Illusion of density...

[Rahal Hair Transplant]

Follically challenged, 

The phrase “illusion of density” is open to interpretation however, essentially it’s exactly as it sounds. “True density” refers to the amount of hair somebody has in a given area, typically measured in centimeters squared before any hair loss. True density is typically between 80 to 100 follicular units per square centimeter. FU/cm2.  Typically however, it takes a loss greater than 50% of natural hair per square centimeter to notice actual hair loss. Therefore, to obtain an actual illusion of density, the surgeon typically re-creates 50% of true density. In other words, illusion of density is typically between 40 to 50 FU/cm2.

I hope this helps.

Rahal Hair Transplant 

[follically challenged]

6 hours ago, NARMAK said:

I think it's much more unusual to get side affects years down the line that within the first few months.

Perhaps unusual but i have seen more than one case on this forum of people claiming to have gained sides 10 or so years on. Whether those sides are directly from Fin....who knows. i guess we'll never know for sure...

 

6 hours ago, NARMAK said:

People literally have no problem popping a paracetamol etc. for a headache or other stuff which also has a risk of side affects, but somehow a pill with like 20 years worth of clinical studies and safety review/approval that has side affects for 2% of people, most of which resolve with discontinued use of Finasteride; is frowned on. 

Fair point, but not a totally fair comparison. A paracetamol would be taken as and when a headache arises, say, once every two weeks, perhaps? Whereas fin just feels like a lifelong, daily commitment. Once you're on it, you are on it!

 

6 hours ago, NARMAK said:

Seriously, HOW did we get to such a stage that something that occurs so rarely is the biggest cited put off for men to not try. 

A good point. Though, if going from purely anecdotal evidence, i see many, many people claiming to have tried and got sides, which does put me off. Again, how much of that is down to placebo on their part is very hard to say.

 

6 hours ago, NARMAK said:

People pop biotin pills regularly too. Yet not regulating that properly can also have some negative effects. 

I actually haven't heard of biotin side effects....maybe i shouldn't look 😅

[NARMAK]

20 minutes ago, follically challenged said:

Perhaps unusual but i have seen more than one case on this forum of people claiming to have gained sides 10 or so years on. Whether those sides are directly from Fin....who knows. i guess we'll never know for sure...

 

Fair point, but not a totally fair comparison. A paracetamol would be taken as and when a headache arises, say, once every two weeks, perhaps? Whereas fin just feels like a lifelong, daily commitment. Once you're on it, you are on it!

 

A good point. Though, if going from purely anecdotal evidence, i see many, many people claiming to have tried and got sides, which does put me off. Again, how much of that is down to placebo on their part is very hard to say.

 

I actually haven't heard of biotin side effects....maybe i shouldn't look 😅

Honestly, you can try it. If it works, then usually there's no issues. The comparison imo was just to say we pop it when we need it, but to me at least it's become akin to taking a multivitamin a day. Just take it and get on with your life. 

[BLE123]

With the results you see from the top docs nowadays, I think illusion of density is becoming a bit of an outdated concept - and one which is often used to explain subpar growth.

[Curious25]

4 hours ago, BLE123 said:

With the results you see from the top docs nowadays, I think illusion of density is becoming a bit of an outdated concept - and one which is often used to explain subpar growth.

It’s not, because even the most aesthetic results you are seeing from top doctors are usually only implanted at 50-55 max grafts per cm2 . . in which these graft counts are normally only necessary and utilised on people with native density of >80FUcm2. 
 

So when it looks like a killer result and you are unable to tell the difference between the transplanted zone and native zones, this is the ‘illusion’ working at its best because it is at least 25fu per cm2 less than the native areas behind the transition zones. 

Survival rate has most certainly improved over the last 5-10 years, for sure, however it is still always going to be about the illusion of density, until unlimited donor is a thing . . Or unless a patient with minimal hairloss achieves actual native density over what would usually be at least 2 surgeries. 
 

The only one pass surgery aiming for > 60fu per cm2 density I have came across online is the current case by@Fue3361 . . Which so far looks impressive, however still too early to conduct a graft survival count. 

 

[NARMAK]

27 minutes ago, Curious25 said:

It’s not, because even the most aesthetic results you are seeing from top doctors are usually only implanted at 50-55 max grafts per cm2 . . in which these graft counts are normally only necessary and utilised on people with native density of >80FUcm2. 
 

So when it looks like a killer result and you are unable to tell the difference between the transplanted zone and native zones, this is the ‘illusion’ working at its best because it is at least 25fu per cm2 less than the native areas behind the transition zones. 

Survival rate has most certainly improved over the last 5-10 years, for sure, however it is still always going to be about the illusion of density, until unlimited donor is a thing . . Or unless a patient with minimal hairloss achieves actual native density over what would usually be at least 2 surgeries. 
 

The only one pass surgery aiming for > 60fu per cm2 density I have came across online is the current case by@Fue3361 . . Which so far looks impressive, however still too early to conduct a graft survival count. 

 

Another often overlooked reason for going for lesser grafts in a single session it seems is that very graft survival aspect you mentioned at the end. 

You can always try go back to add more density down the line but our heads are a tricky thing and damage to the surrounding follicles already there apparently is the risk surgeons try to avoid. At best it could be temporary shock loss but permanent shock loss will leave people in a much worse position.

[AA1989]

19 hours ago, follically challenged said:

 Whereas fin just feels like a lifelong, daily commitment. Once you're on it, you are on it!

As Dr Bisanga says 'You dont need to take the meds forever, just as long as you want to keep your hair' 😊

[gillenator]

As men continue to produce testosterone and its metabolite DHT, it will deposit the excess in other tissue and organs including the scalp...because of this, the so-called safe zone in the donor area can and will decrease especially as we enter our 30s and older...this is why most men age 25 and younger show little to no diffusion in the occipital zone...however, as we age, many of us begin to show the beginning signs of miniaturization which is confirmed by a progressive decreased change in hair shaft diameter albeit slow in the donor zone, it can occur....the changes can also be confirmed by a decreased level of donor density.

[NARMAK]

3 hours ago, gillenator said:

As men continue to produce testosterone and its metabolite DHT, it will deposit the excess in other tissue and organs including the scalp...because of this, the so-called safe zone in the donor area can and will decrease especially as we enter our 30s and older...this is why most men age 25 and younger show little to no diffusion in the occipital zone...however, as we age, many of us begin to show the beginning signs of miniaturization which is confirmed by a progressive decreased change in hair shaft diameter albeit slow in the donor zone, it can occur....the changes can also be confirmed by a decreased level of donor density.

This is actually a great point and very, very often ignored by most even in the know generally. 

The donor area is considered generally "permanent" because of how it persists due to its natural DHT resistance being so high. However it is as you say, also susceptible to DHT. 

I genuinely feel this is why medication like Finasteride/Dutasteride are so important long term. My only genuine annoyance is regarding Minoxodil and why i wish that hair it regrew were more permanent once its use was discontinued kind of like how hair on the beard area and elsewhere remains despite use being stopped. Apparently Microneedling results are better in this respect but in combination the two give the best results, yet only as long as you keep using Minoxodil. 

This is why in the future, if something can do what Minoxidil can, but make the results much more permanent even after discontinued use, it would be a pretty big game changer. As well as maybe something that eliminates all scalp DHT without the side affects of Finasteride. 

 

[Shah007]

On 2/14/2022 at 7:25 PM, Curious25 said:

It’s not, because even the most aesthetic results you are seeing from top doctors are usually only implanted at 50-55 max grafts per cm2 . . in which these graft counts are normally only necessary and utilised on people with native density of >80FUcm2. 
 

So when it looks like a killer result and you are unable to tell the difference between the transplanted zone and native zones, this is the ‘illusion’ working at its best because it is at least 25fu per cm2 less than the native areas behind the transition zones. 

Survival rate has most certainly improved over the last 5-10 years, for sure, however it is still always going to be about the illusion of density, until unlimited donor is a thing . . Or unless a patient with minimal hairloss achieves actual native density over what would usually be at least 2 surgeries. 
 

The only one pass surgery aiming for > 60fu per cm2 density I have came across online is the current case by@Fue3361 . . Which so far looks impressive, however still too early to conduct a graft survival count. 

 

There’s a case presented by Dr Hasson of 5k grafts HT. The bald areas were planted with at density of 80 cm sq. Looking at the pics it looks like real density not an illusion. Are you talking about the same case?

I was told he can safely transplant 80 cm sq if supply & demand is not an issue. 80 cm sq is real density if most grafts grow. Most docs won’t go over 55-60 cm sq which would be a great illusion but not real density. Wondering what H & W can do what others can’t or won’t do. 

[Curious25]

Not it was from a Brazillian Dr - however I am aware of the Hasson case you are referring to. 
 

Whether or not the difference in aesthetic between 55 grafts cm2 vs 80 grafts cm2 is worth the extra depletion in donor area (given we know continual progression is almost guaranteed), the heightened risk of shock loss and lower survival rates . . Is down to dr and patient discretion. 
 

I would argue that for most hair loss sufferers, the pro’s of going for 55cm2 outweigh seeking out that native density. However - for some, perhaps not.
 

And it’s great if we are going to soon be living in times where native density can be restored via surgery. 

[gillenator]

It's one thing to achieve the highest levels of grafted densities but then the apparent issue becomes graft survival and overall yield...why?...because the level of trauma greatly increases as the number of recipient incisions exceeds 60 cm2 and when the level of trauma increases, graft survival and yield decreases...also in part because the blood supply also becomes much more compromised... other factors to consider?...really, how much visual difference is going to be achieved by increasing grafted density by adding another 10-20 cm2 at the top end?...meaning, how much at the top end is actually going to survive “and”, is it worth it to use up that valuable limited donor or have it available for the future?

[NARMAK]

11 minutes ago, gillenator said:

It's one thing to achieve the highest levels of grafted densities but then the apparent issue becomes graft survival and overall yield...why?...because the level of trauma greatly increases as the number of recipient incisions exceeds 60 cm2 and when the level of trauma increases, graft survival and yield decreases...also in part because the blood supply also becomes much more compromised... other factors to consider?...really, how much visual difference is going to be achieved by increasing grafted density by adding another 10-20 cm2 at the top end?...meaning, how much at the top end is actually going to survive “and”, is it worth it to use up that valuable limited donor or have it available for the future?

Just on this point. A hypothetical more than anything.

If a person's natural density was circa 80cm/2, would it be then possible to do a single procedure for 40cm/2 density and 12 months later another 40cm/2 or do we then run into the issues of possible permanent shock loss due to trauma of the scalp? 

Unlike hair transplants, the native density almost seems so high and possible because there's no trauma being caused to the hair. 

Another aspect, and i know this isn't really mentioned too much. Apparently the hair we "lose" even in slick bald areas isn't apparently completely removed. The DHT has apparently affected the dermal papilla to such an extent that apparently they never recover and regrow. That said, transgender cases have shown male to female examples where slick bald areas and individuals have practically regrown all their hair. 

Now, i don't think that's obviously a viable route for the majority, but it does indicate a scientific based situation that could with the right treatment allow significant regrowth in male hair loss sufferers if they manage to find the right mechanisms of action to cause such greatly weakened follicles to be revived.

A literal holy grail for hair loss lol

[dotdashdashdash]

On 2/8/2022 at 11:24 AM, LaserCaps said:

Many "things" have an impact on this "illusion." First consider the limitation and characteristics of the donor area.  Some believe there are over 101 different combinations of hair quality in the donor, ranging from very fine to very course.  It is up to the doctor to choose the hair and to closely match it to what he sees in the recipient area.  Fine hair for hairline, for example, often comes from behind the ear.  (In the old days it would come from the nape.  Soon thereafter they realized this was not such as good idea, particularly if the patient was experiencing retrograde alopecia). 

I've always heard, most patients start out with 100,000 hairs.  By the time they are teenagers, they have lost 50% of their hair and they still do not realize they're experiencing any hair loss.  We have also heard about donor area limitation.  How much hair is available lifetime? 7 - 8,000 grafts? At an average of 2.2 hairs per graft.....So, you are asking 17,000 hairs, plus or minus, to do the job of 50,000.  Of course, it is an illusion! Add more to the mix.....

Color of hair also has an impact.  Dark hair, light scalp does not help. The contrast makes it look worse than what it really is.  Blond, salt and pepper, blend with the color of the scalp and will typically give the illusion of more density. Hair length, as well, will also have an impact. If too long, the weight will pull away from the area and make seem thinner.  There always seems to be a perfect length that allows for the hair to look a lot fuller.  Work with your stylist to figure out what this is.  

I have a question for you.  If you are considering a transplant procedure, it is because you want more hair, not less.  Why would you keep it so short? Just wondering.

The beauty of transplants is the fact that now you can style it any which way.  Comb-over no problem.  Slick-back? No problem either.  Obviously, your current pattern and numbers of grafts will also have an impact.  The more shingling, the better. 

This industry has come a long way when you consider education and the equipment.  Results can be as natural as nature itself. Just make sure you ask about credentials of the doctor. 

Someone told me long ago, the good thing about transplants - it's permanent.  The bad thing, it's permanent.  Thus, if natural - permanent.  If unnatural - also permanent.  Do the research!

 

 

Can you say more about why long hair can be a bad style for post-ht? I am about a year since my fue and had hoped to grow my hair out. I thought it had been looking good, but last night someone took a picture of me in very harsh light and it looked so terrible. 

[LaserCaps]

On 2/27/2022 at 3:15 PM, dotdashdashdash said:

Can you say more about why long hair can be a bad style for post-ht? I am about a year since my fue and had hoped to grow my hair out. I thought it had been looking good, but last night someone took a picture of me in very harsh light, and it looked so terrible. 

This will all depend on the result, particularly a year later.  Was the density achieved by the doctor to your satisfaction? Do avoid the bright lights!

Sounds like you may want to have another procedure. When did you have the procedure done? How many grafts?

[gillenator]

Personally for my own case, I grow the hair on top of my scalp long to more so achieve the illusion of coverage rather than density.