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Category Archive for Density


Transplanting Patients with Low Donor Density

Can clients with a low donor density get a hair transplants above 70% of their donor density? I for example got my first transplant and my donor density was only at 60 grafts per cm. Therefore the doctor transplanted 30 grafts per cm. For my second procedure, instead of focusing on the crown I want to increase the areas of where hair transplants has been already transplanted. So I want 45 grafts per square centimeter. Would I able able to add 15 cm per grafts in the same area or would that cause a failure ?

My crown is already bald, but I don’t care about that getting that area fixed. I just want more density.

You can add more density if the donor supply is there. People with low donor density can not cover large balding areas, as they just don’t have enough hair. I always warn patients not to be overambitious when it comes to filling in a bald area.


I Have Below Average Density and Great Laxity

Hi Dr Rassman

What is your advise for patients with below average density and great laxity ? I got a hair transplant a month ago but it turns out my density of hairs is 60 hair per square cm and above the ears it was only 40 hair per centimeters. Am I still an acceptable candidate for a hair transplant ?

The Dr managed to cut a strip which went over the ears yet it only gave a total over 2660 grafts in the end. Since my hair is thick and wavy it appears like I have more hair than I really do. I come from an Indian background, but my density is even lower than Indian and in fact its lower in comparison to the Chinese society as well. The Doctor then transplant 30 grafts per centimetres per square using the FUT method.

The magic formula is balancing the supply that is available with the demand for hair (Norwood Class). A Norwood class 3 patient will not be impacted by low donor density, while a class 6 or 7 patient may not be able to meet his goals. Good laxity helps offset the lower density in donor yield, but the eventual supply will be restricted.

Did you ask your doctor for an estimate on how many hair transplants you would need to achieve your goals?


Hairline Density

Hello Dr.Rassman and team. Just wanted to say you guys are doing an excellent job educating people like myself about hair loss and what available options are out there to cope with baldness.

I had a couple questions regarding hair density. Lets say for example two men have a hundred hairs on their hairline. Could one of the individuals hairline seem thinner then the others even though they have the same amount of hair at the hairline? As well, lets say one person has 50 hairs on their hairline and another has 100. Could the person with the 50 hairs still appear to be thicker hairline then the one with 100 hairs?

I understand it depends on hair type for example straight vs. curly hair. The curly hair would appear thicker even though there is less hair. But I want to know in individuals with black hair which is slightly wavy.

Thank you once again for your excellent work.

I think you answered your own question. Hair density is not just about numbers when it comes to the look of fullness. It all depends on skin to hair color contrast, hair style, length, diameter of the hair shafts, wave, and distribution.


Is My Low Density Because My Scalp Is Stretched and Spreading My Follicles Apart?

Hi Dr. Rassman et al.!

I am a 22-year-old Caucasian male with blond hair, a NW2 hairline and somewhat low hair density. I’m not worried about my hairline, but my low density bothers me.

Here’s the thing: I have hydrocephalus, and with it an abnormally large head circumference. I’ve always had thin hair, but I shaved my head for the first time the other day and the density really scared me. Given my history of thin hair, is it possible that my low density is due to my scalp being “stretched” and causing the follicles to spread apart? The hair at the back of my head is slightly denser than at the top, but it’s very fine and light-colored. I know this is an unusual question and I understand if you can’t offer any answers.

Thanks for your time and all the advice you give!

I suppose if you start with a normal scalp hair number (100,000 hairs), but with a large head circumference (large area), you would have a lower hair density (hair numbers per unit area). But for those with normal head circumference, you can still have low hair density because some of us can be born with low hair numbers. It’s just the way we are different.

Hair color and skin color can also contribute to the perception of hair density or fullness. High contrast (dark hair / light skin) can be perceived as a lower density than low contrast (light hair / light skin). Hair length can also change the perception, as longer hair looks more full than shorter hair.

Finally, hair style can be a factor, as well. Curly hair looks more full than straight hair. These factors may be common sense, but it all plays a factor in how one perceives density and fullness of hair.

If you were to visit us, we could measure your hair density in different parts of your head, compare one part with another and give you an assessment of your total hair count and any differences that are area dependent.


The Back and Sides of My Head Are Decreasing in Density

Hi guys,

I started thinning when I was 19 and this continued slowly up until I turned 25 when it became far more aggressive and has continued in that vein for 18 months now. I had tried Minoxidil over a year to seemingly no effect and I had significant side effects from using finasteride. Overall in the past 18 months I’ve gone from a Norwood II to a Norwood IV and adjusting has been extremely difficult.

The back and sides appear to be decreasing in density at a similar rate (although they have more hair than across the top, as you would expect) and for that reason I’m very concerned I would not be a good candidate for hair transplant surgery.

I guess my question is whether this is attributable to only androgenetic alopecia, or could there be an additional problem? (be it some sort of telogen effluvium etc)

Thanks :)

The basis of good clinical medicine is to establish metrics (measurements) that give baselines from where we started. If you take such measurements yearly, you will be able to document the degree of thinning and this will help in the diagnosis.

Your story is not one that I hear too often, but to give you any insights I would have to examine you, take a good history from you, take bulk and miniaturization measurements of your scalp (sides and back, as well as front and crown). I can say that the back and sides of the head should not be decreasing in density, but only after you are examined can I do a better job of answering your questions.


Is Density Up Top Normally Lower than the Back of the Head?

Is it normal for hair volume to be less dense on top of your head than the lower back of head / neck area if you still have a full hair line up front above your face?

On a non-balding person the hair density is similar throughout the scalp, but there are areas where the density may be lower, like the sides of the head (above the ears).

Only the area in the back of the head (a 2 1/2 inch area) is considered permanent, as shown in the hair that remains in the Norwood class 7 pattern.


How Many Hairs Would Need to Be Transplanted to Achieve 100% Density?

Hello Rassman! I was just wondering where you got your degree?

I was also wondering how many hairs per square cm you would (theoretically) need to achieve the illusion of 100% density. 50%, 75%, 90%? Generally speaking of course.

Well, if an average Caucasian male has 200 hairs per square centimeter, and 50% of this density can be perceived as normal density, you can say 100 hairs per square centimeter can achieve the fullness. But it really all depends on your hair color, skin color, hair length, hair texture, hair style, etc.

For example, if you have 100 hairs per square centimeter and you have black hair on white skin with a short, straight hair cut, it will not even look close to a fullness enjoyed by someone with 25 hairs per square centimeter, but with black hair, dark skin and long curly hair. My point is, to achieve the maximum illusion of density, it isn’t just strictly about the numbers. Hair color, character, and style are also very important factors.

As to your first question — all of the our resumes can be found here.


Best Country for a Hair Transplant?

Hi, what countries are the best for hair transplant? Trying to debate whether to find HT center in india or go abroad. Cant seem to find one here and its not easy getting centers to let us interract with patients as most patients want their confidentiality.

Also, in your website you mention it may take about 6000 hairs for a class 6 to get coverage. Does this mean full dense coverage?

I would be biased to say the best hair transplant surgeons are in the United States as a whole, but I am sure there are great doctors spread out all over the world. Look at the patient results and meet patients. Most patients do want confidentiality, but we have open house events every month where past patients come in to meet with and talk to prospective patients… so it’s not impossible to find live examples if the patient is really pleased with the work. With an ‘open door’ policy, that means that anyone can come in, even if there were patients who may not be pleased with their results. In 20 years of doing open house events, there has never been an unhappy patient showing up at our ‘open house’ events.

As for the second question — you will never get a completely full dense coverage with ANY hair transplant. It is mathematically impossible! Hair transplant surgery is basically moving your existing hairs around, so the density will never be full as it once was. For a Norwood 6 patient to get good coverage, about 6000 grafts is what is typically needed. Sometimes more, sometimes less. It also depends on many variables such as your hair texture (fine, medium, coarse), hair character (straight, curly, wavy), length (long, short), color contrast (between hair and skin color). These subtle factors all contribute to the results of a hair transplant. So while we strive to create the illusion of full density, it simply can’t be as full as it once was because those hairs are gone.


How Much Hair Can I Transplant Now While Leaving Enough Donor Hair for the Future?

Dr Rassman,

I’m a Caucasian 27-year-old male with zero known family history of MPB. However, I’ve lost some hair on the front of my head, and crown miniaturization was detected — meaning that down the road, I could have a serious (Norwood 6?) pattern. I started taking Propecia and hope it can hold onto my hair for 5+ years.

That said, I already need a transplant. (A “conservative” well-regarded doctor recommended 1400 FUT.) I understand the need for a Master Plan and to not run out of donor hair too early. However, it’s very important to me to not be viewed as balding as a young man (I’m single and haven’t firmly established a career.)

I have fair skin and dark brown hair. Luckily, I’m blessed with wavy hair, donor density 2.3, that people commonly describe as coarse and thick. So, I’m wondering, how big of a transplant could I do now for the front of my head, and still leave enough donor hair for future loss? Could I transplant 2000-2500 grafts without worry? I imagine other patients might be in a similar situation to me.

Thanks so much.

Everyone is different. A 2.3 density suggests you have more hair in the donor area than many people, and with coarse hair you may be able to cover an extensive pattern. But for those with fine hair, it may not be enough to cover a class 6 or 7 balding pattern. I have many patients who have had more that 6500 grafts and most of them get quite depleted. A few of these patients have gone to 10,000+ grafts like this man, and although he could have passed the 10,000 graft number, he got realistically what he needed.


What If There Was an Unlimited Donor Supply?

If an unlimited supply of donor hair were available, could transplant surgeons give a patient the 200 hairs per cm squared that the average human head has or would a new tool smaller than the .5mm tool im aware need to be created to achieve this look?

I suppose you can achieve 200+ hairs per cm squared (which is about the average for a non balding Caucasian male), but I find most people who are obsessive with hair per square centimeter don’t understand the full story and are mislead by all the discussion groups on the Internet.

You can have 100 hair per cm squared and still look like someone with 200 hairs per cm squared, as this is not a numbers game. Furthermore, hair transplant is NOT about the numbers and density. It is about the art of creating a natural looking hairline with minimal number of hairs you harvest.

With respect to graft survival, there may be some issues of the grafts surviving such close packing in ONE surgery. Now 200 hairs in a square centimeter is possible with multiple surgeries to the same area… but again, numbers do not translate to how it looks overall.