I have been recommended 600 to 1000 grafts to the front.  I would like to know what is the highest density and graft count with more aggressive density on the front hairline.  I would like to have the front hairline to be suitable for a 36yo that is not on meds.

You can go with the maximal density, but I’ve seen many patients from physicians who claim to place 70 to 100 grafts per sq cm that are growing 20 grafts per sq cm. One of two things occurred. One is that the patients received 20 grafts per sq cm, which is not likely. The other is that they received 60 to 70 grafts per sq cm and they lost 50 grafts per sq cm because the placed density was much higher than their scalp could tolerate. There are studies out there showing that densities of 40 per sq cm grow only 73%. I like to keep my maximal density between 40 and 50 per sq cm because I have seen consistent growth rates above 90% in my hands. The other problem with poor growth from an attempt to achieve maximal density is that it may poison the scalp for future surgery and nothing may grow subsequently. It is best to stick with a safe density of 45 per sq cm on the hair line and in the rest of the scalp. This seems to work best for my patients. It’s not as if 70 per sq cm will not grow in some patients. The problem is that you cannot tell which patients it will grow in and which patients it will not grow in. The only way to tell is to try it and if it does not work, the patient is in real trouble.

He can go with the maximal density, but I’ve seen many patients from physicians who claim to place 70 to 100 grafts per sq cm that are growing 20 grafts per sq cm. One of two things occurred. One is that the patients received 20 grafts per sq cm, which is not likely. The other is that they received 60 to 70 grafts per sq cm and they lost 50 grafts per sq cm because the placed density was much higher than their scalp could tolerate. There are studies out there showing that densities of 40 per sq cm grow only 73%. I like to keep my maximal density between 40 and 50 per sq cm because I have seen consistent growth rates above 90% in my hands. The other problem with poor growth from an attempt to achieve maximal density is that it may poison the scalp for future surgery and nothing may grow subsequently. It is best to stick with a safe density of 45 per sq cm on the hair line and in the rest of the scalp. This seems to work best for my patients. It’s not as if 70 per sq cm will not grow in some patients. The problem is that you cannot tell which patients it will grow in and which patients it will not grow in. The only way to tell is to try it and if it does not work, the patient is in real trouble.

One reason for poor growth with high densities is that you have to fractionate the follicular units to get densities above 50 per sq cm. This means splitting 3, 4, 5, and 6 hair follicular groups into 1 and 2 hair follicular clusters. There are many studies showing that fractionation of grafts can lead to lower yields and I suspect that the lower yield is much greater at very high densities. Of course fractionation is always done by in strip surgery although some clinics are more guilty of it than other clinics. This is one reason why my CIT procedure produces a much better result with far fewer grafts than any strip surgical procedure that I have seen to date.

Therefore, I would recommend that patients do not take this chance. Furthermore, it is not an option that I will give my patients because I’ve seen it fail for reasons that are not understood. Scalp hair transplant surgery is very safe and it has a proven success rate. I don’t see any reason to take unnecessary chances that put an almost sure thing in risk of overall failure.

Body hair transplants are not always a sure thing. However, we know from experience that they are even more susceptible to failure from high density. For this reason, I keep body hair transplants to a maximal density of 20 to 30 grafts per sq cm