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Are Hair Transplants an “Illusion” of density?

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57 minutes ago, GuruPete said:

OP stated he was a NW2 before surgery and had 3000 grafts. The hairline looks awful I would not be happy. No worder OP is covering with fringe. Graft angles look way off like most Asmed patients. IMO poor technique and below par quality

This is HT0416, he’s been banned for creating duplicate accounts. This is now his 4th account.

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I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

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13 hours ago, home1212 said:

for me, even having a "thinning" look after my hair transplants is way better than where I started - which was near complete baldness - therefore while I could achieve a denser look with products such as hair fibers, etc... I really don't want the extra hassle or fuss. In fact, just being able to shampoo, towel dry and add some gel and be out the door is an exhilarating freedom from the exhaustive time previously spent trying to cover up my baldness from comb-overs, hairsprays, etc.  My HTs, while definitely an illusion of coverage, have given me a great relief, and that's what I'm appreciative of most.

 

Many of you researching hair transplants should adopt this mindset.

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I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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Posted (edited)
1 hour ago, GuruPete said:

OP stated he was a NW2 before surgery and had 3000 grafts. The hairline looks awful I would not be happy. No worder OP is covering with fringe. Graft angles look way off like most Asmed patients. IMO poor technique and below par quality

Can't see even 1/2 way clear enough to see graft angles with certainty. But they look okay to me from what I can tell. Without before pics it's meaningless because many guys don't even know what NW they are. He is a 2 now!  But judging by the abrupt hairline I am guessing what we are seeing there is transplanted hair. And that transplanted hair in the pics (not great pics) looks pretty dense. Guessing mid 40's for grafts per cm2.  Not too many places pack more dense than that in one operation. So I get the impression this is a decent HT all in all.  Payam..His results are sub-par for where he is. Time will tell on that one. But not eveyone is a home run even though they all want to be. For every above average result, there is going to be below average ones too.  But HT1046's. This looks to me like a solidly average and decent HT. It's not a $30,000 job, but that's not what he signed up for either. 

 

 

This thread is great though!  It shows the range of mindsets, due diligence, emotional stability and vastly different expectations people build up in their minds.  It goes to show you the same results to one patient might love it in spite of the weaknesses and want to show it off in a positive way. Another with the same results might just continue to obsess over the places it came up short and miss the forest between the trees.  Like most plastic surgery, there is a percent. I am guessing 10-20 who are never satisfied and will always see the next flaw. We see them in real life looking like freaks. Too big lips, too much filler, too small nose. It really is a disorder where people obsess over precived flaws and tie their self worth or well being to it. Cold hard facts here people! Most guys don't care enough to get a HT.  So what we have here isn't even a average sample of men. Of course we are going to have a decent amount of guys with an irrational obsession with their hair. Just like body building sites have a fair percentage who are way off in neverland taking horrible drugs and looking like freaks, or talking about guys who don't work out like they are untouchable to women. We all went to school with some girls who stated starving themselves too.  Well, guess where all the man with hair dysphoric disorders end up?? Yep, right here!  And just like the already starving girl. They won't see reality. Just the one spot that could be thinner on her body or thicker on his head. 

Edited by txtransplant

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Posted (edited)
On 3/9/2019 at 1:11 PM, chicago2017 said:

This is not illusion. This is called a good result. 

It’s objectively an illusion. Do you think you can magically using the back of the head restore full original density to the top? Some of you people are being ridiculous. Try looking at a result post-shower (not the silly quick spray) with hair spread apart in different directions and you’ll understand. Try parting the hair in a manner like Payam or Melvin does in the original post for example and you’ll understand.

Not to mention people are ignorantly ignoring hair and donor characteristics of Couto patients, which are mostly top-tier.

The reality of the illusion doesn’t mean that you can’t expect with reasonable donor characteristics a head of hair that looks natural and doesn’t reflect hairloss, but it does mean that you have to find a way style it, wash it, get ideal lengths etc to make it look good. For a lot of people their personal idea of an ideal situation requires multiple procedures, period. 

 

Edited by JayLDD

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Individuals are born with approximately 100,000 hair follicles, this roughly translates to 50,000 follicular units. An individual with a Norwood 6 pattern would lose about 25,000 fu. How on earth can we expect to restore original density with 5-6K grafts. Luckily, we don't need to restore original density to have the "appearance" of a full head of hair. But make no mistake it is NOT actually a full head of hair. Hair restoration does not create new hair, it simply relocates existing hair to another location.

The majority of patients who end up disappointed are the ones who believe that they will be able to cut their hair any length, go swimming and look like they did before they had hair loss. This is a recipe for disaster IMO. Even someone with a Norwood 2 level of hair loss may be able to see a difference in density at certain lengths or angles. Most have anywhere from 100-80 fu per cm2, the best surgeons can dense pack up to 60fu per cm2, so regardless there will always be a difference in density.

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I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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Posted (edited)

Just to clarify my position on this matter ,the bottom line is I'm a lay -man and only have anecdotal experience on how transplants look in reality i.e my own transplant .

One doesn't have to be great at maths to work out that 4200  grafts will only offer so much density on a NW 5-6 as I was ..I had maybe 3 -4 hundred miniaturised  hair on top which may have grown back after the transplant or not I have no idea . I guess my view is if I can get a pretty good illusion of density in pretty much all lighting situations ..that someone who is a lower NW with good hair characteristics  and goes to a Doc with a proven record of dense packing  without compromising the grafts ..takes blood flow ..and shock -loss of native hair into account etc they will get a better illusion than I have achieved as happy as i am with my result ..believe  me to go from  a NW 5-6 to being able to comb my hair back in a style which suits my features is pretty amazing ..and I have had guys say to me they hope they have hair as good as mine when they are my age ..

I feel Melvin was correct in starting this thread as recently there have been guys showing their results with hair parted under harsh lighting  which even guys with no hair loss  hair  their hair wouldn't look great .

Just to add if I stood under a harsh light with my hair wet and  spread part   of  course it wouldn't look great ..but the reality is no-one sees me in that situation and as soon as the hair begins to dry and is combed back I'm good to go .

Edited by Mick50

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One more thing about how mos HT's look thin in direct overhead light.  Little science here.  My HT is only 6m old and low 40's was implanted over mostly bald areas. Hair is a little thicker than average according to my Dr and average hairs per grafts slightly lower. So I think that makes me pretty average!  On my head at this moment not all hairs have grown, but most have and none are thin. So, as an average characteristic guy probably with low 30's per cm2 I can create the illusion of a full head of hair you really don't notice in thinning at casual glance. It requires styling and length that is ideal to create that. And here is the science.  Even in direct bright sun, if the sun isn't overhead it doesn't look thin really. Indoors in a retail store it doesn't really show it's flaws either.  But even if you go into a bathroom with relatively, but focused overhead light it looks bad without concealer. And with direct overhead sunshine, It looks really thin!  It is all about light getting to the scalp! If the light is coming from the sides or defused it creates lots of little shadows and also a lot reflects back off the hairs. It's almost like the old xrays. Hold the film up in a room and it's dark and you cant really see. Have a bright light reflecting behind it and it changes everything!  Part of the illusion of thickness is filtering the light out before it gets to the scalp.    I am not thrilled with my results yet and honestly followed all the "rules" and did my research. What I learned is that even if I get 100% growth and what should be 1/2 of my original density....it's an illusion and not full, thick hair. It is enough to fake it and look passable in most situations.  BUT even though it's not ever going to be flawless even if I reach 100% regrowth and I am a little disappointed...there is no denying the huge impact it has had on my appearance and life. My face is nicely framed, I can dry my hair and go out without worrying about my hair and it looks quite natural on a early 40's guy. A pretty full head of hair that is thinning isn't a bad look on a mature man. We have to remember that! It is a completely different look than bald or mostly bald!  It is truly at a point where to the general public, hair isn't impacting my attractiveness and it looks fine most of the time.  And if I use a bit of concealer it looks perfect in an office or on a date. So I have the ability to fake completely solid hair when i feel like putting in 5min of effort.  Truly the only time it is really a mess is if I use that brown makeup on my scalp and go out in direct overhead sunshine. Then you can see the concealer, or at least something looks funky. If I were really tall, might not be an issue. But being a short guy, lot's of very tall people might notice looking a t my head from a few inches above me. So, even though I realize even a pretty run of the mill HT getting 50% density isn't going to be anything like my hair of yesteryear, it is silly to obsess over the weakness of it. Because it has been an absolute game changer and made balding (at least in the front and top) for me a fairly small inconvenience as opposed to a daily hassle and limiting reality.  Lesson learned here is if you are not happy with the illusion of density you have to go big!  You need to go to H%W or to one of the guys who seem to specialize in cramming 4000 grafts into the frontal 1/3 and start getting into the high 50's to mid 60's per cm2.   Those results are truly undetectable and are not trying to create in illusion. But for most people they are not wise, or realistic. So for most of us, we cover as much as we can and try to find the sweet spot where we buy the best look that our limited grafts can provide.  It takes truly ideal characteristics to have a HT done in one pass that looks close to original density in all situations. Higher than average numbers of multi hair grafts, thicker than average hair diameter and implantation pushing the limits of what most surgeons and patients should be doing. That would be 45-50 grafts per CM2.  In a patient with all those things going for him/her. Then a one pass HT will be an absolute homerun. And even in the front it would be pretty solid looking, but not flawless. But reality is most guys are average.  Most guys getting a typical HT are not going to get those amazing results.  I see a lot of guys going to your typical HT doc and getting pasible results on a first pass. For some, that's good enough and they move on not obsessed with their hair. For others, they obsess over every flaw. And some go get a second procedure and usually those 2nd porcedure guys end up with nearly perfect hairlines if they want to take it that far.       All of my advice excludes people who had well below standard growth, super thin hair or the biggest single problem.....unrealistic expectations.   The ones who go for a far too teenager like hairline that looks silly, Then they blow through way too many grafts to create it. Those fools are screwed!  They usually have to either live with a funky unnaturally thin kiddie hairline that never naturally thins in that way....or go for a second pas and blow through every last available graft and then are in a really bad situation for the future.  We see it every few days here. They think they can go to Turkey or wherever and get their 14y old hairline back in one mega surgery and fill the midscalp too. Realize after a time that their expectations were too high. Sometimes they don't man up and blame the Dr. Occasionally the Dr is at fault. Either way, they are screwed when it didn't have to be like that.   I wish their was an industry standard where doctors refused to restore anyone past an early NW2.  That would solve so many problems. So many 3000 graft frontal 1/3 jobs that would have looked amazing more dense over a smaller area where he patient is just ruined. Or will be in the next decade. The only patients who should be getting low, flat really youthful hairlines are young guys who have a proven family history of only frontal balding and show ZERO signs of thinning anywhere else. This is a rare subset of patients and I don't even think it is wise there. But lot's of patients want what they want and want it today.  The average guy getting a single procedure who is getting the front 1/3 done just needs to know that he will get something workable in all likelyhood. But not perfect. The guys who want perfection there need to cover a smaller area and probably get a 2nd procedure. 

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11 hours ago, Melvin-Moderator said:

Individuals are born with approximately 100,000 hair follicles, this roughly translates to 50,000 follicular units. An individual with a Norwood 6 pattern would lose about 25,000 fu. How on earth can we expect to restore original density with 5-6K grafts. Luckily, we don't need to restore original density to have the "appearance" of a full head of hair. But make no mistake it is NOT actually a full head of hair. Hair restoration does not create new hair, it simply relocates existing hair to another location.

The majority of patients who end up disappointed are the ones who believe that they will be able to cut their hair any length, go swimming and look like they did before they had hair loss. This is a recipe for disaster IMO. Even someone with a Norwood 2 level of hair loss may be able to see a difference in density at certain lengths or angles. Most have anywhere from 100-80 fu per cm2, the best surgeons can dense pack up to 60fu per cm2, so regardless there will always be a difference in density.

You make a good point.  Also, head size and hair caliber/texture plays a big role here with coverage success.  Doc Ive spoken with said i had more than 10,000 grafts available in donor when i started this damn journey.  Physiology will definitely play a big role.  For example, Dr Bisangas latest result posted of 5 thousand something grafts had extensive high end hairloss.  Yet he looks better than most results with other surgeons attempting high density grafting.  Why?  Probably because Dr Bisanga planned it for the patients safety and high ethics as he believes in the doctor’s code.     

Doctor skill definitely matters too.  Doctors ethics definitely matter too.  They can either take your money and screw you or they can do this safely and without wasting precious grafts.  And thats because they are condfident they can do it with lower graft counts.  There are few docs tgat can do this and utilize utmost ethics.  The rest are lean mean marketing machines.  

The crazier the surgical consent form, the crazier they are trying to protect themselves and not the patient.  

Grafts are priceless.  So this surgery should be done with extreme care and not based on greed.  This is a change to the face, the one part of the body that is always visible.   

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I think we need to find another way to say “illusion of density”. Density is not a definitive number. Density can be 100 grafts/cm2 and density can be 40 grafts/cm2 and it can be 5 grafts/cm2. All have different appearances.

The illusion of density is not quantifiable. Therefore, saying the hair transplant is an illusion of density, is not right. A hair transplant is adding hair follicles to create density. There is no illusion. There are density numbers that are more admirable and visually appealing (taking into account hair characteristics) than others that make some transplants stand out more than others.

If you’re going to keep saying hair transplants are an illusion of density, please change it to “hair transplants are an illusion of 100grafts/cm2 density”. 

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51 minutes ago, hairlossPA said:

I think we need to find another way to say “illusion of density”. Density is not a definitive number. Density can be 100 grafts/cm2 and density can be 40 grafts/cm2 and it can be 5 grafts/cm2. All have different appearances.

The illusion of density is not quantifiable. Therefore, saying the hair transplant is an illusion of density, is not right. A hair transplant is adding hair follicles to create density. There is no illusion. There are density numbers that are more admirable and visually appealing (taking into account hair characteristics) than others that make some transplants stand out more than others.

If you’re going to keep saying hair transplants are an illusion of density, please change it to “hair transplants are an illusion of 100grafts/cm2 density”. 

Amen. And will your illusion be 60grafts/cm2 or 20grafts/cm2 depends of area you have to cover and also of percentage of grafts that survived(surgeon skills). I think that surgeons should not do HT if they now your density will be less that 20grafts/cm2, if they are not money greedy and unethical. Also, sometimes surgeons give false promises and are reason of unrealistic expectations.  

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60 fu grafts per cm2 was the best case scenario. You guys are acting as if every surgeon and every person is receiving 60 grafts per cm2. The truth is, very few surgeons ever dense pack this level of density. The majority use about 45-50fu per cm2. There is a visible difference in density, I will not change the title because I'm speaking the truth. I have nothing to gain with telling you guys the truth. If you guys want to believe YouTube videos that's up to you.


I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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Dense packing can actually hinder the growth of a procedure, because of compromised blood supply. When you see these ultra-dense results. They are best case scenarios with individuals who had everything going for them favorable hair characteristics, donor supply and hair styling (layering). I say this because I have had a result where I can make it appear just as dense. The reality is I can also make it appear thin. Obviously, for the purpose of marketing a hair transplant result you want to show the result in the best possible way, as it should be, but actually believing that hair transplants are true density is a recipe for dissatisfied patients.


I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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16 minutes ago, Melvin-Moderator said:

60 fu grafts per cm2 was the best case scenario. You guys are acting as if every surgeon and every person is receiving 60 grafts per cm2. The truth is, very few surgeons ever dense pack this level of density. The majority use about 45-50fu per cm2. There is a visible difference in density, I will not change the title because I'm speaking the truth. I have nothing to gain with telling you guys the truth. If you guys want to believe YouTube videos that's up to you.

How dense did they pack your hair when you did surgery? Did they pack 50 grafts per c2 on you?

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There is actually not much to add to the comments of @Melvin-Moderator and @JayLDD,

Even the best results online e. g. from Couto are Illussions. True his results look like a full head of hair, but they aren't. I assume the results he shows have great growth with characteristics like mine: Dark hair with above average diameter and a natural density of > 110 FU/cm2 everywhere.

Even the best results have typically 55 FU/cm in the front and maybe 40 FU in the crown. This is 50 % (front) and 30-40 % (crown) of the orignal density. Besides the great characteristics, a perfect length and perfect light helps to create that illusions. Again, I am the best example:

- Look at my front. Density looks great in the pics but it is FAR FAR from my original/donor density. Under strong bathroom light and looking from the wrong angle it looks bad.

- Look at my crown pics. Both are with a professional camera at a top transplant clinic. Here is your Illusion

 

 

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3 hours ago, Phillyman1996 said:

How dense did they pack your hair when you did surgery? Did they pack 50 grafts per c2 on you?

Around 45 grafts per cm2


I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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Plus you have good hair quality...:)


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. Robert True & Dr. Robert Dorin, New York, NY

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On 3/11/2019 at 11:04 AM, hairlossPA said:

you guys are missing the point. i’ll leave it be

You mean to say that people should use a phrase along the lines of “the illusion of high density” rather than just “density”, as any area of scalp with hair inherently has a density, whether that density is great or poor. 

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4 minutes ago, yesplease said:

You mean to say that people should use a phrase along the lines of “the illusion of high density” rather than just “density”, as any area of scalp with hair inherently has a density, whether that density is great or poor. 

this guy gets it.

its understood that people can lose about half their hair before thinning is apparent to the normal bystander. If this roughly equates to 50grafts/cm2 compared to the normal teenage density of 100grafts/cm2, and many doctors implant at that level (some more some less), then I just dont agree with the illusion part of it all.

just my opinion...

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I think it's worth mentioning that we are in a  kind of echo chamber, or vacuum rather, in which we are finely attuned to looking at hair density and instantly critiquing it. Even if it's the illusion of density, or even obviously sub-optimal density hair, the average person isn't going to notice. One of the greatest reassurances of hair loss which everybody ignores is that those who notice most are those who suffer it too. If a HT takes the attention away from obvious bald spots and exposed widows peaks, the patient won't look balding in most peoples eyes.

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5 hours ago, yesplease said:

You mean to say that people should use a phrase along the lines of “the illusion of high density” rather than just “density”, as any area of scalp with hair inherently has a density, whether that density is great or poor. 

This is absolute nonsense. So if you grow one hair out that can cover your scalp that is coverage? I don't think so. Density is quantifiable and saying it is not is pure nonsense.


I do not provide medical advice, recommendations, all responses are my opinion.

My Hair Transplant Journey

Melvin- Associate Publisher and Forum Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q&A Blog.

Follow our Social Media Instagram @thehairtransplantnetwork FacebookPintrest, Linkedin and YouTube.

 

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i don’t know where you’re going melvin but if you have 1 hair in a 1cm2 space, yes I would say you have 1graft/cm2 density in that area lol. that would be statistically correct. no one is talking coverage here. coverage was never mentioned. 

i never said density isn’t quantifiable. it most certainly is. my thought is: the phrase “the illusion of density” is not quantifiable. it’s almost like an oxymoron.

it should be something like “hair transplants are the illusion of natural born density”

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Posted (edited)
39 minutes ago, hairlossPA said:

i don’t know where you’re going melvin but if you have 1 hair in a 1cm2 space, yes I would say you have 1graft/cm2 density in that area lol. that would be statistically correct. no one is talking coverage here. coverage was never mentioned. 

i never said density isn’t quantifiable. it most certainly is. my thought is: the phrase “the illusion of density” is not quantifiable. it’s almost like an oxymoron.

it should be something like “hair transplants are the illusion of natural born density”

Hair transplants are an illusion and the nature of that relates to density, natural vs replaced. Hence it is the illusion of density.

No trick or confusion here, you’re just being silly for whatever reason and playing nonsense word games. Have you had a transplant?  Because it most certainly sounds like you havent. If you stand under harsh bathroom lights and look at your hairline after a successful transplant, you will be shocked at how thin it looks and understand the point.

The point of the thread is obviously referencing HT014, Payam etc who post the most unflattering photos possible and make a deliberate effort to make results look worse with lighting, lengths, styling, not washing the hair, spreading it,  extreme close ups etc. The photo Melvin initially posted shows this perfectly and I guarantee if a new poster showed that a lot of people would be calling for blood of the doctor thinking it was a bad result. Anyone who has had a transplant gets it, I personally can both make it look like I have a full head of hair or look like absolute shit through the above means.  The reason is because of the level of density, and that is the illusion.

 Transplants often give you hair that can appear both severely balding or having virtually a full head of hair depending on conditions, a lot of people clearly refuse to understand this or the logic behind it. If people are posting crown results like that Couto in which the hair is combed for perfect coverage and never in opposing directions, while “wet” hair is with a spray bottle, to say that there’s no illusion proves a lot of people clearly don’t appreciate what illusion refers to. Clearly the clinic understands very well which is why they manipulate in this manner (although yes it is a terrific result).

Not sure why you keep playing dumb, I guarantee you understand all this. 

Edited by JayLDD

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4 minutes ago, JayLDD said:

Hair transplants are an illusion and the nature of that relates to density, natural vs replaced. Hence it is the illusion of density.

No trick or confusion here, you’re just being silly for whatever reason and playing nonsense word games. Have you had a transplant?  Because it most certainly sounds like you havent. If you stand under harsh bathroom lights and look at your hairline after a successful transplant, you will be shocked at how thin it looks and understand the point.

The point of the thread is obviously referencing HT014, Payam etc who post the most unflattering photos possible and make a deliberate effort to make results look worse with lighting, lengths, styling, not washing the hair, spreading it,  extreme close ups etc. The photo Melvin initially posted shows this perfectly and I guarantee if a new poster showed that a lot of people would be calling for blood of the doctor thinking it was a bad result. Anyone who has had a transplant understands this, I personally can both make it look like I have a full head of hair or look like absolute shit through the above means.  The reason is because of the level of density, and that is the illusion.  Transplants often give you hair that can appear both severely balding or having virtually a full head of hair depending on conditions, a lot of people clearly refuse to understand this.

Not sure why you keep playing dumb, I guarantee you understand all this.

Man imagine how many people would do hair transplants. If transplants gave 100 percent density. 

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