Isn't dense packing the hairline extremely risky?

[Mikey1970]

One of the biggest surprises for me since being a member of this forum has been the common practice of dense packing even a centimeter of recession on hairlines with anything up to 2000 grafts!

 

To my way of thinking this kind of practice uses a massive % of total donor for such a small area (admittedly the most seen area).

 

What happens if hairloss continues behind the transplant? I know most HT patients utilize DHT inhibitors but I don't think they work 100%.

 

How many HT patients experience further loss behind the transplants and are then left with one hell of a problem down the track?

[Dr. Alan Feller]

One of the biggest surprises for me since being a member of this forum has been the common practice of dense packing even a centimeter of recession on hairlines with anything up to 2000 grafts!

 

To my way of thinking this kind of practice uses a massive % of total donor for such a small area (admittedly the most seen area).

 

What happens if hairloss continues behind the transplant? I know most HT patients utilize DHT inhibitors but I don't think they work 100%.

 

How many HT patients experience further loss behind the transplants and are then left with one hell of a problem down the track?

 

Yes, this is called "Front Loading" and it is a real problem in the Hair Transplant industry. It usually happens with young patients whose hairline is just beginning to recede. The area is packed with grafts and then, of course, the hair continues to recede behind it. Now the patient has this really thick band of hair in the front and a donor area that does not have enough hair to balance it by filling up the areas behind.

This is not to say you can't transplant young people, you can, but they must already be receded enough that filling in the front area can be balanced out by the remaining donor hair if necessary.

 

Dr. Feller

Great Neck, NY

[Spanker]

It depends on the pt, their risk for further loss, the shape of the hairline, their donor, etc. I think if you chose a great doc, you shouldn't have to worry too much. Here is an example of shape of hairline. A higher and more conservative allows you to pack more hair in the hairline with less worry because there is less area to cover. I actually wish my hairline was higher but I didn't want to wait a decade to get the hairline I wanted for my hair to recede more, so since I was dedicated to meds and non aggresive in balding so far, I rolled the dice with what I have. So, I guess to respond to your thread, I think it is risky on some patients, but not all. Most patients that have a nice transplanted hairline are going to need 2k grafts in their hairline. The risk is where the hairline was placed.

 

Example

Imgur: The most awesome images on the Internet

[esrec]

What about front loading and lowering hairlines? Always surprised when I see someone under 30 try to enhance their native lines.

[home1212]

excellent points Spanker - when I see a very young patient getting their existing hairline lowered, it always makes me wonder what they've gotten themselves into in terms of trying to keep up with that hairline with a lifetime of surgeries - and hopefully their donor would allow them to do it - I believe the hairline should always be conservatively placed, except of course if you have a low probability of losing more hair, etc.

[Sean]

Looks like it can be. Esp if a doc implants 65cm2 in an area you have ample native hairs, thus harming your chances of an acceptable result as discussed due to shocked recipient and native hairs which obviously did not grow or recover. Then to go back to same areas of massive scar tissue to a repair and still not reach your goals. This is when patients specifically initially mention to implant in front if such native areas and not all if that behind the hairline. Thats why good documentation and etc is necessary at all times.

 

So yea in some cases it can be risky and doctors should always do what is safe for patient and understand their concerns.

[mamzuka]

The biggest problem that concerns me is a hairline that is to thin and see through. Not to thick. Also if it is to high it doesn't look very good.

[Spanker]

The biggest problem that concerns me is a hairline that is to thin and see through. Not to thick. Also if it is to high it doesn't look very good.

 

You can make a hair line as dense as you want to, but what about the rest of the head? It's all a balancing act.

[YouOnlyLiveOnce]

Different variables. If you're a 25 year old guy who's never used med who's lost a ton of hair, you're probably not a good candidate for a dense hairline.

 

Hair loss and transplantation has come a long way in the past decade or two. Guys are getting on meds sooner and doctors are able to perform surgery more efficiently. Unfortunately, we wont really know how big of an impact all that is for another decade or so when we reflect. Between the combination of FUT and FUE with decent donor I think most guys can harvest 10k+ grafts. Unless you're deep in the 6/7's, I think most can end up with a decent head of hair.

[Spanker]

Different variables. If you're a 25 year old guy who's never used med who's lost a ton of hair, you're probably not a good candidate for a dense hairline.

 

Hair loss and transplantation has come a long way in the past decade or two. Guys are getting on meds sooner and doctors are able to perform surgery more efficiently. Unfortunately, we wont really know how big of an impact all that is for another decade or so when we reflect. Between the combination of FUT and FUE with decent donor I think most guys can harvest 10k+ grafts. Unless you're deep in the 6/7's, I think most can end up with a decent head of hair.

 

 

I tend to think most guys with decent donor and laxity have 6k to 7k grafts, which was a lot of grafts 15 yearsna ago, buthe u think you have to be pretty special to push out 10k at 2 hairs per graft.

[Dr Blake Bloxham]

Mikey,

 

Good questions. As you can see, this is a complicated issue. I think the most important points are 1) Avoiding "front loading;" 2) Avoiding OVER dense packing; and 3) Planning with future loss in mind.

 

Here is a very extensive post I wrote about points 1) and 2) a few weeks back in this thread. The patient had similar questions, so it may be useful (but fair warning, it is long!).

[newbie33]

Par example, non?

 

http://www.hairrestorationnetwork.com/eve/181045-dr-hakan-doganay-1700-grafts-7-months-fue-implanter-pen.html

[esrec]

Par example, non?

 

http://www.hairrestorationnetwork.com/eve/181045-dr-hakan-doganay-1700-grafts-7-months-fue-implanter-pen.html

 

I'd say so.

 

I'll stop short of saying it's the doctors responsibility to communicate how dangerous a decision to lower an already healthy hairline can be, but the patient needs to do the due diligence to understand the risks too.

 

I don't get that one. Guy had a perfect head of hair.

[YouOnlyLiveOnce]

I tend to think most guys with decent donor and laxity have 6k to 7k grafts, which was a lot of grafts 15 yearsna ago, buthe u think you have to be pretty special to push out 10k at 2 hairs per graft.

 

I respectfully disagree. I think 6-7k is attainable through strip alone. Then however many extra via FUE once you've become stripped out.

 

Personally speaking, I don't think my donor area is great by any means. According to Hasson, we can easily go for another pass after the first 3k that were extracted. Since we were shooting for a relatively small number, I didn't do any scalp stretches either. Then I had a consult with a FUE doc who estimates he can harvest 7k before any noticeable change. So, I dunno..

[YouOnlyLiveOnce]

I'd say so.

 

I'll stop short of saying it's the doctors responsibility to communicate how dangerous a decision to lower an already healthy hairline can be, but the patient needs to do the due diligence to understand the risks too.

 

I don't get that one. Guy had a perfect head of hair.

 

To that point, he's hasn't necessarily made a bad choice. We don't know any history of his loss, family loss, meds, his age etc etc. His hair seems to be thick and healthy otherwise. Perhaps, he just wanted to frame his face a little better.