Firstly, I would like to say congratulations to Matt for starting this forum for people to educate themselves and research their problems. I have no doubt Matt will run an honest and informative forum for discussion. As my first post I wanted to go into a topic that I was replying to an email; regarding the question of density placed and what is a "natural look" and thought I would share parts with you.

Density of the hair placed is just one issue that determines the natural look of a hair transplant; factors such as hair calibre and characteristics and the angle and direction on placement also play very important parts.

The illusion of thickness and a natural look is due to be able to block the light from reflecting back of the scalp, if this can be achieved a natural looking density is possible, it is when the light penetrates the hair that it can look thin and unnatural. Therefore the first aspect the doctor has to look at is your natural hair calibre and characteristics, then decide what density he has to place to achieve the goal.

A man with very curly, coarse, low skin to hair colour differential, high number of 3-4 hair follicular units will require considerably less follicular units per cm2 than a man with straight, fine, high skin to hair colour difference and mainly 1-2 hair follicular units; in theory he may need double the amount of FU to achieve the same looking density.

That said there is obviously general guides to what is required to block the penetration of light and achieve the look of a natural density; the hair line will always require a greater number of FU per cm2 because single hairs are being placed and then the calibre of hair has to be recognised because coarse hair can look "pluggy" if incorrectly placed; so the varient in density can be wide, maybe between 60-80 FU cm2 on average, that is not to say a higher density cannot be reached if required. Behind the hair line the density is increased with the use of multiple hair follicular units, 2,3,4 and sometimes 5 hair units. These are not randomly placed, the area is designed to ensure the FU maximise the coverage and density, so planning of the design and placement is very important. The depth the FU is placed and the direction/angle of placement will also effect the effect the look of density, so the slit size, direction and depth must be customed to each varient in FU size (1,2,3 hair FU etc), this is important to ensure not just the coverage and density is maximised but for the growth, yield and cosmetic appearance of the hair transplant. As the number of FU will alter depending on the number of hairs and hair characteristics it is possible to have a varient in density behind the hair line but the same looking thickness all over. Again, like the hair line there are averages and guides to follow, and it is considered to block the penetration of light and achieve the look of density over 50-55 FU cm2 is required.

Whether this density can be achieved in one pass will depend on the slit placement design, placing each follicular unit in close proximity to each other; achieving this is always better than having to go back into the same area again with a second procedure. Every time the skin is cut it causes micro-trauma to the tissue and cardio vascular system and this can impair the growth of the existing and newly placed hair, by placing in one procedure this is less of an issue. There is also a cosmetic benefit of reaching the correct density in one procedure also, the result is achieved much quicker and with generally less personal inconvenience. It can take 12 months for all the growth and hair to mature from a hair transplant and it is not recommended that a further procedure in the same area is carried out until after this time, for the reasons stated. This means that for the first 18 months you have a less than natural density that may look unnatural, especially in the frontal area, then there is the inconvenience of time, healing and added expense of having another procedure. These factors are side issues to a degree as the most important factor is the result and a good growth rate; that said there is no reason why a natural density cannot be placed in one procedure so they are factors that should be considered.