View Full Version : Not Enough Grafts vs. Technologically Impossible?

03-04-2015, 08:52 AM
Hey Everyone,

I just had a quick question about hair transplants, specifically directed at density. I was curious if the only reason 100% density from a hair transplant isn't feasible is because of the limit in grafts?

If the amount of grafts was unlimited, would it be possible to achieve 100% density or is it technologically impossible to get the grafts as close together as they are in the donor zone?

Thanks for your feedback!

03-04-2015, 10:24 AM

This is a good question. The easy answer for the majority of patients that we see is that we can't reach 100% density because we are limited in the amount of donor that we have. Most people have more hair loss than the availability of their donor. That is where the artistry of hair transplanting comes in. We use what limited donor hairs we have available to maximize coverage in the thinning areas.

Still, the other reason you gave is also true. Even if we did have an unlimited number of grafts, we can't exactly reach one's native density. A case in point is the younger patient (or older for that matter) who only has a limited area of hair loss, but a relatively normal donor supply. I have done 3+ surgeries on these patients and slowly have increased the density in those areas. Sometimes the patient desires additional procedures after that to increase the density further. With our currently surgical techniques, we do reach a point when we may actually injure native and transplanted hairs alike if we try to put them too closely together. Thankfully, under normal conditions, this never becomes a problem as coverage even with less than native densities typically creates the "illusion" of density that we are seeking with typical hair styling.

Rashid Rashid, MD, PhD
03-04-2015, 11:13 AM
The other consideration is the amount of follicles per cm2 varies in different people. Some people have naturally more per cm2 and others have less. If your natural density is low, you can get closer to the 100% in your case.

If you are a person with higher density it will be harder to get to the 100% for so many reasons. Besides the above mentioned in the posts, consider that studies have shown that dense packing above 35 or so per cm2 results in decreased graft survival. So yes you can over pack and you will get the occasional trophy case to show off, but the data doesnt support the risk/benefit in doing this for all patients.

03-04-2015, 06:33 PM
The problem with density studies is that they are rarely carried out by practitioners that routinely place at higher densities to begin with. It's like asking a casual swimmer to take part in a study to test heart rate and endurance in an olympic level event. When placing at higher densities there are other factors to consider including but not limited to dermal integrity.

And Dr. Josephitis is right, one need not reach actual native density to have the appearance of native density. There are several tricks to placement that alleviates this shortcoming not to mention there is a widely held believe that we don't even notice thinning until roughly 50% of hair in the affected area is gone to begin with. I don't necessarily hold this to be true but it's close which is good enough. Even if the number is closer to 60% or even 70% this density can eventually be reached, if not in one procedure, certainly in subsequent procedures.

Rashid Rashid, MD, PhD
03-04-2015, 08:40 PM
Very true. Like all studies, many points of weakness exist. I have read some other good points about this that include the potential variable of dermal oxygenation in scalps from person to person producing different results and yields.

This is why its good to be objective and open minded when looking at what is possible and always know that you may be able to do it. But on the other hand, realize everything is not always possible in everyone.

03-05-2015, 09:43 AM
Thanks everyone for the detailed responses, I found this quite informing.