I’ve noticed a number of hair restoration physicians like to employ a few hundred double follicular units (DFUs), particularly when working on the balding crown / vertex. It makes sense that this would be a boon towards increased hair density. But what are the downsides? And if you are a proponent of selective DFUs, are virtually all cases of crown/vertex work a good fit to utilize this?
The most immediate concern I have would be “naturalness”, but I’ve seen it stated that when blending in to the crown region this concern is nullified.
I happen to be an advocate of all follicular unit grafting however, Dr. Paul Shapiro and a few others have made a compelling case on our hair loss forum with hair transplant photos that using minimal quantities of double follicular units in certain candidates might help aid the illusion of hair density.
In my opinion, DFUs must be used in small quantities in the forelock or crown area in patients with adequate surrounding hair density – either natural or transplanted hair (follicular units). Otherwise, the DFUs may appear “pluggy”.
Another concern in my opinion, is that using too many double follicular units may limit a patient’s hair length and style. Cutting their hair too short may result in an unnatural look in these areas.
If DFUs have been placed around natural hair that later suffers from hair loss, a patient may feel more pressed to get another hair transplant not only to add more hair density, but to camouflage the double follicular units.