Hair transplant is today an accepted treatment for baldness. Success stories of male pattern baldness through surgical hair restoration abound. We all have come across our colleagues, relatives, and friends who are happy with their hair transplants. The social media platforms are full of information about hair transplants – some true and others misleading.
One such commonly talked about feature of hair transplant is ‘high density’ hair transplant.
Since baldness strikes at an early age, it affects the person psychologically by affecting self-consciousness and social perception adversely. It is natural to get anxious and ask for no less than the highest density restoration to mimic the earlier density of adolescents to regain lost body image, especially when one sees such treatments being offered by some hair companies.
Thankfully, it is not possible to harvest slender grafts and pack them up to achieve such goals to a great extent using the FUE technique of hair transplant.
In this article, I will delve upon several factors that need to be considered when offering a high-density hair transplant.
Hair transplant simplified
Before you have unrealistic expectations from a hair transplant, you need to know that your surgeon will work with available hair from the permanent donor zones only (of the scalp, beard, and chest) to restore the large area of balding (in Grade 5-6 MPB). Since the surgeon is not a magician, how does he do this? he does it by the placement of available grafts in a strategic manner with plantation density decreasing as he covers the baldness from the hairline backwards. In other words, it is an illusion he creates by densities varying from 50% to 25% in various parts of the bald scalp.
The truth is that 100% natural densities can never be achieved even after several sessions of hair transplant due to the restrictions of available grafts and due to the nature of the surgical process.
However, we are able to create an illusion of fullness that will look naturally full.
What is ideal hair transplant density?
Irrespective of the procedure adopted for hair transplant, whether slit grafts or micrografts, the removal of hair from the back and planting it in front depends on several factors. In slit graft, 4 to 10 strands of hair are used per graft and in micrograft, it is 1 to 4 hair.
In normal healthy scalp of a male the hair density, i.e. the total number of hair follicular units in a square centimeter, is 90 to 110 follicular units. In hair transplant procedure your surgeon never even tries to achieve this normal high hair density. And for a reason.
A ‘head full of hair look’ does not mean the surgeon will give you natural density in mathematical terms.
Hair density facts to know before hair transplantation
i) Normally, your surgeon will suggest a hair density of 45 to 60 follicular units per square centimeter for transplantation. This average hair density will need 2500 follicular units to cover the frontal area of the hairline alone. Why can we not achieve 90-110 hair follicles per square cm? The answer is simple and logically verifiable. Theoretically, for this density, the total graft number would increase to 5000 units. Do you have a supply of 5000 follicular units for high-density transplants for the hairline alone? How will we cover the remaining baldness? if you need just the hairline to be done presently, still we have to keep hair grafts available for future use since hair transplant does not stop your balding process which is forever evolving depending upon your genetic composition and proclivity for extensive balding in your family history. Hence, an ethical hair transplant surgeon will never recommend overly decreasing the density of permanent follicular units of the supply area as you might need a regular supply of natural hair follicles in the future as well.
ii) Dense packing of FUs above 45-55 per sq cm has its drawbacks. Transplanted follicles do not carry their nutrition with them but have to subsist on available blood supply in the recipient area. This is variable from person to person. If the demand by these follicles outstrips available supply, all grafts will not survive. Or even if some do, they will not be more than 10-20% of the FUs originally planted.
iii) You need to know that hair transplant is not a natural process. It is a surgical procedure in which multiple slits are made in the skin. These slits cut off some of the blood supply networks. In simple terms, a 50% FU density per sq cm means the blood supply is cut off by 50%. If we increase this to 70 per sq cm, the blood supply is cut by 70%. So this is not virgin skin. Grafts need blood for sustenance. Reduced blood flow can not support 90-110 per sq cm density.
iv) While a young skin in a 25-year-old can support up to 65 FUs per sq cm density, this may not be true in a 55-year-old. There are so many variables that asking for a solution that fits all in hair transplant density is not only irrational but can lead to outcomes that are against your interest in the long term since they cannot be revised. You only have a limited number of graft supply and it needs to be used judiciously.
v) If you want high-density transplants, above 55-65 per sq cm, you need advice by the surgeon and if possible, the strategy is to go for a two-stage procedure. Even here the natural density of 90 per sq cm may be a tall order for some.