Graft survival and high density procedures

[Julius]

In the past I have been told that a density of 50 grafts per cm2 should not compromise graft survival, though was wondering would transplanting at 55 grafts per cm2 or 65 grafts per cm2 compromise vascularity or hair growth yield? And if any graft survival is compromised at all leading up until natural density? Cheers.

[thanatopsis_awry]

My short answer would be "no"; it certainly depends on whom you go to. My longer answer would be "yes", since it certainly can compromise yield, but in and of itself such a metric could be said for most anything pertaining to HTs.

 

I've seen too many cases from clinics too well respected who have implanted at such high (if not higher) densities to believe otherwise.

 

I think the truly interesting and important question is whether such densities are required -- or, worthwhile -- in attaining an illusion of density, and actual density, that jives with the patient and at the same time takes into account his future needs.

[Where'd It Go]

ive read of a few cases were 55 or higher were achieved. whos your doc ?

[Dr. Glenn Charles]

I agree that the answer really depends on what clinic/doctor you go to. Some doctors have the capabilities of placing higher numbers of grafts in smaller spaces and still obtaining a high yield percentage. There have been a few recent studies showing very high success in the range of 90-100 FU's/cm. Here is an example of a common delema/question . Would you rather have 60 FU's/cm and get 50 FU's grow or have 45 FU's/cm and get 43 FU's grow. Most would choose the latter based on the percentages of successful yield. The bottom line is that there are countless variables that go into the equation, and it will always be a hard decision.

[Julius]

Thank you for your reply doctor. But say that I wanted to achieve a density of about 65 grafts per cm2, would I have a higher percentage of yield by doing a procedure at 40 grafts per cm2 than another twelve months later to the same area at 25 grafts per cm2, or just one procedure at 65 grafts per cm2? Also I will definitely be using a coalition doctor for my ht, but if the doctors agree that I don't have the right characteristics for my goals I won't be getting one at all.

[Guest Brad Limmer, MD]

Julius:

I agree with what has been said regarding percentage yield at various densities and Dr. Charles points out a most important point regarding this question,

'there are countless variable that go into this equation.'

Some are patient dependant and some are clinic/technique dependant, so the outcome can be different between patients even though they go to the same clinic.

 

We have typically approached the problem of yielding densities higher than 50 f.u./cm ?? by a 2 pass approach. While more conservative than some (who produce nice results), I feel it minimizes 3 important risks to the patient:

1. less than optimal growth

2. potential for ridging (dermal fibrosis below the skin ??“ which is basically scar tissue resulting from the multiple recipient sites create in such a small area)

3. permanent neovascularization (redness that won't go away ??“ resulting from capillary proliferation during the healing process)

 

Sorry for the diversion from your question, but the problem of lower yield can often be easily addressed. Ridging and redness can be permanent. Granted this is not always going to occur at high densities, but this had not been seen with f.u. micrografting until ultra high densities became more common. It was a problem seen years ago with plugs/minigrafting but is now occasionally being seen again. So while not an absolute contra indication, at least be aware of the possible risks.

 

Brad Limmer, MD/jac

[Sparky]

Why is it that when I see pictures of people with fresh HT's, the grafts per sq cm looks nothing like 35-60 per cm or whatever is quoted?. I can only ever manage to count like 10-15 per sq cm when I scale it up.

[Julius]

Thank you very much for your reply doctor, I will indeed be using a two pass approach now. Would it be possible to generalise at what FU's/cm the percentage of yield is most successful? Cheers

[Dr. William Lindsey]

Great post by Dr. Limmer.

 

Also Julius remember that shaft thickness can play a huge role in apparent density. Consider a thick hair shafted guy who looks fantastic at 40/cm; and a thin hair shaft guy with a poor color match between scalp and hair who looks to sparse at more than 60/cm.

 

Remember this type of work is science, not math, so the same equation may not yield the same results in significantly different guys; and of course, perfection is the enemy of good.

 

Dr. Lindsey McLean VA

[Julius]

Thank you, doctor.