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Density and Scalp Laxity

In an earlier entry, you were asked to talk about the ability to expand the lower donor scalp. Could you tell me more about why this is important.

The ability to move hair from the permanent zone around the side and back of the head to areas where it may be needed are dependent upon two factors, which are:

  • the density of the hair in the donor area. The normal density measures 1250 hairs per square inch. The more the density, the more is the movable hair
  • the number of square inches of scalp that can be moved depends upon the looseness of the scalp (something we call Scalp Laxity). The more square inches we can safely move, the more hair we can transplant

The ability to move more square inches of scalp with a strip excision also depends on the ability of the surgical team to place them safely into the area of need. Of course, it is important that the need for hair reflects the size of the bald area. For small bald areas, either less hair is needed or more density is needed. The ability for an experienced and skillful surgical team to place the highest density into the recipient area safely is core to the results that one can expect after a hair transplant. This varies between doctors offices and that is why the wide offerings are promoted on the internet. Some physician teams promote 5000 grafts in a single session in a fairly bald person, while other state that a lesser number is the only safe number. The safe number varies with the skills of the surgical team and nothing else.

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Defective beard transplant

This man found that his surgeon used 3-4 hair grafts for the beard. It is clear that there is a texture difference between his normal beard and the transplanted beard as well as skin deformities. I wonder if it would be worth while removing each graft that has multiple hairs and corbelling and replace them with beard hair from under the chin. You can have a test area done and see if it solves the problem to your satisfaction before rushing into a large surgical procedure. Then, after 6 months or so, it the test area approach works, you can replace your entire beard transplant as with the test site ?

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Can Dandruff affect growth from a hair transplant?

No, Dandruff is common and more pronounced after a hair transplant because skin turns over more frequently (skin shedding). If you are concerned about the growth and you are at least eight months since the surgery, then go back and speak with your doctor comparing your expectations to your doctor’s expectations.

poor growth

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Damaged hair grafts from FUE (photos)

The surgical team placed all of these grafts to marvel on the job that they did; however, they shouldn’t have been proud of it as many of these grafts will never grow. Note that the hairs within the grafts are cut in portions (transected). See the zoomed in section identified

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Zoomed in area on the left


2021-05-15 14:06:28Damaged hair grafts from FUE (photos)

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Daily Use Shampoo

Dr Rassman

Many shampoos claim that they are “suitable for every day use” . Does that mean that shampoos that are not for every day use could be dangerous for hair ?

This is a statement that promotes the sale of more shampoos. It has nothing to do with health of hair issues.

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Depleted Donor area at 8 months from 1500 FUE grafts (Photo)

Unfortunately, this is not an uncommon complaint; however, your donor density must have been very low to get such a depletion with 1500 FUE grafts. The only solution for this is Scalp Micropigmentation. I wrote a paper on this which can be seen in this post: https://baldingblog.com/2017/07/21/many-fue-grafts-many-fues-grafts-one-know-safe-limits/. Take a look at this site for more information on the only treatment for this: https://scalpmicropigmentation.com/gallery/bold-shaved-look/#!


2020-09-17 09:23:22Depleted Donor area at 8 months from 1500 FUE grafts (Photo)

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I Have Dents from Chronic Steroid Injections on My Scalp, What Can I Do About It?

These dents are the result of constant steroid injections which causes atrophy of the skin of the scalp. This can be treated by injecting fat cells into the dents to rebuild the scalp infrastructure. Hair transplants, if you need them, fix this problem nicely.


2019-02-20 06:52:15I Have Dents from Chronic Steroid Injections on My Scalp, What Can I Do About It?

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Density of Hair Transplants

Hello, I just had a wonderful procedure. Their offices were clean, procedures were excellent, and the staff was very accommodating. In 2002 I had 800 grafts done by another group in San Francisco and then again I just did 3500 grafts. The follicles were transplanted throughout my scalp approximately 25 FU/CM2. I have a very nice NW2 hairline. Also, I had a very high number of 4-hair grafts. Over 400 of them! They excised a strip of 3500 grafts and got 3703!!!

Do most of your patients get about 25FU/cm2 and are happy with it? I think it will be ok but just need reassurance.

A normal person will have 1250 hairs or 600 two-hair follicular units. When converted to cm/square, that would extrapolate to 100 follicular units per square cm. If you received 25 follicular units in 1 cm, that would suggest that in one procedure, the doctor returned 25% of your normal density on the transplanted area. This is often not really the case, as some areas will have higher densities put in and other areas lower densities. For a person with average weight hair, olive skin, and brown hair, 50% densities overall should be more than enough to produce a full appearance. If you had a high number of four-hair grafts, then that might mean that your overall densities are higher than average. I generally target 25% density return on the first session, but at times I will go higher or lower depending upon other factors.

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Densely Packed Hair Transplant? (with Photos)

hi dr,
i’m curious to know how dense you can make a head of hair if you have plenty of donor hair to work with? i like to keep my hair short is why i’m asking & just wondering what kind of density you are able to create.

here is a link to a famous actor christian bale. my hair resembles his in color & density so i’m wondering if you would be able to re-create that kind of density. heres the link [Google Image Search].

i appreciate your time…

Packing the recipient area with transplants can be done, however, you would want to discuss the general supply/demand ratio with your doctor when it comes to evaluating the donor area.

Here’s an example patient that had work in the hairline and crown. There was a total of 5756 total grafts moved over two procedures at NHI. I realize the side view photos aren’t the exact same angle in the before and after shots (sorry), but it should still give you a good idea of what was done. Click the photos to enlarge.

After (5756 grafts):

 

Before:

 

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Dense Packing Limits?

I am a 26 year old male, who has had two hair transplants in my frontal area. The density of hair in my transplanted regions is much lower than that of my natural hair, and hence looks a bit unsightly. I want to know if there is a limit to the number of FU grafts one can transplant in order to improve density. If so, what are the dangers of exceeding this limit?

The normal hair densities of non-transplanted hair are measured at 193 hairs per cm squared (97 follicular units per cm square). A transplant doctor can put in densities of half of that in a single session. If you have thinning hair, then your density is not up to a level adequate to appear full. There are no inherent dangers in dense packing the hair in a transplant surgery provided that the doctor’s team is able to do it.

Dense packing, a technique we defined in 1993, makes for less surgeries and more fullness. If the wounds are over a particular size (more than 1.7mm each) then the risks start impacting the patient, for example, with regard to blood supply. If the wounds are smaller than 1.7mm, then the risks of dense packing of the grafts all but go away. We use wound sizes of about 1mm (the size of the wounds vary with each patient). The smaller the wounds, the faster the healing. Healing in this context means that the wounds on the skin become almost impossible to see, something that usually takes a day or two on most of our patients. Wounds greater than 1.7 mm, tend to show for longer periods. Some transplant patients in the old days saw wounds measuring 3-4 mm each (the old plugs), and they were visible for weeks after the surgery.