This young man presented with a history of having undergone a 3000 dense-pack frontal hairline megasession. Based on information provided by him, this restoration was intended to restore the frontal hairline region exclusively with a graft density of approximately 100 follicular-units per square centimeter. There has been much debate about the safety and feasibility of using such high graft densities. The potential risks of this approach are revealing in this patient who demonstrates three unique problems: 1) low graft yield; 2) recipient site scarring; and 3) unacceptable donor site scarring.
Much can be said about the adverse consequences of making too many openings in too small an area. However, the primary concern with this approach relates to the risk of compromising the local blood supply within the recipient area. Reduced circulation decreases oxygen delivery to the recipient area. Vascular disruption can ultimately decrease graft survival, and when taken to an extreme it can cause outright tissue damage. The proposed graft density, if successfully implemented, should have restored the hair density to that comparable of the patient’s high school glory days. It is clear from the preoperative photos that this patient continues to have see-through hair. Although 100 follicular-units per square centimeter were implanted, they did not all survive the procedure and the proposed density was not achieved. Even more obvious is the prominent scar located in the graft zone of the right hairline. This scar is the result of tissue destruction caused by an overaggressive recipient site surgical plan.
The patient’s primary goal was now to enhance density within the previously grafted frontal region. A conservative approach to repair and restoration was recommended for the following reasons: 1) previous dense-packing had failed to produced reliable high density in the frontal region; 2) the frontal region was now compromised with diffuse and localized scar from the prior procedure; 3) the donor site was compromised with an extraordinarily wide scar from the initial megasession. The patient underwent repair with 1080 grafts which were placed with the goal of supplementing density throughout the frontal region, with special attention on the dense scar in the right-central frontal hairline. |
