Dear Docs,

I asked this question on another thread but it seems to have got lost in the shuffle so I will put it here in a new thread:

For the patient, there are some available estimates as to how many follicular units per squared centimetre provides "cosmetically dense" coverage for an average patient. The estimates, I think, are 30-40 grafts.

But how many grafts are needed to provide cosmetically dense coverage in a patient with "fine", rather than "medium" or "coarse" hair, assuming average donor density?

Thank you for your time.

-AP

To AP,
I will be interested to hear what the other doctors have to say about this. In my opinion, if you have fine hair you will not have significant density from a transplant. In most cases, people with fine hair never did have significant density. That does not mean that they cannot have significant improvement in their situation. The face can still be framed and they can eliminate their bald look. Mathmatically, if their hair shafts average 50 microns in diameter then they will only have 1/4 the hair volume from a transplant compared to someone who has an average shaft diameter of 100 microns.
If a patient has 50 grafts/sq cm the density is going to be about as good a that patient is capable of having. I must caution you however to be aware of the graft size. Are the grafts 1-hair, 2-hair, 3-hair, or 4-hair grafts? Obviously 40 1-hair grafts will not be as thick as 40 3-hair grafts. However, you can get more 1-hair grafts into a sq cm than you can with 3-hair grafts - partly, because of the size of the needle slit required.
If you have fine hair just be aware that the ultimate volume won't be as thick as with other transplant patients.
Dr. Parsley

Dear Dr. Parsley,

I too am very interested to see what the other doctors have to say on this. I hope they will chime in and that you may facilitate that if you think it useful.

Your math is indeed correct in that the area of a hair with a .10 mm diameter is 4 times the area of a hair with a .05 mm diameter.

Before deferring to the other doctors, let me throw one thing into the pot for discussion.

Area is of course a three-dimensional measure that the human eye cannot fully appreciate, particularly as the distance between the eye and the object increases. Unless one looks down on a head, one practical aesthetic implication of fine
hair might be that the human eye will be more likely to notice the amount of visible scalp due to the increased distance between hairs due to hair diameter (2x higher in fine hair). Hopefully the surgeon uses a staggering pattern of placing the hairs in order to minimize even that effect.

Just some layman's logic and wishful thinking.

-AP

Note: I am not sure what you say is right about those with fine hair never having originally had good density. My now-gone hair appeared very dense and my densitometry reading is average for a Caucasian male.

Dear AP,
Densitometry readings measure FU's/sq cm - it does not measure hair diameter. Actually the diameter of the hair only slightly changes the distance between FU's. Usually the spacing is about 1 mm. You can imagine how hard it would be the remove a graft without transection using a 1mm punch.
If your hair was dense when you were younger it may be you are considering your hair fine by looking at the balding area. If so, that represents miniaturization. When I mentioned fine hair, I was talking about the donor area. It is possible that your donor hair isn't fine if, in fact, your hair was dense when you were younger. Usually the donor area hair is similar to the hair on top of your head before it started to bald. So maybe your donor hair is better than you think.
You are right about staggering the grafts. If you dense pack an area this isn't too much of a worry.
Dr. Parsley

Dr. Parsley:
That you would use a completely unrelated thread to attack Dr. Woods (who doesn't use 1mm punch, as you and your colleagues all seem to think) exemplifies that you are nothing but a ISHRS hatchet man with a medical license.

.....ok. how do you know woods DOES NOT ues a 1mm punch graft? please tell us, what DOES he use? wood's web site says he uses "micro-incisions" that are 1mm in diameter. diameter refers to distance across a circle. you are correct that nobody (at least nobody who is telling) has watched him use the 1mm punch graft. maybe he uses a micro-scalpel and carves a 1mm circular incision around the hair, and does that 600 times a day on that patient. would that be any less likely to transect the follicle? probably make it more likely to happen. give me a break.

Now I'm really curious as to how Dr. Woods harvests his grafts. Does anybody really know? How does he avoid transection?

Hey, maybe he has X-ray vision!

I'd really hoped to get some more answers from doctors on the issue of fine hair coverage. I suppose I cannot control what happens on a thread I start but I am not interested in discussing Dr. Woods and I'm sorry that Dr. Parsley broached the subject for some reason and that the rest of you chimed in on it.

But can we please have some other doctors comment on the original topic? Both Dr. Parsley and I said we were interested in hearing other doctors' views.

I apologize to AP. Parsley's bringing Dr. Woods into a thread in which you never even hinted anything about him was low. To the other posters, Woods does not use a punch. This he has said and patients of his have said so. I don't know how he avoids transection, but he's got no legal waivers so he must be confident that you will not get damaged follicles. Imagine the potential lawsuits.

At any rate, AP's question was actually a pretty good one. I apologize again to you, and hopefully you will get answers about fine hair coverage from the doctors and my fellow posters.

...at all by dr. parsley. i thought he gave a good answer that WAS related to the subject. looks to me like it was questioner who dragged this topic to woods. and if i were you, dr. parsley, i wouldn't sit still for this guy's bashing ("hatchet man with a medical license"). that was WAY uncalled for. i guess thats the hazard of being in business that you're gonna have to deal with the bashers that have nothing constructive at all to say. for the most part, this is a good discussion board pat runs, but the few little people who can't stand it when you happen to disagree with them and start throwing uncalled for insults around really degrade the quality. go ahead questioner...lay one on me now.

quote:

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Originally posted by Questioner:
To the other posters, Woods does not use a punch. This he has said and patients of his have said so.

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What does he use?

quote:

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Originally posted by Questioner:
Dr. Parsley:
That you would use a completely unrelated thread to attack Dr. Woods (who doesn't use 1mm punch, as you and your colleagues all seem to think) exemplifies that you are nothing but a ISHRS hatchet man with a medical license.

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Questioner,
This is from Dr. Woods web site:
"We remove the individual follicle 'cylinders' from the back of the head, one by one, through 'micro-incisions' of approximately 1mm. Diameter."
This sounds like a 1mm punch to me. If not, what is it?

Patients of his on the site, www.hairlosshelp.com have said he does not use a punch. Their word is the best we have. Woods answers questions there, as do a number of other doctors, I don't much care for the website but if you wanted to ask Woods directly there you could get your answer in more detail.

The main point is that Dr. Parsley injected a poorly veiled criticism of Woods into a thread that had up to that point had nothing to do with Woods whatsoever. There was one thread on Woods he already was commenting on. I again apologize to the original poster, you asked a good question, as Parsley said, but no one will address it anymore. Don't let it discourage you from using these boards.

Honestly, we all can start new threads if we want to talk about something. When someone starts a thread, it's probably important to them, so it's better not to take the thread off the topic.