Grafts per sq cm

[Hair4Days]

Hey guys. I am looking for people’s input on the grafts per sq cm topic. When determining what kind of density & coverage you can expect, would you agree it really comes down to the basic math of total sq cm of balding & projected graft count in your donor? For an example, say a patient has 250 sq cm of baldness (nw6) and a projected graft count of 8000 grafts (using fut & fue combined). You can argue each third of the scalp is 83sq cm. If you plant 40 grafts per sq cm in the front third that Would equate to 3320 grafts. 30 per sq cm grafts in the mid scalp (2490) and 25 in the back third (2075) = 7885 total grafts. Obviously you can compromise density in certain areas of the scalp and favor the hairline. Is this a valid way to determine what kind of coverage someone with this size balding pattern can achieve? Also, i have heard anything north of 45-50 grafts per sq cm is risky due to blood supply complications, but I’ve heard some doctors claim they aim in the 55-60 range in the front.  How safe is grafting this many grafts per sq cm?

 

[Westview]

Here's a good article on that: https://www.rahalhairtransplant.com/many-grafts-need-full-head-hair/

[Melvin- Admin]

I will be creating a video of this, and why grafts per cm2 doesn’t matter as much. Dr. Bisanga answered this perfectly.

[arthurSam]

Hello any link to the video ?

[Vann]

On 12/10/2020 at 9:26 PM, Hair4Days said:

Hey guys. I am looking for people’s input on the grafts per sq cm topic. When determining what kind of density & coverage you can expect, would you agree it really comes down to the basic math of total sq cm of balding & projected graft count in your donor? For an example, say a patient has 250 sq cm of baldness (nw6) and a projected graft count of 8000 grafts (using fut & fue combined). You can argue each third of the scalp is 83sq cm. If you plant 40 grafts per sq cm in the front third that Would equate to 3320 grafts. 30 per sq cm grafts in the mid scalp (2490) and 25 in the back third (2075) = 7885 total grafts. Obviously you can compromise density in certain areas of the scalp and favor the hairline. Is this a valid way to determine what kind of coverage someone with this size balding pattern can achieve? Also, i have heard anything north of 45-50 grafts per sq cm is risky due to blood supply complications, but I’ve heard some doctors claim they aim in the 55-60 range in the front.  How safe is grafting this many grafts per sq cm?

 

there's so many variables to it. Scalp size, donor capacity, hair quality. You cant really say one shoe fits all. Also in terms of blood supply you can check you coagulants prior to make sure you do not have any issues (usually blood tests are done at the clinic from what I have read thusfar). If you fear you would have poor circulation you could talk to your physician about that and see if you can take some vitamins to help prepare you.

For example a NW6 vs a NW2.5. You could have 5000 donor capacity for both but considering techniques (FUT/FUE), hair quality, realistic goals, you would want to maximize the donor. 

The NW6 could have a lot of multi hairs and could potentially save a lot of grafts, perhaps they do multiple FUTs and have better quality of grafts from the dissection. The NW2.5 could have more singles and doubles than any other graft. It really depends case by case.

But realistically if you poked 40 holes for implantation in both patients to you could have either 40 hairs, 80, or 120 (single, double, triples).

Personally, if I were you I would consider asking your surgeon or doctor or anyone you do your consultation with about your concerns, goals, and what you expect to have. You could have extremely thick hair and dont need to implant at 50 cm^2 you could have poor density in your midscalp but your hairline is extremely strong. Just make sure you talk to them about your case and how you could achieve the best result.

[Rahal Hair Transplant]

Hair4Days,

Hair Transplant patients love to talk about density and its measurements. There’s absolutely nothing wrong with that but at the end of the day, how much density is sufficient varies from patient to patient. I think it’s usually better that patients don’t get hung up on the numbers but rather how the end result  looks under the various conditions such as styled versus not styled, various lighting conditions, wet versus dry, etc.

As far as numbers are concerned, today’s skilled and experience surgeons can densely pack very high numbers even up to 80 to 100 FU/cm2.  But is this appropriate and necessary?  Not typically.

How much density is appropriate for each patient depends on a number of factors including

1. The size of the recipient area

2. The target areas since typically not every area of the scalp will receive the same level of density

3. Hair caliber / hair shaft diameter

4. Hair color to scalp color contrast ratio

5. Available donor hair over a lifetime aka number of FUs / hairs available for transplanting over a lifetime (Dr. Rahal has an use as a scientist formula to determine this) and whether or not dense packing is appropriate

6. Patient goals - for instance if a patient has a large area they want to cover, sometimes density has to be sacrificed even if a surgeon can potentially dense pack more in a particular area

7. The patient’s “true density” aka their actual natural hair density  

8. Average number of hairs per FU

Now, if we are talking about ideal scenarios assuming donor hair is unlimited, I’d say that average transplanted hair density could range between 40 to 70 FU/cm2.  Now depending on all the above characteristics and variables, this range could be higher or lower.

Like I said, at the end of the day, how many follicular units implanted per square centimeter is much less important than how it looks and appears in the real world.

Let’s be honest, if a particular patient shares their results and it looks fantastic, does it matter if their transplanted hair density is 40 or 70 FU/cm2?

I think what’s wrong is that many patients use these numbers to determine whether not a surgeon is one of the best and this is completely misleading and incorrect.

Just because a particular patient’s transplanted hair density is lower than what some consider average doesn’t mean that the surgeon doesn’t have the ability to do more.   Instead, the particular variables and circumstances in this patient’s case didn’t allow for it.  Now if a particular doctor never does dense packing even when it is appropriate, that’s another story.

So when evaluating a surgeons skill and ability to dense pack when appropriate, one needs to look at and assess a large number of cases.  In some cases, high dense packing with a large number of follicular units per square centimeter is appropriate and in another case is, it’s simply not appropriate.

In other cases, even when there is minimal hair loss or minimal risk of future hair loss, a particular patient may not require such high density because the cosmetic end result looks fantastic with lower hair density. They may have ideal hair shaft diameter and hair color to scalp color ratio, etc.

I’m pointing all of this out because it’s very worrisome when prospective patients get caught up in the numbers and don’t see that it’s not always appropriate. This is coming from a clinic whose doctor (Dr. Rahal) is well known for ultradense packing.  So clearly he has the ability to produce the highest densities when appropriate for the patient   But the key here is “when appropriate “.

I hope this helps

Rahal Hair Transplant 

Edited July 2, 2022 by Rahal Hair Transplant

[Rahal Hair Transplant]

@Melvin- Moderator,

I’d be interested to see this video and whether or not some of his thoughts are aligned with some of the issues I pointed out in my post.  Please let me know when you present this.

Rahal Hair Transplant