Dense Packing: Placing Grafts Close Together

Today, grafts can be placed closer together than ever. Grafts may be placed at densities ranging from as low as 20 FU/CM2 to as high as 50 FU/CM2 or more. As with megasessions, placing grafts closer together can increase the density created in a single session, but also may increase the risk of poor growth. Placing grafts at densities up to 30-35 FU/CM2 will consistently produce survival rates of over 90 percent. Although successfully placing grafts at higher densities (40-50+ FU/CM2) is possible, studies show that as the transplanted density increases beyond 40, the potential for poor survival also increases. With appropriate patient selection and proper technique, this risk can be decreased but not eliminated. The optimum density at which to plant grafts are a subject of controversy in the field and an object of much debate. At SMG, we have the skill and ability to dense pack if and when appropriate.

Below are examples of both dense packing at about 50 FU/CM2 and a more average density of about 35 FU/CM2.

Case 1: The above case is an example of appropriate dense packing. The patient was 45 years old, had good donor density, and had full hair in the central area that did not appear to be at risk of progression. It this situation it was safe and appropriate to create a density in the hairline of about 40-50 FU/CM2.

Case 2: Above is an example of when dense packing is not appropriate and, in fact, not possible. The patient has fine hair with evidence that he may progress to Type 6-7. His donor was poor, and his laxity was tight. Because of this, the physician was only able to get 3000 grafts in this session. To get more would have put him at a risk for a significant scar. The recipient area was the front two-thirds or about 120 CM2. If 3,000 grafts were dense packed at 50/CM2, only 60 CM2 would be covered, barely covering the front third. Clearly it had to be distributed at a lower density, so a density of 30 percent was created. The patient already had a native hair density of about 10 percent, and there was hope that Propecia would add another 5-10 percent. So with the transplant, his native hair, and the effect of Propecia®, he could achieve near 50 percent, giving him an adequate appearance of density. This was indeed the result, and the patient was very pleased with the outcome. If he loses more of his native hair in the future, or if the Propecia® effect wears off, he may drop his density back to 30 percent and could have a second procedure to increase his density to 40 or 50 again. If the patient had better donor density and could have received more grafts (i.e. 5,000 FU), he still would not have had dense packing. Some of the 5,000 FU would have been placed a farther back in the crown. The total area would have increased to about 140 CM2, and the average density would still be about 5,000/140 = 35 FU/CM2. There is a lot of talk on the Internet about dense packing and super dense packing that is not put into perspective. While it can be done (like in Case 1), more typically a density of 30-35-40 percent is created in a single pass.