HOW TO UNDERSTAND THE TRUE GRAFT DENSITY IN A TRANSPLANT?

Article courtesy of Joseph Tillman

For years I have seen patients from all clinics include in their reports photographs of their immediate post-operative phase to document their experience.
This is definitely an important thing because that way they can also inform other users based on these images.

Usually when a user attaches an image of the immediate post-operative phase, he always receives one or more replies from users that underline how “dense” appears the positioning of a follicular unit, even in the case when the receptor area is particularly extense and not a particularly high number of follicular units were implanted. It may happen that several months after the patient, and the other users who had followed the evolution of the transplant, commented that the result is not as dense as could be expected given the photos of the positioning, and then surely some follicular units have not grown.

One possible reason to justify these comments is a phenomenon that I have discovered years ago despite not having the right tools to describe my impressions. I firmly believe that redness after surgery and the little crusts create an optical illusion to those who observe the image. The contrast between the receiving area and the little crusts that form immediately after the operation create an incorrect image of the true reached density of the grafts.

Observe the image below. There are two copies of the same photo. I used Photoshop CS5 to remove most of the post operative redness from the scalp, as well as most of the scabs.
This photo shows how the perceived density decreases once the contrast scalp scabs is equalized.

This is a NW6 patient that has received little more than 4000 FU. The image with the scabs shows us a situation with good density

Now observe the pictures while they change and shows the situation without scabs. It is no longer so dense, true?
What gave us the impression of density was the fact that every post operative scab looks about 500% larger in diameter than the hair that was implanted in the incision. This combined with a high contrast scalp/little crusts and you will have created an amazing optical illusion of density.