Super dense packing (92 grafts/cm2), does it benefit the patients?

Here is the abstract of another presentation that I did at the 2009 ISHRS annual meeting.

Super dense packing (92 grafts/cm2), does it benefit the patients?

I. Introduction
For past several years, mega-session with dense packing is the main trend in hair transplant surgery. The graft number and density get more and higher every year.
Does it really benefit the patient in general?

II. Technique
To precisely calculate the growth rate of the transplanted hair, we transplanted hair onto eyebrow instead of the scalp. We transplanted 544 grafts in an area of 6 cm2. The density is 92 grafts/ cm2.

Prior to this case, we usually deliver a density of 40 to 50 grafts/ cm2 on eyebrow transplantation.

We compare the result of the growth rate to find out if super dense packing benefits the patients.

III. Discussion
Six months after the 92 grafts/ cm2 eyebrow transplant surgery, we counted 455 hairs. The growth rate is 82%.

We have done about 300 eyebrow cases for the past 15 years and the average growth rate is about 96%.

With the super dense packing technique, we have sacrificed 14% of hair.

To grow 455 grafts with 40 to 50 grafts/ cm2 density, we only need to implant 474 grafts. The last 70 grafts (544-474) were wasted.

In order to achieve 92 grafts/ cm2 density, we have to cut the graft much smaller and instead of making 19G coronal slit, we have to make 20G needle coronal slit.

When we transplant hair onto the scalp, we had the same result. http://hairtransplantion.blogspot.com/2009/08/chubby-vs-skinny-graft.html

In the process of preparing the smaller graft, the technician must trim off all the tissue next to the grafts. Bare graft obviously has lower growth rate.


IV. Conclusion
So far no one knows what the best density for best growth rate is, maybe we never will.

I’m sure that depends on age, health, nutrition, etc. everyone has different limitation. Without knowing the body’s limitation, only looking for higher density is not the patient’s best interest.

Super Dense Packing-92 grafts per sq.cm.

Surgery Date: December 7, 2006


Patient designs preferred eyebrow shape.



The length of the eyebrow is about 5 cm.


The widest part is 0.6 cm.


The narrowest part is about 0.2 to 0.3 cm.
The eyebrow area is 5 cm x 0.6 cm=3 cm2 on each side.


The eyebrow outline is about 11 cm (5cm +5cm+0.6cm +0.3cm).
We made 125 slits on the outline, the distance between each graft is about 0.8 mm.


We made 277 slits on an area of 3 cm2.
(The slit number depends on graft number available.)




This photo shows same direction of transplanted hair and original eyebrow hair.
(Coarser hair is the transplanted hair and the fine hair is original eyebrow hair.)




We transplanted 277 grafts on one side of eyebrow (area=3cm2).
This is about 92 grafts in one centimeter square.



June 20, 2007
Six months after surgery- Our patient was very happy with the results. We have achieved his goal in one surgery.



Comments:
The average density on this eyebrow is 92 grafts per cm2. Should I be proud of it? No. Not at all. Every hair transplant facility should have no problem to achieve this super dense packing. As long as you make the slits very small and trim all the tissues around the hair.

Our clinic can achieve 92 % density easily, but why we do not perform super dense packing on all hair transplant procedures?

I have checked the growth rate of the eyebrow hair six months after the surgery; the total re-growth is 455 hairs. The growth rate is 82%. Our average growth rate for hair transplants on the scalp is about 96%. In other words, with the super dense packing technique, we have sacrificed 14% of hair.

The super dense packing method is not suit for all potential hair transplant patients. Factors such as skin color, contrast, hair quality, degree of baldness and the texture of someone's hair can require a different size of graft to achieve the best result. We will work with cases individually to best fit the wants and needs of the patient.

For comparison reasons, please see the following three photos:

Our regular hair transplant grafts



Grafts used for super dense packing



Grafts used in live surgery meeting


Which one do you think will have the best growth rate?

Hair, Eyebrow Transplant, Scar Revision

Before and after two surgeries. 50% density added.

Eyebrow: 150 grafts on each side.

Scar revision: Scar due to car accident. We removed the scar and transplanted hair onto the surrounding area.