It appears my transplanted hairs seem sparse. I am not sure if it looks like there are enough covering the area? (Photo)

Question

My doctor says after asking that those tiny dots in the picture provided are also transplanted hairs and not all of it will be able to stick out. He did a forehead reduction and had grafts in my natural hairline as well so it all flows together well. I am just worried looking at it as is, if it would end up looking sparse or healthy and dense as I'd like it to. He said don't worry but I am and would like a second opinion. Thank you!

Jae Pak, MD · Answer

If your transplants look sparse and you are not pleased with the results, it would be best to discuss this concern with your doctor since we have no way of knowing what was done and what was planned for your surgery.

Michael Vories, MD · Answer

It would be helpful to know when you received the transplant.  If the photo accurately shows the density of the transplant, it looks unlikely that the density once grown out meets your expectations of a full hairline. Usually between 1500-2000 grafts would be needed to fill in the area.

David Josephitis, DO · Answer

Where did you have your hair transplant?  Unfortunately, I feel that you will have a very low density result.  From just a casual look it appears that the average density in the frontal region is only 5-10 grafts per square centimeter.  It should be at least 25-35 in that region.  It appears you only had a few hundred grafts transplanted when you should have had 1500-2000.  Also, I note that the grafts appear to be misdirected and along the hairline they appear to be lofted too high.
I am sorry to have to bring you this bad news as I can understand how stressful it is to undergo a hair transplant procedure.  I too had one myself.
If I were you, I would recommend visiting with a local experienced hair transplant physician and getting their opinion in person.

Hussain Rahal, MD · Answer

Being totally honest, it doesn't look like a very dense procedure. How many grafts were you given? I would normally suggest about 3000-3500 grafts to cover an area of that size.  Time will tell. Your photo was taken only within days of your surgery so you have many more months to see improvement.

Amiya Prasad, MD - Account Suspended · Answer

Thank you for your question. You submitted a single photo, and it seems you recently had both a forehead reduction and hair transplant, so you are concerned the density of hairs is not going to be as good as you hoped. You state you checked in with your doctor who said several of the dots in the scalp are representing hairs that are not necessarily sticking out, so you’re looking for additional thoughts.
I can share with you reflections about patients who we’ve treated like yourself in our practice.  A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. Hair transplant has been a very important part of my practice.  I am also the founder of TrichoStem™ Hair Regeneration Centers, a system that we developed to non-surgically treat male and female pattern hair loss using a material called Acellular matrix with platelet-rich plasma. This situation is not unfamiliar to essentially every hair transplant surgeon.
It is understandable to have these concerns, particularly when you look at the grafts placed. One of the things I always try to communicate to patients when we were doing a lot of transplants was how transplants are done. I would draw squares in the scalp in the areas where we’re transplanting, and say we can put a maximum of about 20 grafts per square centimeter, and look at the donor area and show what’s being harvested. Mathematically, it always made sense, and patients would sign off and understand.  Then came the fear of whether or not the transplanted hair would have the level of density they hoped for. 
I’ve always told my patients there is a limit to how much density you can have with a single transplant. The more you try to crowd the grafts, the higher the rate of grafts that will not make it. This is important because your donor area is a limited resource. I’m sure your doctor had a similar discussion with you. Generally speaking, it takes about a year, if not longer to see full growth. 
We’ve helped a lot of patients who had transplants done elsewhere. Hair Regeneration is a system we developed that evolved out of hair transplant. We wanted the maximal growth of our grafts which we worked so hard to place, as well as healing of the donor area. We were able to observe that thinning hairs actually became thicker which were not directly transplanted hairs. 
From that evolved this system called Hair Regeneration over the past 7-8 years which we’ve used to help men and women with pattern loss, particularly in areas not suitable for transplanted hair. Whenever you have decent density, but not significant coverage, it’s a challenging area to transplant. We figured out that if we reactivated hair that isn't growing, thicken thinning hair, prolong the longevity of existing growing hairs, then the coverage can actually be as good as a transplant, if not better than two transplants. It’s a function of effective coverage depending on density as well as the caliper of individual hairs. 
We’ve taken the same technology and apply it to patients who had transplants done elsewhere. Generally, somewhere in the second and third month, we can do an injection to help stimulate healing and improve the quality of the existing hair. In addition, it appears the transplanted hairs start to grow sooner. I hypothesize there is some value in improving the quality and the survivability of those transplanted hairs. This is not an absolute, but it’s based on my clinical observation with the experience I have doing hair transplant. 
That said, I think you still have a lot of time before you can draw any conclusions. No surgical intervention will be of any significance or benefit in the short-term. You have to wait and see how well those grafts heal, and what the outcome will be. 
It is well known in our specialty from a survey of members of the International Society of Hair Restoration Surgery that 65% of people after transplant felt they wanted more density. That’s not in any way a reflection of the quality of the surgery, but rather the reality of the outcomes desired by the patient, and limitations of what a transplant can deliver. There always has to be a meeting of the minds for realistic outcomes and maximal results, that somewhat depends on the technical execution of the surgery, but also in the limitation of wound healing and the viability of transplanted hairs. 
I often tell my patients that if you’re considering hair transplant, be prepared to do two because it is typical to need more than one for most people who are ready to have a transplant. This motivated a lot of the work we’ve done with Hair Regeneration where anticipating the progression of hair loss and trying to treat before you need transplant has become the core approach to thinning we have been employing for patients who come from around the world. 
I think you need to, as I always recommend, maintain good communication with your doctor. See your doctor for follow-ups as scheduled, and wait this out to see what ultimately happens. Understand that this is a reality not just for you, but for at least 65% of patients who undergo hair transplant. I hope that was helpful, I wish you the best of luck, and thank you for your question.This personalized video answer to your question is posted on RealSelf and on YouTube. To provide you with a personal and expert response, we use the image(s) you submitted on RealSelf in the video, but with respect to your privacy, we only show the body feature in question so you are not personally identifiable. If you prefer not to have your video question visible on YouTube, please contact us.

William Rassman, MD (retired) · Answer

You will not really know what you have until the growth starts.  By the 8th month 80% of the growth to styling length. You may see it start up as early as 3-5 months after the surgery

Sara Wasserbauer, MD - Account Suspended · Answer

You did not mention when your surgery was so it is difficult to give you any useful direction. You need an in-person exam and a second opinion from a doctor who does what you had done. Unfortunately, photos are not enough in your particular case.

Good luck!

Good luck!

It appears my transplanted hairs seem sparse. I am not sure if it looks like there are enough covering the area? (Photo)

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