Dense Packing

[Squidward]

So everyone obviously wants their transplant to be nice and dense, but when is dense packed, well too dense? So in my consults I have come to terms that in the US, 50 grafts per cm2 is a dense packed hairline, but in places like turkey, I see they are going for 70+ in cases, while some yield good results, I cant help but to think this may be the reason that people are becoming disappointed in their results. When its about graft survival most of the US doc's I have spoken with say that beyond 50 you are suffocating the grafts from proper blood flow and they are dying. The Dr's are very reluctant to go beyond this mark most of the time as I have asked if they could do even 60, they fear for survival of the grafts. The work always looks very clean, atleast what I say from these turkish dr's but could it be too dense packed and starving the grafts of blood flow? I know that everyone reacts differently and there are some who get these mega packed and have outstanding results, but lately I have been seeing a lot of disappointed people and it just makes me a bit curious. If you go for one session at 50 grafts per cm2 , do you risk losing those grafts if you try to pack in more grafts in another session?

[rocketmas]

Great question. I would also like to know the opinion of people here. Obviously its desirable to have dense packing assuming the donor supply is there. There are some great results with dense packing and lowering hairlines, and without question they look better. But what are the risks of doing this ? Some doctors I agree would like to take a conservative approach because they feel comfortable not taking any risks, but others with the skill level may feel happy doing it.

What are the other things to consider ?

[Dr. Glenn Charles]

I know patients want to get as much density as possible in a single session. However, every person has a limited amount of donor hair and most cannot afford to waste any. So would you rather have 50 FU's per sq cm and get 47 survive or place 70 FU's per sq cm and get 54 survive. Keep in mind that the situation you are in did not occur over night and often cannot be fixed over night. That does not mean that if you have a large area of hair loss you cannot try to get a lot of grafts in  a single session, but in many cases additional sessions will be requested to obtain more density.

[gillenator]

Larger sessions on average produce higher levels of trauma and when the trauma level is raised, the yield can decrease.

We have to remember that the premise is attaining the illusion of coverage, not necessarily attaining the highest levels of density.

[Sean]

On 11/6/2018 at 10:57 AM, Dr. Glenn Charles said:

I know patients want to get as much density as possible in a single session. However, every person has a limited amount of donor hair and most cannot afford to waste any. So would you rather have 50 FU's per sq cm and get 47 survive or place 70 FU's per sq cm and get 54 survive. Keep in mind that the situation you are in did not occur over night and often cannot be fixed over night. That does not mean that if you have a large area of hair loss you cannot try to get a lot of grafts in  a single session, but in many cases additional sessions will be requested to obtain more density.

Spot on, anything over 55cm2-60cm2 and you are in high risk zone.  If you have medium to thicker caliber hair, you are even at a higher risk as your grafts will fight to get blood supply.  Trust me, density should be done safely on all patients.  Lots of priceless grafts can go to waste.  Then imagine the scar tissue bullshi you have to deal with when you are in need of a repair or repairs.  Aside from that if you have weaker hairs, they may not even survive extraction.  In the end, sales will be sales for some professionals and ethics and standard of care will be what some other docs seek.  Do not fall for all the hype and misinformation presented by some clincis and docs.  

Best of luck for anyone that gets a procedure but definitely weigh ootions very carefully.  Talk to multiple docs too and get muktiple opinions.