Density Matters: High Density hair transplantation from Nuleaf Hair Transplant Center, Pune, India (Nuleaf Skin & Hair Clinic, Pune, India)

What is High Density hair Transplantation?

“High density” hair transplantation is a latest hype in the hair transplant world.  Patients come to the doctor with a demand of high density after watching mind-blowing densities in YouTube videos. Density is the total number of hair follicular units in a square centimetre. Normal natural hair density in an average male is 90 to 110 follicular units in a cm².  When this is lost in the process of baldness, theoretically we should try to achieve this density by hair transplantation. However this has many implications on the outcome of the surgery. Following are some of the important ones.

Natural appearance of the transplanted hair: This is, without doubt, the best outcome of the high density hair transplant. Hairs appear more natural, fuller and give the patient best results after the transplant.

Consumption of the follicular units: We have limited number of follicular units in the back of the scalp which are permanent. These are the follicles which are available with us for the hair transplantation. In an average case of the hair transplant, (not a high density one), the follicles are planted in densities ranging from 45 to 60 follicular units per cm². By this density you will require 2500 follicular units to cover the frontal area with mid-scalp in grade IV baldness. If you increase this density to 100 or 110 FU/cm² then the total graft number will obviously be double i.e. 5000 follicular units. Now the question is whether you have 5000 follicular units available or not. We cannot deplete the number of available permanent follicular units for the name of high density hair transplant. A recent trend is where just for frontal hair line correction the number of follicular units used at 110/cm² exceeded 4000 follicular units. This will invariably deplete the follicular units from back of the scalp and hence future hair transplant (which is required because only frontal hair line of 3-4cm is corrected) becomes a very low density one or sometimes impossible.

Survival of the follicles: Whenever a follicular unit is implanted in the skin, it cuts the blood vessels below causing a relative lack of blood supply to the newly placed hair follicle. If this is severe the unit may not survive for long time. Imagine is a centimetre of instead of making 50 punctures to implant the follicle, 100 punctures are made. Theoretically the damage to blood vessels would be twice and hence twice the reduction in the blood supply which will ultimately result in poor survival of the units. The final outcome by this logic is sparse or poor hair growth. However in recent studies even the densities of >100 FU/cm²  have shown a survival of almost 100% of the units. In our experience too lack of blood supply has never been a problem and high density transplantation show hair growth pattern similar to regular hair transplantation albeit more dense growth. However this is a real worrisome problem in the patients with diabetes and atherosclerosis where blood circulation to the skin is already compromised. We don’t perform high density sessions in these patients.

So why do ‘high density’ hair transplantation? : High density hair transplant are done specifically for the patients who have ample donor follicular units in the permanent zone. It is also done for the patients who have a very small area of baldness with stabilized hair loss.

Cost of the surgery: The cost of the surgery will obviously increase as the number of follicular units is doubled, surgery time is doubled. 

Nuleaf’s Stand on High Density hair transplantation: We perform high density hair transplants of up to 110FUs/cm² in selected cases taking care that we don’t overuse and waste the donor supply of the follicular units required in the future. In cases of Grade IV and above with no/unusable body hair, we go for densities of 45FU/cm². Sometimes we may perform surgery in 2 stages of 45FU/cm² with a gap of 2-6 months in order to achieve densities equivalent to 90-110FU/cm² .