Dense packing is the philosophy of fitting more than 30 to 35 follicular unit grafts per square centimeter in one operation. The aim is to produce a more even, consistent, and natural looking flow of hair after just one procedure. Although desirable in principle, not all patients are suitable candidates nor is it possible to achieve in certain patients (eg, coarse or curly hair). Patients who have sufficient donor availability, reasonably stable hair loss, and high hair-to-skin color ratios are the ideal candidates. The authors highlight their philosophies and strategies for dense packing.
Key points
- •
The treatment goal is to achieve first a natural impression of a full look.
- •
For advanced hair loss, the best to aim for is a balanced look and to settle on less than optimal density.
- •
Indications for dense packing are smaller areas of loss, low risk of potential further loss, and high hair/skin color contract.
- •
A full assessment of hair type and quality, donor hair density, and current and potential future areas of hair loss as well as patient’s expectations will help decide the plan.
- •
Accurate assessment of size and depth of recipient sites for a snug fit is vital.
- •
The usual approach is 40 to 50 follicular unit grafts per square centimeter for the hairline using single grafts followed by 2 haired grafts with the remainder distributed behind with decreasing densities.
Introduction
For most practitioners, dense packing is defined as placing hair grafts at a rate higher than 30 grafts per square centimeter in the recipient area. Forty to 50 grafts per square centimeter are fairly common ( Fig. 1 ); more than that is considered controversial with debatable practicality and graft survival rates.
The general goal of any hair transplant treatment should be to achieve a natural as well as an impression of a full look of hair as possible depending on the degree of baldness and donor hair availability. Naturalness has to be the primary aim. Baldness may not be desirable but it is a natural phenomenon, whereas inappropriate looking hair is neither natural nor desirable, making future planning or allowing for potential future deterioration of the baldness a very important part of the treatment. The potential is the prospect of an ever-expanding bald scalp canvas and a paradoxically decreasing material of hair with which to work. Allocating grafts at higher than 50 per square centimeter in extensive areas in one part of the bald scalp will likely leave the surgeon short of grafts in other significant areas should the patient progress to a Norwood stage 6 or 7. For current or potential future advanced hair loss it is always best to aim for an overall balanced look and perhaps settle on less than optimal density, which is especially relevant as the patient’s own expectations tend to lean toward this as they get older.
Ideal Patient for Dense Packing
The ideal patients for dense packing or those who require it the most are those with the following:
- •
Smaller areas of hair loss surrounded by otherwise dense areas
- •
Low risk of potential further loss
- •
High hair-to-skin color contrast (eg, white skin and dark brown or black hair)
- •
Frontal forelock and hairline zone in most patients
- •
Those with fine quality hair, as opposed to wiry or curly
- •
High-density, quality, and quantity donor hair in both occipital and parietal areas
Advantages to Dense Packing
There are obvious advantages to the dense packing approach, which include the following:
- •
A more natural appearance achieved from the start because of the more even distribution of hairs and less gaps between the grafts
- •
The obvious higher level of density achieved from a single operation
- •
Both of the above lead to a higher level of patient satisfaction and help to achieve a more complete result in less time and expense ( Fig. 2 )
Fig. 2
Result after one pass of dense packing hair transplant.
Disadvantages to Dense Packing
There are disadvantages as well to dense packing, and these include the following:
- •
Increased number of grafts per session means more time required for dissection, recipient site creation, and graft placement, increasing the risk of graft exposure and damage
- •
Smaller incisions are needed in very close proximity, requiring more care and higher magnification
- •
Increased number of staff who a have the appropriate skill, training, and expertise is required
Introduction
For most practitioners, dense packing is defined as placing hair grafts at a rate higher than 30 grafts per square centimeter in the recipient area. Forty to 50 grafts per square centimeter are fairly common ( Fig. 1 ); more than that is considered controversial with debatable practicality and graft survival rates.
The general goal of any hair transplant treatment should be to achieve a natural as well as an impression of a full look of hair as possible depending on the degree of baldness and donor hair availability. Naturalness has to be the primary aim. Baldness may not be desirable but it is a natural phenomenon, whereas inappropriate looking hair is neither natural nor desirable, making future planning or allowing for potential future deterioration of the baldness a very important part of the treatment. The potential is the prospect of an ever-expanding bald scalp canvas and a paradoxically decreasing material of hair with which to work. Allocating grafts at higher than 50 per square centimeter in extensive areas in one part of the bald scalp will likely leave the surgeon short of grafts in other significant areas should the patient progress to a Norwood stage 6 or 7. For current or potential future advanced hair loss it is always best to aim for an overall balanced look and perhaps settle on less than optimal density, which is especially relevant as the patient’s own expectations tend to lean toward this as they get older.
Ideal Patient for Dense Packing
The ideal patients for dense packing or those who require it the most are those with the following:
- •
Smaller areas of hair loss surrounded by otherwise dense areas
- •
Low risk of potential further loss
- •
High hair-to-skin color contrast (eg, white skin and dark brown or black hair)
- •
Frontal forelock and hairline zone in most patients
- •
Those with fine quality hair, as opposed to wiry or curly
- •
High-density, quality, and quantity donor hair in both occipital and parietal areas
Advantages to Dense Packing
There are obvious advantages to the dense packing approach, which include the following:
- •
A more natural appearance achieved from the start because of the more even distribution of hairs and less gaps between the grafts
- •
The obvious higher level of density achieved from a single operation
- •
Both of the above lead to a higher level of patient satisfaction and help to achieve a more complete result in less time and expense ( Fig. 2 )
