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Attached are magnified scalp samples of a patient who presented his case to us today. The right-mastoid sample area depicts clusters of healthily growing follicular families while the frontal sample area depicts follicular groups succumbing to the effects of DHT. These photos illustrate the process of miniaturization in patterned hair loss. In other words, the hairs are not “falling out” over the scalp, but rather they are shrinking progressively and irregularly in the male-pattern area.
Interestingly, the follicular densities of both samples are roughly the same, 20-25 follicular groups per unit area (depending on what hairs are counted as being in the field). The hair diameter is markedly different however. In essences, the photos illustrate how follicular unit densities are not the only determining factor in the appearance of coverage. Hair shaft diameter plays a crucial role. Therefore, hair quality as well as quantity will determine scalp coverage. While this conclusion may seem self-evident it should be kept in mind in the context of hair restoration surgery. The final result of a hair transplant is determined not only by the number of grafts transferred but also by the diameter of the donor hair.
On a separate another note, one should carefully analyze the number of hairs per follicular cluster when viewing these photos, particular in the right-mastoid sample. While it is impossible to be entirely accurate with hair counts based on surface photos, roughly 5% -10% of the units are singles in this Norwood class 6’s donor area. These percentages are not unusual yet many times we see published hairs transplant surgery accounts where 20-30% of the grafts are single hairs. This is inconsistent with the natural distribution of hair bundles and should therefore be attributed to excessive graft fractionation. Unless a hairline is being constructed, breaking up follicular groups is a sub-standard practice. How does this practice affect the patient? Well if you are paying a per graft fee for your treatment, you are paying more money, perhaps significantly more, than you would if the groups were kept intact.
Also remember that FIT is a harvesting technology whereby follicular groups can be cherry-picked by the physician. So not only do we provide a better result and better value by keeping larger groups intact, we also do so by avoiding and skipping over the smaller groups that would have necessarily been harvested if the area was excised with a STRIP. This would account for the consistently high calculated densities (hairs per follicular group) seen with FIT. |
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