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Transplant Density

Bigmac

Bigmac

Administrator
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#1
Below is a quote from Dr Paul Shapiro which addresses this issue very well.



The amount of grafts needed to give a good illusion of density varies with each patient. What I have noticed is that each patient has a threshold level that when the density is greater than that threshold the hair looks dense. That can be 40 FU/sq.cm. in some patients and it can be up to 60FU/sq.cm. in other patients. A lot depends on the volume of the hair follicles. It is really the hair volume, not the graft density that is important. We can plant the exact same graft density in two patients and get very different result if their hair caliber is different. If one doubles the hair diameter, the volume is quadrupled. (This is because the area of a circle is pi times the radius squared).

At Shapiro Medical Group in most patients we plant at densities between 40 and 50 FU/sq.cm. We do this because of the issues of limited donor density and the fact that hair loss is a continual process through ones life. In some patients this gets us above the threshold and the hair looks very dense, in others it still looks see-through in some situations. Sometimes we will plant at higher densities but because of the issue of limited donor we have to be very careful in picking patients in which we can plant at higher densities. When planning a hair transplant if we don’t take the issue of limited donor and future hair loss into consideration we could paint ourselves into a corner.

Take this patient as an example. He is only 28. It is impossible to predict his future balding. Suppose he progresses to a Norwood type 6. If I had planted his temporal corners at a density of 50 to 60 FU/sq.cm., and if his balding progresses to a Norwood type 6, most likely he will not have enough donor to cover the rest of the front half of his scalp at a density of 60 Fu/sq.cm. Thus he would have very dense temporal corners and less dense central core area. Cosmetically I don’t think that would be look good.

Unfortunately we are limited by the patient’s donor supply and the likelihood of future hair loss. I know that some doctors will plant at higher densities. I think there are some risks in these procedures unless the patient is picked very carefully. I have planted at densities of 60 FU/sq.cm. I only do high densities in patients with a great donor supply and no or very little evidence of miniaturization in the areas behind where I am transplanting. Also these patients should be at least in their 30’s, preferably, mid 30’s. Remember, a patient who is 30 now will only be 60 in 30 years. With most of us are living until 80 or 90 years old and there is still a lot of life after 60. And with the divorce rate being 50% at least half of us will be single again later in life. In twenty or thirty years from now we may see patients in which doctors have been aggressive in their hairline and/or temporal peaks and these patients may regret what was done. Also to get the high number of grafts needed to cover large areas of scalp at high densities we may be taking hair from areas that may not be in the traditionally safe donor area. There is a possibility that hair taken from these areas may not be permanent.

If we can still a get good cosmetic results with densities of 40 to 50 FU/sq.cm., I believe it is better to err on the side of caution. At these densities we still get a big cosmetic improvement and we are not at risk of using up the limited donor.

Below is an example of a patient who I dense packed 60 FU/sq.cm into the hairline. But he met the criteria I mentioned above. Not many of the patients I see meet these criteria. As you can see the density of his hair transplant does match the density behind the transplant. This patient was in his mid 30’s and had great donor and no miniaturization behind his hairline. The top photo is his before photo ( with the proposed new hairline drawn in red),the bottom photo is one year post op.







 
sl

sl

BHR Clinic Patient Advisor
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#2
Nice post and good to see the conservative educated approach used here, bearing in mind the longterm wellbeing of the patient.
 
D

Donor Supply

Member
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#3
This is something not discussed enough, density and the possibility of losing more hair further down the line. I like hearing the strategy and planning a clinic use.
 
W

Wannabee

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#4
50 FU per cm2 seems high enough to achieve a densely packed result that will yield a high success rate. Hairlines can be placed at a higher density as single hair follicles are used, therefor the incisions can be made in closer proximity to each other. When placing behind the initial rows of single hair FU`s... 2 and 3 hair units are used which aren`t as close together but provide good density if placed correctly.

40 FU per cm2 provides a very natural result providing it matches the surrounding hair. I would opt for 40 per cm2... saving my donor for the possibility of more work.




 
D

Donor Supply

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#5
A few issues with transplanting at a density over 60 fu/sq cm is the blood supply to the follicles, the higher the density - the greater the demand, thus survival rates are put at risk. Surrounding native hairs are at risk of dissection and shockloss.

As Dr. Paul Shapiro pointed out, future hairloss has to be taken into consideration as in an ideal world one procedure would be sufficient, done and dusted, however a high percentage of patients will require more work as their hairloss progesse`s. Thus donor management is essential. Supply and demand!






 
K

karmenelec

Valued member
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#6
Perhaps once Dr. Cooley announces his ACell Matristem results to the world in October at the IHRS Conference, these concerns about donor supply will be all but a distant memory.

Acell is growing back the hairs extracted in the donor area. They are multiplying the hairs in the recipient area from 50-400%. But this is what is most exciting to me: they are successfully and consistently growing hairs in the recipient area that have been PLUCKED from the donor by a pair of tweezers for pete's sake! If that's not hair cloning I'm not sure what is...

This is not speculation or wishful thinking, this is happening as we speak. Best part is, Acell is already FDA approved and proven to be completely safe. IMHO, as of October 2010, there will be absolutely no reason why every HT doc should not immediately employ Acell in their practice.



 
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Bigmac

Bigmac

Administrator
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#7
Acell has been around for 6 years plus now so we will have to wait and see.
 
K

karmenelec

Valued member
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#8
Indeed it has. But Acell only first contacted a HT doctor to see if it could be of any use in 2009. Skepticism is healthy and, in this field of medicine, especially important. October will be a very good month.
 
K

karmenelec

Valued member
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#10
Cooley is reluctant to discuss it until the October conference. But in previous interviews he confirmed that it works. The data will be released in October.


 
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K

karmenelec

Valued member
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#12
Cooley has interviewed with Spencer Kobren. Hitzig (albeit with a slightly less stellar reputation) has also interviewed. Some of his results are also posted on his website. They also issued a press release. Makes me wonder if all this is being deliberately ignored! I know it sounds too good to be true. But in two months it will be impossible to shrug off any longer. Without going into further detail, I have personally seen the results with my own eyes. And so has pvtpoint. Hair is being cloned, people.



 
J

jasikazenith

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#15
Ethnicity play a major role in determining hair density and type,the thinnest hair and the contrast in the color of their skin and hair may produce a see-through effect,which may offset the visual effect of relatively low coverage that is presented with lower density and also the high contrast in the color of the skin and hair.