4,426 grafts 2 sessions Dr Cooley

[Jerry Cooley, MD]

This patient has IVA hair loss, has typical Asian donor density of 70 FU/cm2, and desired the lowest hairline possible. Over two sessions, 4,426 grafts were transplanted (1=1279, 2=2163, 3=847, 4=137; total hairs= 8,694). Result is one year after last session. The patient wears his hair down, but is gelled up and parted to show the hairline and grafted area.

[Follicle Death Row]

Well done doc. A very nice result indeed. May I ask, do you usually create that density zone in the central forelock that blocks out the passage of light from all angles or do you go with the wall effect behind the hairline? I've seen different methods employed and sometimes almost a combo if there's enough grafts.

I may be just reading too much into the lines I've seen marked out preop by different docs but it seems to me that a doctor like Dr. Rahal tries to get a band of 60FU/cm2 near the hairline, then 50 behind, and dropping off to 45/40 further back. Feriduni on the other hand has done many hairlines with 50-55 FU/cm2 where it varies a little to make it look natural and then places an oval or circular density zone in the central forelock of 2s at a nice density.

Does the density layout differ for patients with different characteristics? Do doctors have different artistic styles on how to best approach the case? Or is it a little bit of both?

I'm trying to better understand the aesthetics of hair transplantation. Thanks for your time.

[ParraPhil]

Is it better to have 2 smaller sessions of 2,200 each, or one large session of 4,400?

[Jerry Cooley, MD]

Good question. The grafts and hairs per cm2 determine the result. For example, we may do 60 per cm2 at the hairline, but this is 60 one hair grafts (60 hairs per cm2) and 30 three hair grafts per cm2 in the central forelock (90 hairs per cm2) as a typical template for most of our transplants. Achieving central density behind the hairline (more hairs per cm2) is our objective and a pretty well accepted principle in hair restoration.

[Jerry Cooley, MD]

Is it better to have 2 smaller sessions of 2,200 each, or one large session of 4,400?

In general, I would recommend a single session of 4,400. In this patient's case, the donor density of 70 (dropping off to 60 in the temporal zone) would have required a strip that would have been too wide in my opinion, risking unacceptable donor scarring. On the other hand, there can be a benefit to a planned second session, such as allowing the patient to choose where to add more density or to reshape the hairline.

[John P. Cole, MD]

Nice result!