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All Density related posts


Dear Dr. Rassman,

A couple of years ago I remember reading an article about a hair transplant doctor at UCLA (I believe) that was able to transplant a higher amount of hair into a site by first having the scalp injected with a solution (possibly saline) to actually swell or enlarge the scalp area so more hair could be transplanted into the area. Later when the swelling receded the results would yield a higher density.

Can you comment on this. Is this something that you would recommend? Why or why not?

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Many hair transplant surgeons will inject saline into the scalp to accomplish just what you are talking about. The important thing to focus upon is graft survival. Are the grafts packed so closely that the blood supply may be compromised? It is possible. I recently saw a patient done by another doctor who had the skin in the recipient area develop gangrene from a decision to put too many grafts too close together in skin that could not tolerate dense packing of grafts. The details of what the surgeon does is not a simple one thing vs another thing. A good hair transplant is the result of a complex series of decisions and takes into account not only the size of the grafts and the nature of the skin, but many other judgments. I have heard doctors focus on one thing that makes them unique, but ask yourself, “Am I being pitched a sales line here?”

Tags: hairloss, hair loss, hair transplant, scalp, saline, density


I’m a 24 year old male, and I have a family history of balding. I have close-cropped hair, and I noticed that I can see a bit more scalp in the “runways” along the sides of my head and around the crown than I can see on the top of my head. The individual hairs in the thinner areas do not actually seem to be miniaturized compared to the hairs in the thicker areas, which is what confuses me. It looks like there are just fewer overall hair follicles in the thinner areas. It may have always looked like this and I never noticed, since I never thought to check until my brother started balding. My front hairline is not receding at all. Could this be a normal (non-balding) hair pattern, or is hair always completely uniform over the entire head on a non-balding person?

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There are two independent measurements that will point to what is going on. There is the actual hair counts by area and miniaturization by area. Both of these metrics can be obtained when you map out your hair for miniaturization. I do not always do hair counts in all of the areas I map, but in your case, this might be worthwhile.

Genetic hair loss causes both miniaturization (thought to be a precursor of balding, but not always) and direct reduction of hair counts without going through the miniaturization process. What you are viewing should have numbers put to it so that the diagnosis is in hand answering the basic question: Do you have genetic balding going on?

Most people will have some variations of densities by the part of the scalp, and these differences do have some consistency in the population. Hair along the sides is often less dense than hair in the very back of the head, for example. Yesterday however, I met a man who had just the reverse — a higher density on the sides, less in the very back. Good baselines are critical to understanding your hair loss, and good measurements in the hands of a good doctor will reveal that information for you.

Tags: density, hairloss, hair loss


ive had about 6 or 7 full strip procedures over the past seven years and have developed a scar that runs almost ear to ear and is an inch wide!

My surgeon has tried twice unsuccessfully to cut out the scar. There feels like very little excess tissue when i try and pinch. Im a dentist and am sure the tension from looking downwards post surgery was a factor although my surgeon says no. He is now talking about FUE from my chest. Would i be better suited seeing a plastic surgeon. He doesnt think anyone could achieve a better scar result. Ive had 2 colleagues get similar scars from the same doctor. Any advice would be greatly appreciated.

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You must be careful here. Do you want to continue on a never ending process from surgery to surgery? There are creative options including:

  1. FUE — but not from the body, rather from the scalp where hair is active 85% of the time, rather than 20% of the time as with body hair
  2. Balloon expanders which can reduce scars very nicely if there is reasonable donor hair

Send me pictures (which I will keep confidential) and then I can offer you general advice about what is possible and what is not. You might consider coming to California after I get your photos for a one-on-one consultation if the photos lead me to believe that there may be a good solution for you.

Tags: density, hair transplant, surgery, fue


can you fit 100 grafts in a 1sq2 cm without damaging existing hair ?

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Yes, the density or 100 grafts per square cm can be achieved in some people. Generally it would take fine hair and supple skin with good elasticity to do it. The issue of a successful transplant is a more important issue. By crowding the grafts at 100 per square cm, the blood supply may be compromised. Some very crude studies of this have been done and presented at the past few ISHRS meetings (the largest society in the industry), which have shown that as more than 40 grafts are put into a square cm, the successful growth of these grafts starts to fall off significantly. If there is hair already present in the transplanted recipient area, there is great likelihood that it would damage the existing hair as well as obtaining poor growth.

I have seen this issue become one where doctor’s ego is pushed at the expense of patient welfare. Just because a doctor says he can do this, does not mean that this type of density has value and will grow out. I did the first dense-packing ever reported at about 100 grafts per square cm in 1993, but the growth was less than that number, so I toned down these numbers and developed judgments that allowed me to know just how far I could push densities at the time of transplants. Everything is strategy and judgments in the field of surgey. So I smile when I hear doctors talk about the high densities that they can achieve, realizing that they may be less patient outcome focused, and more in love with their own image in the morning mirror.

Tags: density, hair transplant, hairloss, hair loss


I had my second consultation with Dr. Bernstein in Fort Lee recently, and He told me that with a 1.3 rear hair density, I was not a great candidate for a transplant. I already have atleast a Norwood 4a and I don’t see what I have to lose (pardon the pun) by what I think would significantly improve my appearance if for a while. What is your opinion on this?

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Telling me your donor density in one area does not tell me enough about your donor hair quality or your hair health. Asians often have donor densities of 1.6 and Africans have donor densities of 1.3. Do you have Diffuse Unpatterned Alopecia? What is your age? These two questions are very important. For an African or Asian man under 25, a donor density of 1.3 without Diffuse Unpatterned Alopecia may make a good candidate with high quality hair, while a Caucasian with Diffuse Unpatterned Alopecia present and an effective density of 1.3 might make a very bad candidate for a hair transplant for many reasons. I am sure that Dr. Bernstein knows the answer to these questions and you should speak with him about it. I need more information to give you more help here.

Tags: density, hair transplant, hair loss, hairloss


Hello Dr. Rassman… I am now 4 weeks post op and I seem to be on track, thanks to you and your team. My question is about losing or gaining weight in relation to density/fullness of one’s hair on their head. When a person loses a significant amount of weight this weight lost is evident through out the whole body even the person’s head. With significant weight lost would hair on the head appear more dense or full? And vice-a-versa, would significant weight gain cause hair on the head to appear less dense or full? This question may sound rather odd and funny but I got the idea from a ballon with prints on it. When the ballon with prints was semi-blowned-up it appeared all covered up with prints but when it was blown-up to a nice size ballon it appeared less covered and gaps between the prints were very evident. The reason why I’m asking this question is of course I need to lose a significant amount of weight for health reasons and to get your professional opinion to satisfy my master plan of hair restoration.

I believe that your blog is of great service to many people. Keep up the good work and God bless!!!

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I am glad your surgery at NHI went well and that you are pleased.

With respect to weight loss and hair density and your analogy to a balloon, it is an interesting question. However, your head is not a balloon and I suspect when you lose weight your head won’t shrink and it would not have any significant impact on the density of your hair.

I hope to see you on your 8th month follow-up a few pounds lighter and thousands of hairs fuller. Thank you for writing.

Tags: weight loss, diet, hairloss, hair loss, density


I would like to achieve even density on head, like I originally had before I lost it there. I dont mind my hair being short, but i would like to fill in the runways that run down the sides behind what is now an OK frontal area. How many grafts will it take and how much will it cost?

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I am not sure if you really understand your own question. The average person has 1250 hairs per square inch so if that is your target, the number of grafts (usually about half of the number of hairs or 625 grafts per square inch in your case) is easy to calculate by measuring the # of square inches you want to cover. But that number has no significance if you really just want to look full in those runways. The answer to looking full depends upon the color/contrast in your hair and skin color, the thickness of each hair shaft (coarse is better than fine and wavy is better than straight). If you are a blonde with white skin, you may only have to return 15% of the hair density, with coarse hair, you might get away with 25% of your original density in the runways, and if your hair is wavy with good body, who knows that value. Our charge per graft is lower during our Summer Special: $5.50 if you schedule an exact date and $4.50 if you take our standby rate. My personal rates are slightly higher.

Tags: hair loss, hairloss, density, hair transplant


Id like to get a transplant by your clinic soon, but do not have enough donor to produce the illusion of full coverage… Can you tell me if cell therapy will be available within a few years so i dont have to worry about donor depletion? i understand it will be in phase 2 trials at the middle or end of this year through ADERANS…. I want to get a transplant now, but will only do it if it this new donor supply or cell therapy will be out… can you give me some info?

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Cell therapy is not going to be on the market for a few years at the least and there is still no guarantee that it will work yet. Hair transplantation for some very bald people is still the best way to go. Sooner or later, alternatives to transplants will be available. Depleting the donor supply is a real concern for some people and that is why you need a good doctor who can design a customized master plan for you to be assured that your ‘worst case’ scenario is covered.

Why do you feel that you do not have enough donor hair? Consider sending me pictures of yourself to evaluate you more fully.


I’ve heard that 20 to 40 fue per centimeter is recommended.Is this true? Does this give someone enough coverage? What do you recommend? I hope I asked the question correctly.

Thank You

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This is a good, but difficult question to answer. What you are really asking is: “What density of follicular units is enough to give you good coverage?” Whatever the harvesting mechanism used, (FUE or standard strip harvesting) the amount of density achieved reflects fullness as modified by hair and skin color, hair thickness of each hair shaft, and the character of the hair (curly or straight). The health of the scalp determines just how close you can place the grafts (for scalp that is atrophic and lost its infrastructure of blood vessels, glandular structures and fat less densities are often better).

The normal density of a person is 100 follicular units per square centimeter (200 hairs), so clearly the amount that is placed will depend upon what you buy, the size of the balding area, etc. For blonde people, low density is often able to look full, while in a black hair person with white skin, higher densities are often needed.


Hello Doctor. I am a 20 years old and I had suffered from thin hair all my life. Since I was young, it was noticiable that I didn’t have a full set of hair, and as I grew older, my hair just mantained the same volume. There is no actual hairloss, but there is just not enough hair. Something maybe like half of the density it should have. I’ve been taking Propecia for 2 years now, and although the hair seems to be thicker, there is no hair regrowth at all. I’ve always wonder is this is something different from baldness, given that I dont lose hair; i just never had enough hair to look normal. If so, what are my options.
Thank You so much

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I believe that your see through thin hair is just your genetics. Now that you are getting into the dating scene, you are more sensitive to your see through hair than you were before. We used to call people like you “towheads”, which implied see through hair. When I was young, people would always rub my hair for luck because it was thick, gorilla like and non-see through.

First, you need to have baselines made with good measurements for miniaturization, as I have talked about in many previous blog answers. It is critical to know if you are actually losing hair or just have thin hair and a changing view of your hair situation. This will give you comfort, at least, for knowing. If by chance that I have guessed right and you are a “tow head” and have no balding, then this is a situation that can be adequately address with hair thickening agents, of which there are many on the market today.

And yes, “towhead” is a real word. Here’s a link to towhead in the dictionary.


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