Average Donor Density 80 Grafts Per Sq Cm

[Cant decide]

In looking at my graft breakdown from my SECOND procedure, I noticed that my donor density before the strip was taken was about 80 grafts per sq cm. Note that I had 5229 grafts taken out in my first procedure. Is 80 grafts per sq cm considered decent for a second procedure where over 5000 were already harvested in the first?

 

I think the answer is yes but wanted to check with you guys.

[gillenator]

Absolutely that's a good number to harvest from...

 

But the real more important question is, "What is the actual donor density to accommodate any upcoming subsequent procedures?" And that continues to be one of the dilemmas in that not many doctors will actually or scientifically calculate and determine the donor zone density in subsequent procedures. So if your density was 80 cm2 just before your second procedure, that's decent...

 

In addition, the density can and will vary throughout the occipital zone where strips are taken. So the determination throughout that strip zone may be more of a hypothetical number and not actual.

 

The positive factor is "if" there has been enough time for the scalp to regain a decent/adequate level of laxity, then more density can be realized. Not to it's original virgin level but enough for another successful harvest.

 

I had four strips in my lifetime. The 3rd and 4th strips were taken ear-to-ear and culminating an average of roughly 2300 - 2500 grafts each strip excision...

 

The third strip was roughly 1.4 cm wide and the fourth strip was approximately 2 cm wide so the doctor closed me with staples on my fourth procedure...

 

And before I forget, I wish you great success and a superb yield...

[Spanker]

I think 80 is above average after having a larger procedure.

[hsrp10]

yep I was told I have 70/cm2 and "average density," so 80 would be above average

[Cant decide]

Ok so if my donor density before my first procedure was about 110 and 80 before my second, I wonder why only about 2600 were able to be taken in round 2. My laxity was decent. Rahal said if I do any more, it should be FUE and I have 2000 max left. However, with these numbers, I would think I have more left???

[gillenator]

A couple of things. First, not sure how your doctor arrived at your pre-op density numbers. It certainly sounds like your doc did it, however most docs do not clinically calculate it. And those who do oftentimes evaluate at just one point in the occipital zone through a densitometer, count the number of FUs within the 1cm viewed lens and chart the number.

 

As I said before, the entire scalp has density variations throughout and that's just from birth. Obviously any HT surgery is also going to affect the density levels. I know of one surgeon that I trained under who evaluates six different points in the occipital zone before any procedure. He mostly did this in the advanced consultation appointment once the patient enrolls for the procedure. He would evaluate and call out the numbers to me and I charted them onto a diagram of the occipital zone that is permanently retained in every patients' chart.

 

He then took an average between all six numbers to arrive at what he called generalized density equation. Before any HT surgery, he called it (VDL) virgin density level, and subsequent numbers: procedure 2 density level, GDL-P2, procedure 3, GDL-P3, etc. In other words, whatever numbers he evaluated in subsequent procedures he called GDL, generalized density level.

 

With FUHT, this point of analysis was always within the proposed width of the strip all across the back of the scalp. He now only performs FUE so he does a more comprehensive analysis within the proposed zones where the extraction sites will be.

 

He also calculates differences in hair shaft diameter to note any impeding miniaturization and tends to keep his extractions outside of those areas. Very scientific in his approach...

 

The other thing that I did not comment on in my prior post is the area on either side of the strip scar. Although not always readily seen by the naked eye, there is usually at least 1mm of width in scalp tissue on both sides that cannot be harvested. There may be hair growing but due to the build-up of scar tissue, those grafts are not always usable in the next procedure. And there is really no way of knowing this until the strip specimen is out and passed to the surgical techs for microscopic dissection. Then the exact graft count is tallied and charted. Bottom line, some of them are not transplantable and will not survive.

 

So the numbers are not as perfectly exact as we might think them to be.

 

And some might jump to the opinion or conclusion that FUE is the only way to go to prevent collateral damage to FUs within the donor zone. Not true. Because the forces of torsion, traction, and compression from manual FUE can potentially also do collateral damage within the donor zones and make these neighboring FUs unable or ill-advisable to use. Trust me, I have seen enough horrible photos and in person observations of donor zones post-op both FUHT and FUE where FUs had collateral damage, especially from FUE extractions where the surgeon was learning manual FUE for the initial trial period, or from FUHT where the closing was poor and the patient ended up with a wider than expected strip scar.

 

This is why when having either method FUHT or FUE, the skill of the surgeon is impeccably critical. And depending in how each and every individual heals, the level and volume of scar tissue formed in the healing process will vary. And I'm referring to the amount/level of scar tissue formed than can be seen on the outer epidermis layer as well as the underside layer of the scalp.

 

These are just part of the implications in the aftermath of HT surgery.

 

So really, I have tried to see surgical hair restoration as more of a viewpoint of having the overall donor to achieve my attainable life goals and appearance.

 

And from your pics, I must say Can't Decide that you have some very nice results and I sincerely believe that you are going to be very happy when your second procedure fully matures my friend...

[Cant decide]

Thanks again Gill!! I just took the size of the strip (in Sq cm) and divided that into the # of grafts taken to get the grafts per sq cm. Dr. Rahal did not actually measure it.

[gillenator]

Your welcome my friend. I should have told you two other things.

 

When I worked inside the clinic, I had the benefit of looking at multiple strip specimens in the OR under a scope. Amazing view! The thing that you never hear about is the irregularity of the pattern of FUs within the strip itself. In other words, the final count can be ambiguous depending on each individual. Yet some strips have a very definite pattern and spacing of their FUs, others do not. Ethnicity and other factors can vary one's FU patterns in the scalp.

 

The other very critical factor that I should have mentioned is the "skill and competence" of the techs who do the microscopic dissection. Bottom line? Their competence varies and so do their individual experience.

 

Good ethical docs seem to retain the best staffs. They compensate them well and they take pride in doing the best job possible.

 

Then there are the greedy ones who do not treat their staffs very well at all. Because of this their turnover is high and they tend to employ sloppy and inexperienced techs who could care less about transecting those precious FUs.

 

This is why I always tell patients to inform the doctor and surgical team upfront that you want your donor density calculated and charted, and that you want a total graft breakdown and count taken of what was implanted back into the scalp.

 

Then at the end of the procedure, if the actual count is noticeably different from what the strip should yield, then that is a big red flag...:rolleyes:

 

I mean could there have been a lot of transection going on while the strip was being dissected? Why the huge difference? Was the tech new who was dissecting the strip? :confused:

 

Any patient will want to know which techs are dissecting the strip and how much experience they have. These questions can be asked in a respectful manner without offending the staff and best asked during the doctor consultation appointment and not the day of surgery.

 

In other words, it is best advised to ascertain who will be on the actual team for "my procedure" and then they know you did your homework and that you expect nothing less than a professional competent team who is going to do surgery on you. Professionals appreciate the fact the patient is informed and only expects the best.

 

Thank goodness you chose a good one...