What is the maximum density you plant in your “as much as possible” hair transplant procedures?
I think you’re referring to the maximum graft number I would transplant in an “AMAP” or “as much as possible” procedure? Again, it really depends on the patient. In a strip procedure, it really comes down to how much I can safely extract from the back as a strip. I probably take a little more time than most in the morning figuring out my margins for the strip. The goal, in my mind, is to maximize the yield without compromising the closure. So once I know the maximum dimensions of the strip, the patient’s density determines how much “AMAP” they will really get.
For some, it may be 3,000 or 3,500. For others, it may be up to 5,000 or more. And I know there is some controversy when it comes to cases of this size, but I do believe it is ethical as long as it as done as an FUT — because of my views on FUT and how it preserves the donor.
I try not to focus on numbers when it comes to slits (or grafts) per cm^2. I know it probably sounds a little counter intuitive, but a lot of it comes down to 1) the overall goal, 2) the way the tissue is responding to the dense packing during slit creation, and 3) the patient’s follicle size/hair type. Three is especially important; for hair transplant patients with very fat follicles that grow thick, coarse hair, 45 grafts/cm^2 will provide as much, if not more, density than someone with thin follicles (and therefore finer hair) at a density of 55 grafts/cm^2 — for example. If you tried to pack them both at 55 or 60 grafts/cm^2, you could run into some issues with overwhelming the tissue with the guy who has the fat follicles. But if you tried to pack them both at 45 grafts/cm^2, the guy with the finer follicles may not get that thick, dense look. So I kind of take all of this into account, create an appropriate blade size (I use all custom cut blades with lateral incisions), and go as dense as I can while still maintaining a safe and “correct” look. And this refers more to the multis compared to the singles. Singles you can be a little tighter in general, but that’s a whole other discussion!
Dr. Blake Bloxham
Feller and Bloxham Hair Transplantation
Editorial Assistant and Forum Co-Moderator for the Hair Transplant Network, the Coalition Hair Loss Learning Center, and the Hair Loss Q & A Blog.