However, progress is made by listening to what others are doing and trying to figure out not only how they do it but, also, what percentage of the time they can do it. I remember one of my favorite quotes from back in the 90s when Dr. Rassman retorted to critics of his 1000 graft "megasessions" by saying (perhaps paraphrasing a bit), " To those who say it can't be done, I say, 'Stand out of the way for those of us who do it everyday!' ". So I'm not saying that density over 40ish grafts/cm3 can't predictably be done by anybody, I'm just saying that as a skeptic and late adaptor, I don't think one session can reliably produce much more density than the case I presented and that more "dense" appearing cases are often the result of styling or hair fiber diameter. The case I showed is the standard to which I would like to be held accountable by people considering working with me. Again, Corvettetester, your remarks are fair and thoughtful. You obviously know our subject well.

 

Thanks for your kind words, too, RCWest. Trying to do what's best for the patient is best for everybody.

[Spanker]

Thanks for your thoughtful, fair and balanced reply, Corvettetester. BTW, the number of grafts used was limited by the amount of donor obtainable. Also, more dense packing does not produce more density in my hands. Density and fullness are two different parameters, of course, but both seem to be determined more by hair fiber diameter and reliable, non-miniaturized growth (with miniaturization often and unpredictably resulting from too densely packed a pattern) than from creating a pattern of ever higher densities. However, progress is made by listening to what others are doing and trying to figure out not only how they do it but, also, what percentage of the time they can do it. I remember one of my favorite quotes from back in the 90s when Dr. Rassman retorted to critics of his 1000 graft "megasessions" by saying (perhaps paraphrasing a bit), " To those who say it can't be done, I say, 'Stand out of the way for those of us who do it everyday!' ". So I'm not saying that density over 40ish grafts/cm3 can't predictably be done by anybody, I'm just saying that as a skeptic and late adaptor, I don't think one session can reliably produce much more density than the case I presented and that more "dense" appearing cases are often the result of styling or hair fiber diameter. The case I showed is the standard to which I would like to be held accountable by people considering working with me. Again, Corvettetester, your remarks are fair and thoughtful. You obviously know our subject well.

 

Thanks for your kind words, too, RCWest. Trying to do what's best for the patient is best for everybody.

 

That is a fair and honest respsonse. I paraphrased it myself as: "This is what you can expect from me."

 

For the number of grafts I would call this a acceptable result for any surgeoun (and a good result for most), and I believe that most people need 2 proceedures in the same area to achieve optimal density.

 

However, I do not think that Dr. Konior, Dr. Rahal, or SMG, etc put firbers on their patients hair before showcasing a result. So that said, I would expect a more dense look from them if the grafts were available. I think some doctors have a technique down that just allows them to pack more densely, like Rahal, than most doctors are able or willing to do.

 

This is not taking anything away from the result above, because for the grafts, it looks fine, I was just taking note with you saying that you do not think that a docotor can not reliably get a denser result than this in one session, I think they can.