2324 FUG Maximum Harvest by William Reed, MD

[Dr. William Reed]

Hair transplantation is a very satisfying procedure both to the patient as well as his doctor. The most common dissatisfaction, however, comes from disappointment in the density achieved with one procedure. The solution, if such dissatisfaction occurs, is another procedure to increase the density, but this roughly doubles the expense for the patient. One procedure has several important characteristics that need to be understood by the patient in order to avoid this disappointment: 1. Common consensus is that the maximum density that can result in reliably good growth is around 40 graft sites / cm2 for 2 and 3 hair FUGs and perhaps 50 / cm2 for the one hair grafts at the leading edge of the hairline. 2. The density achieved from this density is perhaps a 60% dense result. ("Fullness" is more optical than mathematical and is impacted by factors other than just density including hair fiber diameter, color of hair vs the skin color and waviness of hair. "Fullness" is also often more a reflection of "hair mass", i.e., hair diameter, length as well as density.) 3. At maximum density 2800 grafts will cover only approx. 70 cm2 (2800 / 40 = 70). Most people have more than 70 cm that require some coverage as in this case shown here. Therefore, certain areas will have less density than 40 sites / cm2 and the resultant, theoretical 60%. 4. These points mean that one procedure will be more "styling dependent" than, for instance, doubling up the density with a second procedure.

 

These photos show at 8 months the results of a pattern covering in excess of 70cm2. We were able to obtain a total of 2324 grafts from a maximum harvest that wasn't as long a strip as usual due to decreased density above the ears and a donor density that is somewhat below average (see photo). The strip width was as wide as 1.5 cm. The fullest result possible was imperative due to an important upcoming life event. I would submit that a styling dependent full look will be achieved for this upcoming event in another two months when the hair of the mid frontal forelock grows longer to allow more hair mass to cover the thin area shown in the photos. Looking at the uniformity of the graft growth at the hairline, I think most of the grafts are growing at 8 months. However, there may be some more hair mass from the grafted hairs attaining their longer, optimal lengths. A second procedure may be necessary just for ease of achieving a style that will be durable enough for wind and water.

[Spanker]

The important thing is that a patient in this situation is told that he will need more that one procedure to reach his goal (depending on what it is), and that he had donor issues before the case started. As far as needed grafts, I would have guessed him at at least 3500, which at over 70cm2, seems like it would be appropriate, depending on the doctor. I hope he gets another pass if he wants one.

[RCWest]

Outstanding post, Dr. Reed! You did a good job in explaining density.

 

Even at only 2324 grafts, this is a pretty dense outcome. Very natural looking.

[Dr. William Reed]

The important thing is that a patient in this situation is told that he will need more that one procedure to reach his goal (depending on what it is), and that he had donor issues before the case started. As far as needed grafts, I would have guessed him at at least 3500, which at over 70cm2, seems like it would be appropriate, depending on the doctor. I hope he gets another pass if he wants one.

 

Agreed: "depending on what it [goal] is." The problem is that the patient doesn't know what the goal is until he sees the hair growing. (Due to variables in density, hair diameter, styling as discussed in the initial remarks other patient examples are unrelaible.) Therefore, the doctor can't really say what will be necessary either. That is why I think it most respectful to the patient to always include the possibility of needing more grafts from additional procedure(s). However, the physician can have a pretty good idea that one procedure will not suffice if the patient insists on a short hair style since 40 grafts/cm2 is too sparse to be likely to succeed in achieving adequate density. However, even this cannot be counted on since fine blond hair can look really good at that lower density.

[Mick from Farjo]

Dr Reed,

 

I think this is an excellent post and result thus far.

 

Mick

[Dr. William Reed]

Dr Reed,

 

I think this is an excellent post and result thus far.

 

Mick

 

Thanks, Mick. And thanks, too, to RCWest and Spanker for the discussion.

[Gandolf]

 

However, even this cannot be counted on since fine blond hair can look really good at that lower density.

Can you elaborate on this? Wouldn't fine hair require MORE density to look normal as opposed to coarser hair? I am interested in this because I have fine blonde hair.

[redlonghair]

overall looks nice. pix 16/18 shows some scalp at front, so density is not high, pix 17/18 confirms low density once hair is parted, pix 18/18 shows this person seems(to me) to have good donor hairs for future procedures