Dense packing issue.

When I had My neograft dove several roots were implanted with my native hair to give it a much fuller look. However it has been just over 3 months now and I can clearly see and touch the hairs at my hair line but where it was dense packed it is extremely difficult to see or feel anything. Is there a much bigger difference between transplanting in a bald area rather than in an area where there is already existing hair? it even looks a bit worse than before......Thanks.

Doctor Answers 11

Dense packing with Neograft

Hi Jesse, in general I have seen poor results with dense packing using the neograft as most doctors are using a large punch (I believe 1.2mm) to extract the grafts and thus its difficult to place them close together.  Anyhow, you are only 3 months out from your surgery.  All you can do is wait to see how things turn out and if you are not satisfied you may need a future procedure to add more density.

Irvine Hair Restoration Surgeon
5.0 out of 5 stars 25 reviews

Hair regrowth

Regrowth of new hair follicles after transplantation will vary depending on where they were in the growth cycle at the time of the procedure. The new hairs will come in staggered and variable. This is why it takes up to 12 months to see your final result. If an area looks thinner at this point, you have probably experienced some shock loss of your original hair. Fortunately it will regrow as well. Whatever you do, don't stress and be patient.

Gregory Chambon, MD
Overland Park Family Physician
5.0 out of 5 stars 5 reviews

Hair shock loss

You may have some hair shock loss which occurs in about 5% of patients.  This can be more common in packing of hairs between existing native hairs.  

However,  typically the grafted hairs fall out and new hair growth begins at about four months.

Pramit Malhotra, MD
Ann Arbor Plastic Surgeon
4.6 out of 5 stars 87 reviews

Remain Patient

I suggest you continue to remain patient and follow your surgeon's recovery instructions. In 2-3 months, you should expect to see results from the growth of the implanted roots. I suggest you schedule a follow-up appointment with your board certified facial plastic surgeon. The board certified credential ensures you receive the highest quality knowledge, treatment, care and skill available. A follow-up appointment will provide you the opportunity to relay your concerns to the surgeon while the surgeon assesses your progress.

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 120 reviews


Of course, it depends on the number of grafts and the native density.  At 3 months, it is still far too early to jump to conclusions about your results.  More hair will grow.  Grafting into a zero density region is always more challenging, and until hair fully grows it is going to look much less dense than areas with native density.

Tim Neavin, MD
Beverly Hills Plastic Surgeon
4.9 out of 5 stars 46 reviews

Hair growth after hair transplant

Your doctor should have told you that the transplanted hair shafts usually falls off after a few weeks and it will start to grow back after three to four months. It may take up to 18 months for all the hair to grow in, therefore you need to be patient.  If you have concerns you can do a follow up visit with your doctor. 

Michael Meshkin, MD
Newport Beach Hair Restoration Surgeon
4.8 out of 5 stars 27 reviews

Dense Packing Hair Restoration

Dense packing generally refers to placing grafted hair at a much high density into an area, not placing grafted hair into an area where hair already exists.  When doing dense packing you need to use a very small blade to make the recipient site (0.7-0.8 mm instead of the normal 1-1.2 mm blade).  Consequently, the grafts need to be cut and trimmed down dramatically in order to fit in the much smaller recipient site.  I am not a big believer in dense packing for a couple reasons.  First, the graft survival seems to drop when you remove all of the supporting tissue around the hair follicle to make them fit in the sites.  Secondly, you will often need to break up the multi-hair units into singles to get them to fit.  It doesn't make sense to take a triple hair unit, break it up into 3 grafts, make three separate very small sites and reimplant all three hairs into different spots.  You would be better off placing the three hair graft into one slightly larger site.  The improvement in hair volume and hair count would be the same.  
As for the extra thinning that you see at three months, I wouldn't worry yet.  The hair has just started to grow and you may not see improvement for another three months.  It takes up to a whole year before all the transplanted hair is fully grown.  Some shock loss in the surrounding existing hair can also take several months to grow back but should return.  Try and continue to be patient.  

John Bitner, MD
Salt Lake City Facial Plastic Surgeon
4.9 out of 5 stars 89 reviews

Dense packing between native hairs

The term "dense packing" refers to the process of placing hairs harvested from the donor area into the recipient areas with as much density as possible, i.e., as close together as one can to give the fullest look possible with one procedure. Dense packing is only possible or recommended in areas where there is no native hair, since dense packing will damage native hairs if they are present. So I believe that what you mean is that there were grafts placed in between your existing hairs in order to create more density, which is a normal procedure. This, however, has to be done with extreme caution, in order to avoid permanent trauma to the native hairs.

The fact that it looks a bit worse than before is due to "shock loss", a phenomenon seen commonly after transplants are added into areas populated with native hairs. This should resolve with time.

Your concerns, however, should be discussed with your surgeon, so he or she can examine your scalp and make sure everything is going as planned.

Marco Barusco, MD
Daytona Beach Hair Restoration Surgeon
5.0 out of 5 stars 8 reviews

Neograft is just a method of harvest, it doesn't relate to growth or final results.

Neograft is just a method of harvesting hair follicles, it doesn't relate to growth or final results.  If you are noticing issues in terms of growth, follow up with your doctor. Keep in mind it takes 6 to 12 months to see the final results.

Jae Pak, MD
Los Angeles Hair Restoration Surgeon
5.0 out of 5 stars 100 reviews

Dense Packing FUE

I could more easily answer your question if you supplied some pictures.  However, I have seen poor graft survival with dense packing and this is why I don't generally recommend it.  With the advent of FUE, there is really no reason not to spread out some surgery over time since the recovery is so easy.  This way the same density can be achieved without the risk of dense packing.

It is also quite possible you are having simple shock loss.  I generally avoid this with growth factors and PRP at the time of surgery and I also use implanters not pre-made slits.  If your doctor used pre-made slits (that is he made sites and then he/she or the technician but in the hairs later) then shock loss is very likely.   The good news here is that these hairs will likely come back in. 

Either way, you should go back to your surgeon and get some follow up right away.  

Ryan Welter, MD
Boston Hair Restoration Surgeon
5.0 out of 5 stars 6 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.